GORHAM — Dozens of workers wearing masks and hoods with plastic face shields gather in front of the Gorham House nursing home as Master Sgt. Mary Pelletier sticks a plastic tube under their face shields and pumps in an invisible mist.
“If you taste any sweetness, we’re going to have to fit you for another mask,” says Pelletier, who is dressed in fatigues and wearing a mask and gloves.
What could be a scene in a science fiction movie is instead one in a series of ongoing training sessions for workers in nursing homes and other congregate care settings where the coronavirus can spread rapidly – often with devastating consequences.
Since late April, two dozen Maine National Guard members have been fit-testing health care workers with N95 masks, a process more familiar to hospital workers who train for infectious disease control.
Unlike the face coverings Mainers are wearing to prevent them from spreading droplets to others, N95 masks are intended to prevent respiratory particles from being inhaled. N95 masks must be fitted properly to prevent health care workers from becoming infected and getting sick or spreading the disease.
But getting a tight fit is not as simple as it may sound, especially when facilities don’t have a steady supply of masks and have to use whatever brands or styles they can get.
There have been outbreaks, defined as three or more linked cases of COVID-19, at 32 congregate care facilities across the state, including the Maine Correctional Center in Windham, according to the Maine Center for Disease Control and Prevention.
A total of 365 cases – 17 percent of the state’s total – have been reported in long-term care facilities, which account for 46 deaths, or 57 percent of all COVID-19 related deaths in Maine. Of the 498 health care workers who have been infected, nearly one third – 140 – worked in long-term care facilities.
Air National Guard member Anna Johnson administers the slightly sweet aerosol solution to test the seal of a Gorham House staff member’s N95 mask during a personal protective equipment fit-testing and training from Air and Army National Guard members in the parking lot of the assisted living facility on May 19. National Guard members have been traveling around the state to different nursing homes performing fit testing and training for personal protective equipment. Brianna Soukup/Staff Photographer
The Guard’s overriding mission is to help get ahead of that trend and prepare workers before their facility has an outbreak.
As of Tuesday, Guard members had fit-tested 1,305 workers over the course of 47 sessions, with roughly 450 additional workers awaiting training as part of 18 planned missions, a spokesperson said.
The fit tests are one of several ways the Maine National Guard members are filling roles in the state’s fight against the virus.
Guard members were deployed to the Tall Pines nursing home in Belfast, the site of an early outbreak, for more than two weeks to conduct a deep cleaning on the facility and its medical equipment. Following that deployment, no additional cases of COVID-19 have been reported and the last person who was isolated because of the disease has been released.
Maj. Carl Lamb, public affairs officer, said the Guard also is helping to inventory, pack and ship personal protective equipment, including additional respirators for the Portland Fire Department and Northern Light Eastern Maine Medical Center.
The Guard also has provided liaison officers to the Maine Emergency Management Agency and Maine CDC to assist in planning, provided equipment support for the external triage unit at the VA Maine Healthcare at Togus, and inventoried and staged equipment in preparation for setting up alternate care sites that would have been used if hospitals became overwhelmed.
Air National Guard Master Sgt. Mary Pelletier shows Gorham House employees how to get a proper seal on their N95 masks. Brianna Soukup/Staff Photographer
The assistance with fit-testing is especially important for long-term care facilities because a test has to be done each time a different brand of mask is used, and it has been difficult to get consistent supplies of any one brand, said Dr. Jabbar Fazeli, spokesman for the Maine Medical Directors Association, which represents physicians and staff members at long-term care facilities.
“That’s one of the main challenges that persists today,” Fazeli said. “We’re getting whatever we can get our hands on.”
Health care workers are put through a battery of tests to ensure a tight fit.
First, Pelletier acclimates each worker to the sweet-tasting saline solution by spraying it directly into each worker’s mouth. She records how many pumps it takes for each worker to notice the taste.
Next, they’re are told to put on their masks, cup them in their hands and breathe in and out to create a seal.
After putting on their hoods with plastic shields, they’re put through a series of minute-long tests meant to replicate the everyday movements of caring for patients and speaking with co-workers. They include periods of deep breathing, turning their heads side to side and then up and down; reading a poem out loud; bending over; jogging in place; and normal breathing.
In between each test, Pelletier inserts a nebulizer and adds more saline mist inside the hood to ensure that the mask is still sealed correctly.
“Is everyone, OK?” she asks.
It didn’t take long for Taylor Locklin, a CNA and CRMA, to taste the saline solution that was pumped under her hood. That meant her mask was not on securely and she could have been exposed to the coronavirus. She was soon fitted with a smaller mask.
“The bridge of the nose was really big at first, so they gave me a different style and it was more flexible so it fit better,” Locklin said.
Each mask is placed into a paper bag with the employee’s name written on it, to be used only if there is a case of COVID-19 confirmed in the facility, which has not occurred at Gorham House. If an outbreak does occur, the facility will request additional protective equipment, including N95 masks, from the state. And the employees will know which types and sizes to use.
Fit-testing of masks happens annually in respiratory units of hospitals, Pelletier said, but not at nursing homes and other congregate care facilities.
Jackie Farwell, a spokeswoman for the Maine Department of Health and Human Services, said nursing homes have not traditionally stocked N95 masks. Most nursing homes use surgical masks, which do not meet standards for providing care to people with communicable respiratory diseases. Federal workplace safety guidelines require that workers be fit-tested before using an N95 respirator, Farwell said.
Before the Guard was enlisted, local fire and emergency responders and public health coalitions were conducting fit-testing for congregate care facilities, Maine CDC spokesman Robert Long said. The Guard was called in to help satisfy the demand, he said. A range of workers – from nurses to cooks and custodians – are being fitted for masks.
Long said there is no evidence that improper use of N95 masks or other personal protective equipment played any role in outbreaks reported in congregate care settings in Maine.
“The increased access to personal protective equipment is part of a public health response to COVID-19, not an indication of any concern about training at congregate living communities,” Long said.
The highest priority is to prepare facilities in York, Cumberland and Androscoggin counties, where the virus is more widespread, the CDC said.
Kayla Belanger, a nursing scheduler at Gorham House, said she was glad management took the proactive step of requesting fit-testing from the guard, so all levels of staff will be prepared if the facility records its first case.
“I feel good knowing we’re being as safe as we can for our residents,” Belanger said.
Debe Gibson, a registered nurse, said the fit-testing gave her peace of mind.
“You always worry about your family,” she said. “This is our second family.”
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