Milwaukee VA Medical Center
CAPR helmets keep front-line workers safe
In the ongoing battle against COVID-19, personal protective equipment – PPE – is the key line of defense for front-line health care workers.
And the most valued piece of PPE at the Milwaukee VA Medical Center has become the CAPR helmet.
CAPR stands for “controlled air purifying respirator,” and the devices supersede N95 masks and face shields for those working with COVID patients.
“They are the Cadillac of respiratory PPE,” said Courtney Wilson, Progressive Care Unit program manager. “They offer an additional layer of support and protection.”
“I feel very safe in the CAPRs,” said Shannon Ribbich, a registered nurse on 6C South who has been working with COVID patients since the pandemic began. “I can attest that we’re wearing the CAPRs, and we’re not getting sick. That’s been really awesome.”
“I feel very safe in the CAPRs. I can attest that we're wearing the CAPRs, and we're not getting sick. That's been really awesome.” Shannon Ribbich, registered nurse
What makes a CAPR different from traditional PPE is a built-in, battery-operated air handling system that draws air in through a HEPA filter and blows it into the “breathing zone, creating a positive pressure of air,” according to Mike Moran, industrial hygienist.
“In that way, air is constantly blowing out away from your face so contaminants can’t get drawn up into the breathing zone,” he said.
The filter is 99.97 percent efficient in filtering out particles of 0.3 microns, compared to 95 percent for N95s, Moran said.
A clear, detachable lens snaps to the helmet, creating a face shield, and a pliable piece of plastic creates a seal under the chin.
The small battery pack – about the size of a smartphone – can be clipped to a belt or carried in a pocket. The batteries are rechargeable.
Each user has his/her own lens, and the lenses can be easily detached, sanitized and reused.
“We disinfect the shield between each patient contact, and we write our names on our shields,” Ribbich said. “And we’re able to reuse them until their integrity is gone.”
Instead of purchasing new lenses, the hospital creates its own using in-house equipment.
“The ones they make here in the hospital are awesome,” Ribbich said. “They’re super clear; they clean really well, and they last a long time. That’s been really great.”
Ahead of the game
The Milwaukee VA was ahead of the game when it came to CAPRs. Before the pandemic hit, the hospital was already pivoting away from N95s in favor of the CAPRs.
And that was fortunate because once the pandemic hit, demand for CAPRs skyrocketed, resulting in manufacturing and delivery delays.
“Before COVID, we wanted to begin replacing N95s with the CAPR helmets because we found that individuals who wore the N95s infrequently didn’t always put them on correctly,” Moran said.
“Plus there’s the ease of use of the CAPR vs. having to fiddle with a mask and trying to get a tight seal to your face.”
Moran said the Milwaukee VA acquired 92 CAPRs before COVID hit and distributed them throughout the hospital. In August, the hospital received 25 more, and another 100 have been ordered.
“But it will be several months down the road before we receive them. With COVID, that’s become a hot commodity,” he said.
The CAPRs are not cheap; Moran said each one costs about $1,300 once all the equipment is figured into the cost.
When COVID hit, the CAPRs were directed toward high-need areas, including the East Entrance screeners, dental, the COVID ward and the emergency department.
Anesthesia, the ZIHP clinic and other areas that may employ aerosol-generating procedures have them as well, Moran said.
Another advantage of the CAPRs: They don’t require a fit test, like N95s, Moran said. Instead, the helmet easily adjusts, like a bicycle helmet.
“And it’s more comfortable to wear longer term,” Moran said, noting that N95 users often develop sores or lesions on their faces from longtime use of the masks.
Nurses on the COVID ward readily attest to all the advantages of the CAPRs.
“They’re definitely better than the N95s,” said registered nurse Kelli Jansen. “The fan is great as it cools you off, and they’re easy to put on. They’ve been great.”
Fellow registered nurse Rachel Scherf said the clear face shields also allow patients to see the nurses’ entire faces.
“It gives you a little more freedom for the patients to be able to see who you are and your facial expressions, which is a really big thing,” she said.
“These patients are so vulnerable right now, and these make for a good interaction with the patient. You can see me smile. And the caring and the listening – it’s not just about your eyes; it’s about your facial expression.”
“It gives us an opportunity to joke around with our patients,” Ribbich said. “The patients are able to see our whole face, and that helps develop rapport with them.”
The nurses also realize they are lucky to have access to CAPRs. Ribbich said she has friends at other hospitals who don’t have them. Shoshana Malcolm, a registered nurse who just recently started at the Milwaukee VA, backed that up, saying there were no CAPRs at her previous hospital.
“I’m really grateful our hospital bought these CAPRs,” Ribbich said.