In hospital verification of non CE-marked respiratory protective devices to ensure safety of healthcare staff during the COVID-19 outbreak

Effective ultraviolet C light disinfection of respirators demonstrated in challenges with Geobacillus stearothermophilus spores and SARS-CoV-2 virus

BACKGROUND

The global COVID-19 pandemic, accompanied by spikes in the number of patients in hospitals, required substantial amounts of respiratory protective devices (respirators), thereby causing shortages. Disinfection of used respirators by applying ultraviolet C (UVC) light may enable safe reuse, reducing shortages.

AIM

To determine whether UVC disinfection is applicable to enable repeated safe reuse of respirators.

METHODS

The UVC chamber, equipped with low-pressure mercury discharge lamps emitting at 254 nm, was used to determine the sporicidal and virucidal effects. Respirators challenged with spores and viruses were exposed to various UVC energy levels. Deactivation of the biological agents was studied as well as UVC effects on particle filtration properties and respirator fit.

FINDINGS

A 5 log10 reduction of G. thermophilus spore viability by a UVC dose of 1.1 J/cm2 was observed. By simulating spores present in the middle of the respirators, a 5 log10 reduction was achieved at a UVC dose of 10 J/cm2. SARS-CoV-2 viruses were inactivated by 4 log10 upon exposure to 19.5 mJ/cm2 UVC. In case UVC must be transmitted through all layers of the respirators to reach the spores and virus, a reduction of >5 log10 was achieved using a UVC dose of 10 J/cm2. Exposure to a six-times higher UVC dose did not significantly affect the integrity of the fit nor aerosol filtering capacity of the respirator.

CONCLUSION

UVC was shown to be a mild and effective way of respirator disinfection allowing for reuse of the UVC-treated respirators.

Management of donations of personal protective equipment in response to the massive shortage during the COVID-19 health crisis: providing quality equipment to health care workers

Background

In the COVID-19 pandemic context, a massive shortage of personal protective equipment occurred. To increase the available stocks, several countries appealed for donations from individuals or industries. While national and international standards to evaluate personal protective equipment exist, none of the previous research studied how to evaluate personal protective equipment coming from donations to healthcare establishments. Our aim was to evaluate the quality and possible use of the personal protective equipment donations delivered to our health care establishment in order to avoid a shortage and to protect health care workers throughout the COVID-19 crisis.

Methods

Our intervention focused on evaluation of the quality of donations for medical use through creation of a set of assessment criteria and analysis of the economic impact of these donations.

Results

Between 20th March 2020 and 11th May 2020, we received 239 donations including respirators, gloves, coveralls, face masks, gowns, hats, overshoes, alcohol-based hand rubs, face shields, goggles and aprons. A total of 448,666 (86.3%) products out of the 519,618 initially received were validated and distributed in health care units, equivalent to 126 (52.7%) donations out of the 239 received. The budgetary value of the validated donations was 32,872 euros according to the pre COVID-19 prices and 122,178 euros according to the current COVID-19 prices, representing an increase of 371.7%.

Conclusions

By ensuring a constant influx of personal protective equipment and proper stock management, shortages were avoided. Procurement and distribution of controlled and validated personal protective equipment is the key to providing quality care while guaranteeing health care worker safety.

Assessment of the impact of multiple mild-steam decontaminations on the protection performance of disposable KN95 filtering facepiece respirators

The COVID-19 pandemic caused tremendous supply bottlenecks of single-use filtering facepiece respirators (FFRs) leading to a growing need for a potential reuse. This study assesses the impact of multiple mild-steam decontaminations with 121 °C/2000 mbar/20 min on the protection performance of disposable FFRs. It focuses on FFRs of type KN95 that is recently dominating the markets, but its decontamination is not covered in the literature. It was found that up to ten cycles, only minor degradation in the filter efficiency, breathing resistance and none in the material structure is apparent, suggesting a potential for multiple decontamination cycles at almost unchanged protective properties of KN95 FFRs.

Compatibility and Safety Implications Associated with Interfacing Medical Devices in Neonatal Respiratory Care: A Case Example Using the Inhaled Nitric Oxide Delivery System

Over the past decade, international organizations have instituted strict regulations for the safe use of connected medical devices. The International Organization for Standardization and the Medical Device Single Audit Program instituted certifications to ensure that connected devices are compatible and operate within their proper clinical parameters. These efforts came about, in part, as a consequence of clinicians’ decisions to use nonstandard, modified, or improvised devices for purposes outside the original manufacturers’ approved parameters. Unapproved device modifications can be associated with increased risk of dosing errors, monitoring errors, tubing misconnections and serious or potentially fatal adverse events; furthermore, health care providers who implement unapproved device modifications may assume legal and financial liability should harm come to patients as a consequence of the modification. Using the inhaled nitric oxide delivery system as an example, the objective of this paper is to raise awareness of the potential dangers associated with unapproved modification and interfacing of therapeutic gas delivery systems and ventilators in the neonatal intensive care unit setting. The paper also highlights the rationale and necessity for rigorous validation processes that ensure that interfaced medical devices perform as intended in the clinical setting.

Heat sterilisation dramatically reduces filter efficiency of the majority of FFP2 and KN-95 respirators

BACKGROUND

Because of the enormous demand for personal protective equipment and especially respiratory protective devices (respirators) during the initial phase of the corona pandemic shortages arose. Sterilisation of used respirators can reduce these shortages. In our study, respirator testing was carried out after only one sterilisation cycle.

AIM

To determine if steam sterilisation and reuse could be safely applied for used respirators.

METHODS

In a cabinet an aqueous solution of NaCl (0.02% w/v) was nebulized and passed through a sample of the material of a respirator. Passing particle concentrations were measured directly from the cabinet and via the filter material of the respirator for particles ≥ 0.3 μm, ≥ 0.5 μm and ≥ 1.0 μm.

FINDINGS

only three out of ten steam sterilised respirators met the requirements of 94% filtration efficiency.

CONCLUSION

The results prove that heat sterilisation cannot be generically applied for reuse of respirators safely.