Contribution of breathing frequency and inhalation flow rate on performance of N95 filtering facepiece respirators

Validation of N95 Filtering Facepiece Respirator Decontamination Methods Available at a Large University Hospital

BACKGROUND

Due to unprecedented shortages in N95 filtering facepiece respirators, healthcare systems have explored N95 reprocessing. No single, full-scale reprocessing publication has reported an evaluation including multiple viruses, bacteria, and fungi along with respirator filtration and fit.

METHODS

We explored reprocessing methods using new 3M 1860 N95 respirators, including moist (50%-75% relative humidity [RH]) heat (80-82°C for 30 minutes), ethylene oxide (EtO), pulsed xenon UV-C (UV-PX), hydrogen peroxide gas plasma (HPGP), and hydrogen peroxide vapor (HPV). Respirator samples were analyzed using 4 viruses (MS2, phi6, influenza A virus [IAV], murine hepatitis virus [MHV)]), 3 bacteria (Escherichia coli, Staphylococcus aureus, Geobacillus stearothermophilus spores, and vegetative bacteria), and Aspergillus niger. Different application media were tested. Decontaminated respirators were evaluated for filtration integrity and fit.

RESULTS

Heat with moderate RH most effectively inactivated virus, resulting in reductions of >6.6-log10 MS2, >6.7-log10 Phi6, >2.7-log10 MHV, and >3.9-log10 IAV and prokaryotes, except for G stearothermohphilus. Hydrogen peroxide vapor was moderately effective at inactivating tested viruses, resulting in 1.5- to >4-log10 observable inactivation. Staphylococcus aureus inactivation by HPV was limited. Filtration efficiency and proper fit were maintained after 5 cycles of heat with moderate RH and HPV. Although it was effective at decontamination, HPGP resulted in decreased filtration efficiency, and EtO treatment raised toxicity concerns. Observed virus inactivation varied depending upon the application media used.

CONCLUSIONS

Both moist heat and HPV are scalable N95 reprocessing options because they achieve high levels of biological indicator inactivation while maintaining respirator fit and integrity.

Efficacy and safety of decontamination for N95 respirator reuse: a systematic literature search and narrative synthesis

PURPOSE

Under times of supply chain stress, the availability of some medical equipment and supplies may become limited. The current pandemic involving severe acute respiratory syndrome coronavirus 2 has highlighted limitations to the ordinary provision of personal protective equipment (PPE). For perioperative healthcare workers, N95 masks provide a stark example of PPE in short supply necessitating the creation of scientifically valid protocols for their decontamination and reuse.

METHODS

We performed a systematic literature search of MEDLINE, Embase, Cochrane CENTRAL databases, and ClinicalTrials.gov to identify peer-reviewed articles related to N95 mask decontamination and subsequent testing for the integrity of mask filtration and facial seal. To expand this search, we additionally surveyed the official statements from key health agencies, organizations, and societies for relevant citations.

RESULTS

Our initial database search resulted in five articles that met inclusion criteria, with 26 articles added from the expanded search. Our search did not reveal any relevant randomized clinical trials or cohort studies. We found that moist mask heating (65-80°C at 50-85% relative humidity for 20-30 min) and vaporous hydrogen peroxide treatment were supported by the literature to provide consistent viral decontamination without compromising mask seal and filtration efficiency. Other investigated decontamination methods lacked comprehensive scientific evidence for all three of these key criteria.

CONCLUSIONS

N95 mask reprocessing using either moist heat or vaporous hydrogen peroxide is recommended to ensure healthcare worker safety.

Advanced testing method to evaluate the performance of respirator filter media

Filter media for respirator applications are typically exposed to the cyclic flow condition, which is different from the constant flow condition adopted in filter testing standards. To understand the real performance of respirator filter media in the field it is required to investigate the penetration of particles through respirator filters under cyclic flow conditions representing breathing flow patterns of human beings. This article reports a new testing method for studying the individual effect of breathing frequency (BF) and peak inhalation flow rate (PIFR) on the particle penetration through respirator filter media. The new method includes the use of DMA (Differential Mobility Analyzer)-classified particles having the most penetrating particle size, MPPS (at the constant flowrate of equivalent mean inhalation flow rate, MIFR) as test aerosol. Two condensation particle counters (CPCs) are applied to measure the particle concentrations at the upstream and downstream of test filter media at the same time. Given the 10 Hz sampling time of CPCs, close-to-instantaneous particle penetration could be measured. A pilot study was performed to demonstrate the new testing method. It is found that the effect of BF on the particle penetration of test respirator filter media is of importance at all the tested peak inhalation flow rates (PIFRs), which is different from those reported in the previous work.