Scalable in-hospital decontamination of N95 filtering face-piece respirator with a peracetic acid room disinfection system

Decontaminating N95/FFP2 masks for reuse during the COVID-19 epidemic: a systematic review

BACKGROUND

With the current COVID-19 pandemic, many healthcare facilities have been lacking a steady supply of filtering facepiece respirators. To better address this challenge, the decontamination and reuse of these respirators is a strategy that has been studied by an increasing number of institutions during the COVID-19 pandemic.

METHODS

We conducted a systematic literature review in PubMed, PubMed Central, Embase, and Google Scholar. Studies were eligible when (electronically or in print) up to 17 June 2020, and published in English, French, German, or Spanish. The primary outcome was reduction of test viruses or test bacteria by log3 for disinfection and log6 for sterilization. Secondary outcome was physical integrity (fit/filtration/degradation) of the respirators after reprocessing. Materials from the grey literature, including an unpublished study were added to the findings.

FINDINGS

Of 938 retrieved studies, 35 studies were included in the analysis with 70 individual tests conducted. 17 methods of decontamination were found, included the use of liquids (detergent, benzalkonium chloride, hypochlorite, or ethanol), gases (hydrogen peroxide, ozone, peracetic acid or ethylene oxide), heat (either moist with or without pressure or dry heat), or ultra violet radiation (UVA and UVGI); either alone or in combination. Ethylene oxide, gaseous hydrogen peroxide (with or without peracetic acid), peracetic acid dry fogging system, microwave-generated moist heat, and steam seem to be the most promising methods on decontamination efficacy, physical integrity and filtration capacity.

INTERPRETATION

A number of methods can be used for N95/FFP2 mask reprocessing in case of shortage, helping to keep healthcare workers and patients safe. However, the selection of disinfection or sterilization methods must take into account local availability and turnover capacity as well as the manufacturer; meaning that some methods work better on specific models from specific manufacturers.

SYSTEMATIC REGISTRATION NUMBER

CRD42020193309.

The COVID-19 pandemic and N95 masks: reusability and decontamination methods

BACKGROUND

With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of extraordinary measures to minimize the negative health impact from an insufficient supply of masks. The decontamination, and reuse of healthcare workers' N95/FFP2 masks is a promising solution which needs to overcome several pitfalls to become a reality.

AIM

The overall aim of this article is to provide the reader with a quick overview of the various methods for decontamination and the potential issues to be taken into account when deciding to reuse masks. Ultraviolet germicidal irradiation (UVGI), hydrogen peroxide, steam, ozone, ethylene oxide, dry heat and moist heat have all been methods studied in the context of the pandemic. The article first focuses on the logistical implementation of a decontamination system in its entirety, and then aims to summarize and analyze the different available methods for decontamination.

METHODS

In order to have a clear understanding of the research that has already been done, we conducted a systematic literature review for the questions: what are the tested methods for decontaminating N95/FFP2 masks, and what impact do those methods have on the microbiological contamination and physical integrity of the masks? We used the results of a systematic review on the methods of microbiological decontamination of masks to make sure we covered all of the recommended methods for mask reuse. To this systematic review we added articles and studies relevant to the subject, but that were outside the limits of the systematic review. These include a number of studies that performed important fit and function tests on the masks but took their microbiological outcomes from the existing literature and were thus excluded from the systematic review, but useful for this paper. We also used additional unpublished studies and internal communication from the University of Geneva Hospitals and partner institutions.

RESULTS

This paper analyzes the acceptable methods for respirator decontamination and reuse, and scores them according to a number of variables that we have defined as being crucial (including cost, risk, complexity, time, etc.) to help healthcare facilities decide which method of decontamination is right for them.

CONCLUSION

We provide a resource for healthcare institutions looking at making informed decisions about respirator decontamination. This informed decision making will help to improve infection prevention and control measures, and protect healthcare workers during this crucial time. The overall take home message is that institutions should not reuse respirators unless they have to. In the case of an emergency situation, there are some safe ways to decontaminate them.

Strategies for managing N95 mask shortages at water resource recovery facilities during pandemics: a review

As the numbers of COVID-19 cases grew globally, the severe shortages of health care respiratory protective equipment impacted the ability of water resource recovery facilities (WRRFs) to acquire N95 masks for worker protection. While the Occupational Safety and Health Administration (OSHA) encourages WRRFs to conduct job safety assessments to mitigate risks from bioaerosols, it does not provide clear guidance on respiratory protection requirements, leaving the use of N95 masks across the industry non-standardized and difficult to justify. Strategies need to be developed to cope with shortages during pandemics, and these should take into consideration a WRRF's size and disinfection equipment available. Our objective is to provide an overview of respiratory protection-related practices recommended for health care professionals that apply to WRRFs (e.g., elimination, substitution, extended use, reuse, disinfection). Reviewed N95 mask disinfection strategies included using hydrogen peroxide, autoclaving, moist heat, dry heat, ultraviolet germicidal irradiation (UVGI), ethylene oxide, chlorine and ethanol. Of these, dry heat, autoclaving and UVGI present the most promise for WRRFs, with UVGI being limited to larger utilities. We recommend that WRRFs work closely with disinfection technology manufacturers, mask providers, health and safety staff and inspectors to develop suitable programs to cope with N95 mask shortages during pandemics.

Tailoring surface wettability to reduce chances of infection of COVID-19 by a respiratory droplet and to improve the effectiveness of personal protection equipment

Motivated by the fact that the drying time of respiratory droplets is related to the spread of COVID-19 [R. Bhardwaj and A. Agrawal, "Likelihood of survival of coronavirus in a respiratory droplet deposited on a solid surface," Phys. Fluids 32, 061704, (2020)], we analyze the drying time of droplets ejected from a COVID-19 infected subject on surfaces of personal protection equipment (PPE), such as a face mask, of different wettabilities. We report the ratio of drying time of the droplet on an ideal superhydrophobic surface (contact angle, θ → 180°) to an ideal hydrophilic surface (θ → 0°) and the ratio of the maximum to minimum drying time of the droplet on the surfaces with different contact angles. The drying time is found to be maximum if θ = 148°, while the aforementioned ratios are 4.6 and 4.8, respectively. These ratios are independent of the droplet initial volume, ambient temperature, relative humidity, and thermophysical properties of the droplet and water vapor. We briefly examine the change in drying time in the presence of impurities on the surface. Besides being of fundamental interest, the analysis provides insights that are useful while designing the PPE to tackle the present pandemic.