Aerosolized Hydrogen Peroxide Decontamination of N95 Respirators, with Fit-Testing and Viral Inactivation, Demonstrates Feasibility for Reuse during the COVID-19 Pandemic

In response to the demand for N95 respirators by health care workers during the COVID-19 pandemic, we evaluated decontamination of N95 respirators using an aerosolized hydrogen peroxide (aHP) system. This system is designed to dispense a consistent atomized spray of aerosolized, 7% hydrogen peroxide (H₂O₂) solution over a treatment cycle. Multiple N95 respirator models were subjected to 10 or more cycles of respirator decontamination, with a select number periodically assessed for qualitative and quantitative fit testing. In parallel, we assessed the ability of aHP treatment to inactivate multiple viruses absorbed onto respirators, including phi6 bacteriophage, herpes simplex virus 1 (HSV-1), coxsackievirus B3 (CVB3), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For pathogens transmitted via respiratory droplets and aerosols, it is critical to address respirator safety for reuse. This study provided experimental validation of an aHP treatment process that decontaminates the respirators while maintaining N95 function. External National Institute for Occupational Safety & Health (NIOSH) certification verified respirator structural integrity and filtration efficiency after 10 rounds of aHP treatment. Virus inactivation by aHP was comparable to the decontamination of commercial spore-based biological indicators. These data demonstrate that the aHP process is effective, with successful fit-testing of respirators after multiple aHP cycles, effective decontamination of multiple virus species, including SARS-CoV-2, successful decontamination of bacterial spores, and filtration efficiency maintained at or greater than 95%. While this study did not include extended or clinical use of N95 respirators between aHP cycles, these data provide proof of concept for aHP decontamination of N95 respirators before reuse in a crisis-capacity scenario.

IMPORTANCE The COVID-19 pandemic led to unprecedented pressure on health care and research facilities to provide personal protective equipment. The respiratory nature of the SARS-CoV2 pathogen makes respirator facepieces a critical protective measure to limit inhalation of this virus. While respirator facepieces were designed for single use and disposal, the pandemic increased overall demand for N95 respirators, and corresponding manufacturing and supply chain limitations necessitated the safe reuse of respirators when necessary. In this study, we repurposed an aerosolized hydrogen peroxide (aHP) system that is regularly utilized to decontaminate materials in a biosafety level 3 (BSL3) facility, to develop a method for decontamination of N95 respirators. Results from viral inactivation, biological indicators, respirator fit testing, and filtration efficiency testing all indicated that the process was effective at rendering N95 respirators safe for reuse. This proof-of-concept study establishes baseline data for future testing of aHP in crisis-capacity respirator-reuse scenarios.

Under-mask beard covers achieve an adequate seal with tight-fitting disposable respirators using quantitative fit testing

BACKGROUND

Tight-fitting respirators are a critical component of respiratory protection against airborne diseases for health workers. However, they are not recommended for health workers with facial hair. Some health workers are unable to shave for religious or medical reasons. Under-mask beard covers have been proposed as a solution to allow health workers with facial hair to wear tight-fitting respirators. However, studies to date have been limited by their predominant reliance on qualitative rather than quantitative fit testing techniques.

AIM

To assess the efficacy of under-mask beard covers in achieving an adequate seal with tight-fitting disposable P2/N95 respirators using quantitative fit testing.

METHODS

Bearded adult males underwent quantitative fit testing with an under-mask beard cover using either a TSI PortaCount Respirator Fit Tester 8038™ or AccuFit 9000 PRO™ fit testing device on up to five disposable P2/N95 respirators (3M 1860, 3M 1870+, BYD N95 Helathcare Particulate Respirator, BSN Medical ProShield N-95 Medium and Trident RTCFFP2). The primary outcome was the proportion of subjects that passed or failed quantitative fit testing with an under-mask beard cover.

FINDINGS

Thirty subjects were assessed, 24 (80%) passed quantitative fit testing with at least one tight-fitting P2/N95 disposable respirator. Among these subjects the median (IQR) best achieved fit factor was 200 (178-200). No subject had an adverse reaction to the under-mask beard cover.

CONCLUSION

The under-mask beard cover technique may be used to achieve a satisfactory seal with tight-fitting P2/N95 respirators in health workers with facial hair that cannot shave.

How hearing conservation training format impacts personal attenuation ratings in U.S. Marine Corps Training Recruits

OBJECTIVE

The purpose of this fit-testing study in the field was to systematically compare three Hearing Protection Device (HPD) fit-training methods and determine whether they differ in the acquisition of HPD fitting skill and resulting amount of earplug attenuation.

DESIGN

Subjects were randomly assigned to receive HPD fit-training using one of three training methods: current, experiential HPD (eHPD), and integrated. Personal Attenuation Ratings (PARs) were acquired via HPD fit-testing and used to verify attenuations pre- and post-training.

STUDY SAMPLE

US Marine training recruits (n = 341) identified via HPD fit-testing for remedial HPD fit-training and assigned to three cohorts.

RESULTS

The post-training HPD fit-test passing rate differed by training method, with pass rates ranging from 50% (current) to nearly 92% (eHPD). The difference between group delta PAR values were significantly higher (>9 dB) in both the eHPD and integrated methods compared to the current method.

CONCLUSION

The HPD fit-training methods that teach "what right feels like" (eHPD and integrated) provided a greater number of trainees with the skill to achieve noise attenuation values required for impulse noise exposures encountered during basic training. The attenuation achieved by those methods was significantly greater than the current training method.

Consistency of attenuation across multiple fittings of custom and non-custom earplugs

Hearing protection devices (HPDs) play a significant role in protecting workers from occupational noise-induced hearing loss. Individual HPD fit-testing estimates the amount of protection, or attenuation, that an individual achieves from a given HPD as it is worn. Results from a single fit-test may not be representative of real-world HPD performance over time, however, due to inconsistency in how the individual fits the HPD from time to time. In this study, the effects of HPD type and user training on the consistency of attenuation achieved across multiple fittings were evaluated in a within-subjects design. Attenuation measurements using a real-ear attenuation at threshold procedure were obtained on 30 participants wearing custom-molded and non-custom earplugs. The subjects were initially naive to proper earplug insertion techniques and later received one-on-one training for the second half of the attenuation measurements. Consistency, or reliability, of fit was assessed using (i) the standard deviation of the 'distance to ear mean attenuation', a measure of fitting uncertainty, and (ii) the standard deviation of the attenuation values across multiple fit-tests for each subject. The custom earplug provided statistically significantly better consistency of attenuation than the non-custom earplug at 500, 1000, and 2000 Hz. Training effects were statistically significant at 250, 500, and 1000 Hz and at the Personal Attenuation Rating. No interactions were statistically significant. These results indicate that, in general, subjects obtained more consistent attenuation with the custom earplugs than with the non-custom earplugs and that consistency improved with training for both earplug types.