Filtration performance, fit test and side effects of respiratory personal protective equipment following decontamination: Observations for user safety and comfort (original) (raw)
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Impact of extended use and decontamination with vaporized hydrogen peroxide on N95 respirator fit
American Journal of Infection Control, 2020
Background: To address the shortage of N95 respirators in the wake of the COVID-19 pandemic, some organizations have recommended the decontamination of respirators using vaporized hydrogen peroxide (VHP) sterilizer for up to 10 times. However, these recommendations are based on studies that did not take into account the extended use of respirators, which can degrade respirator fit. Methods: We investigated the impact of extended use and decontamination with VHP on N95 Respirator Fit. We performed a prospective cohort study to determine the number of times respirators can be decontaminated before respirator fit test failure. The primary outcome was the overall number of cycles required for half of the respirators to fail (either mechanical failure or fit test failure). Results: Thirty-six participants completed 360 hours of respirator usage across 90 cycles. The median number of cycles completed by participants before respirator failure was 2. The overall number of cycles required for half of respirators to fail was 1, 3, 5, and 4 for the 3M 1860(S), 3M 1870+, Moldex 151X and ProGear 88020 respirators, respectively. Conclusions: The combination of prolonged usage and VHP decontamination was associated with early failure. Decontamination and prolonged usage of respirators must be done cautiously.
Eurosurveillance, 2022
Background The shortage of FFP2 and FFP3 respirators posed a serious threat to the operation of the healthcare system at the onset of the COVID-19 pandemic. Aim Our aim was to develop and validate a large-scale facility that uses hydrogen peroxide vapour for the decontamination of used respirators. Methods A multidisciplinary and multisectoral ad hoc group of experts representing various organisations was assembled to implement the collection and transport of used FFP2 and FFP3 respirators from hospitals covering 86% of the Finnish population. A large-scale decontamination facility using hydrogen peroxide vapour was designed and constructed. Microbiological tests were used to confirm efficacy of hydrogen peroxide vapour decontamination together with a test to assess the effect of decontamination on the filtering efficacy and fit of respirators. Bacterial and fungal growth in stored respirators was determined by standard methods. Results Large-scale hydrogen peroxide vapour decontami...
Hydrogen Peroxide Methods for Decontaminating N95 Filtering Facepiece Respirators
Applied Biosafety, 2021
Introduction: During a pandemic, when the supply of N95 filtering facepiece respirators (FFRs) is limited, FFRs may be decontaminated by methods that inactivate pathogens as long as they do not damage FFR function. Hydrogen peroxide (H 2 O 2) is widely used for decontamination in medical settings. Objective: To review the literature on the use of H 2 O 2 to decontaminate N95 FFRs and identify methods that inactivate virus and preserve FFR filtration efficiency and fit. Methods: The literature was searched for studies evaluating H 2 O 2 decontamination methods on inactivating SARS-CoV-2 and other viruses and microorganisms inoculated on N95 FFRs and the effects on respirator filtration efficiency and fit. Current U.S. Federal guidelines are also presented. Results: Findings from relevant laboratory studies (N = 24) are summarized in tables. Commercially available H 2 O 2 decontamination systems differ on how H 2 O 2 is delivered, the temperature, the duration of treatment, and other factors that can impact N95 FFR filtration efficiency and fit. Some methods inactivate SARS-CoV-2 virus-contaminated N95 FFRs with >3 log attenuation, whereas other methods are yet to be evaluated. Discussion and Conclusion: Most of the H 2 O 2 methods reviewed effectively decontaminate N95 FFRs without damaging FFR function. However, some methods adversely impact N95 fit or filtration efficiency, which could go undetected by the end user and compromise their protection from pathogen inhalation. When making decisions about H 2 O 2 decontamination of respirators, it is important to understand differences in methods, effects on different FFR models, and potential hazards to workers who manage the decontamination process.
International Journal of Environmental Research and Public Health, 2021
To cope with the shortage of filtering facepiece respirators (FFRs) caused by the coronavirus disease (COVID-19), healthcare institutions have been forced to reuse FFRs using different decontamination methods, including vapor hydrogen peroxide (VHP). However, most healthcare institutions still struggle with evaluating the effect of VHP on filtration efficiency (FE) of the decontaminated FFRs. We developed a low-cost in-house FE assessment using a novel 3D-printed air duct. Furthermore, we assessed the FE of seven types of FFRs. Following 10 VHP cycles, we evaluated the FE of KN95 and 3M-N95 masks. The 3M-N95 and Benehal-N95 masks showed significant lower FE (80.4–91.8%) at fine particle sizes (0.3–1 µm) compared to other FFRs (FE ≥ 98.1%, p < 0.05). Following 10 VHP cycles, the FE of KN95 masks was almost stable (FE stability > 99.1%) for all particle sizes, while 3M-N95 masks were stable only at 2 and 5 µm (FE stability > 98.0%). Statistically, FE stability of 3M-N95 masks...
Evaluation of Multiple (3-Cycle) Decontamination Processing for Filtering Facepiece Respirators
Journal of Engineered Fibers and Fabrics
Disposable N95 filtering facepiece respirators (FFRs) certified by the National Institute for Occupational Safety and Health (NIOSH) are widely used by healthcare workers to reduce exposures to infectious biological aerosols. There is currently major concern among public health officials about a possible shortage of N95 FFRs during an influenza pandemic. Decontamination and reuse of FFRs is a possible strategy for extending FFR supplies in an emergency; however, the NIOSH respirator certification process does not currently include provisions for decontamination and reuse. Recent studies have investigated the laboratory performance (filter aerosol penetration and filter airflow resistance) and physical integrity of FFRs following one-cycle (1X) processing of various decontamination treatments. The studies found that a single application of some methods did not adversely affect laboratory performance. In the event that healthcare facilities experience dramatic shortages of FFR supplie...
2020
ObjectiveThe COVID-19 pandemic has led to widespread shortages of personal protective equipment (PPE) for healthcare workers, including filtering facepiece respirators (FFRs) such as N95 masks. These masks are normally intended for single use, but their sterilization and subsequent reuse could substantially mitigate a world-wide shortage.DesignQuality assurance.SettingA sealed environment chamber installed in the animal facility of an academic medical center.InterventionsOne to five sterilization cycles using ionized hydrogen peroxide (iHP), generated by SteraMist® equipment (TOMI; Frederick, MD).Main outcome measuresPersonal protective equipment, including five N95 mask models from three manufacturers, were evaluated for efficacy of sterilization following iHP treatment (measured with bacterial spores in standard biological indicator assemblies). Additionally, N95 masks were assessed for their ability to efficiently filter particles down to 0.3µm and for their ability to form an ai...
2020
During the COVID-19 pandemic, a shortage of personal protective equipment (PPE), namely surgical masks, N95 masks, and gowns, has been experienced by some hospitals and could be expected in others due to a rapidly increased need. One method of addressing the shortage is to decontaminate and re-use PPE. The Centres for Disease Control (CDC) specifically recommends N95 filtering facepiece respirators (FFRs) for healthcare workers who are interacting with patients with COVID-19. There are anecdotal reports and published literature evaluating the potential of using disinfectants, such as hydrogen peroxide and bleach to decontaminate FFRs, with mixed reports of impact on structural integrity. To date this literature has not been comprehensively synthesized and the purpose of this review is to systematically review the existing literature on the use of disinfectants for the decontamination of facemask PPE.This information will be used to contribute to FFR decontamination protocols at the ...
Scientific Reports, 2021
The COVID-19 pandemic has led to widespread shortages of personal protective equipment (PPE) for healthcare workers, including of N95 masks (filtering facepiece respirators; FFRs). These masks are intended for single use but their sterilization and subsequent reuse has the potential to substantially mitigate shortages. Here we investigate PPE sterilization using ionized hydrogen peroxide (iHP), generated by SteraMist equipment (TOMI; Frederick, MD), in a sealed environment chamber. The efficacy of sterilization by iHP was assessed using bacterial spores in biological indicator assemblies. After one or more iHP treatments, five models of N95 masks from three manufacturers were assessed for retention of function based on their ability to form an airtight seal (measured using a quantitative fit test) and filter aerosolized particles. Filtration testing was performed at a university lab and at a National Institute for Occupational Safety and Health (NIOSH) pre-certification laboratory. ...
Evaluation of at-home methods for N95 filtering facepiece respirator decontamination
2021
Shortages in N95 filtering facepiece respirators (FFRs) are significant as FFRs are essential for the protection of healthcare professionals and other high-risk groups against Coronavirus Disease of 2019 (COVID-19), a disease caused by severe acute respiratory syndrome coronavirus 2. In response to these shortages during the ongoing COVID-19 pandemic, the Food and Drug Administration issued an Emergency Use Authorization (EUA) permitting FFR decontamination and reuse. However, although industrial decontamination services are available at some large institutions, FFR decontamination is not widely available. Effective FFR decontamination must 1) deactivate the virus; 2) preserve FFR integrity, specifically fit and filtering capability; and 3) be non-toxic and safe. Here we identify and compare at-home methods for heat-based FFR decontamination that meet these requirements, but utilize common household appliances. Our results identify viable protocols for simple and accessible FFR deco...
Decontamination Methods for Respiratory Protection Mask Model N95: A Rapid Review
2020
Background: N95 respiratory protection masks are used by healthcare professionals to prevent contamination with infectious microorganisms transmitted by droplets or aerosols. Methods: We conducted a rapid review of the literature analyzing the effectiveness of decontamination methods for mask reuse. The review was carried out in April 2020 using a simplification of the formal systematic review process. A total of 166 articles were retrieved of which 17 laboratory-based studies were selected. Results: Two of the studies only examined the effectiveness of decontamination methods, seven only reported on the maintenance of mask integrity, and eight considered both outcomes. Twelve decontamination methods were included in the studies. Conclusions: Positive results should be considered with caution as they represent a small number of studies, reflect ideal laboratory conditions, and may have limited applicability in realistic situations and for health systems. Nonetheless, five methods ap...