Background: Shortages of personal protective equipment during the COVID-19 pandemic has led to the extended use or re-use of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination. Objectives: To synthesise current guidance and systematic review evidence on extended use, re-use, or reprocessing of single-use surgical masks or filtering facepiece respirators. Data sources: World Health Organization, European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. Medline, Pubmed, Epistemonikos, Cochrane Database and preprint servers for systematic reviews. Methods: Two reviewers conducted screening and data extraction. Quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesised. Results: Six guidance documents were identified. Levels of detail and consistency across documents varied. Four high-quality systematic reviews were included: three focused on reprocessing (decontamination) of N95 respirators, one on reprocessing of surgical masks. Vaporised hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale. Conclusions: There is limited evidence on the impact of extended use and re-use of surgical masks and respirators and gaps and inconsistencies exist in current guidance. Where extended use or re-use is being practiced, healthcare organisations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.
Background During the early months of the Covid‐19 pandemic, studies demonstrated that healthcare workers (HCWs) were at increased risk of infection. Few modifiable risks were identified. It is largely unknown how these evolved over time. Methods A prospective case‐referent study was established and nested within a cohort study of Canadian HCWs. Cases of Covid‐19, confirmed by polymerase chain reaction, were matched with up to four referents on job, province, gender, and date of first vaccination. Cases and referents completed a questionnaire reporting exposures and experiences in the 21 days before case date. Participants were recruited from October 2020 to March 2022. Workplace factors were examined by mixed‐effects logistic regression allowing for competing exposures. A sensitivity analysis was limited to those for whom family/community transmission seemed unlikely. Results 533 cases were matched with 1697 referents. Among unvaccinated HCWs, the risk of infection was increased if they worked hands‐on with patients with Covid‐19, on a ward designated for care of infected patients, or handled objects used by infected patients. Sensitivity analysis identified work in residential institutions and geriatric wards as high risk for unvaccinated HCWs. Later, with almost universal HCW vaccination, risk from working with infected patients was much reduced but cases were more likely than referents to report being unable to access an N95 mask or that decontaminated N95 masks were reused. Conclusions These results suggest that, after a rocky start, the risks of Covid‐19 infection from work in health care are now largely contained in Canada but with need for continued vigilance.
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