The SARS-CoV-2 (COVID-19) pandemic has placed a tremendous amount of strain on resources in the health care setting. One of the most pressing issues is the rapid depletion of personal protective equipment (PPE) used in the care of patients. This is a significant concern for health care workers' health and safety. Many entities have depleted or soon will exhaust their stockpile of PPE despite adopting PPE-sparing practices as the number of COVID-19 cases in the United States increases at an almost exponential rate and manufacturers struggle to keep up with the worldwide demand. This potential shortage is particularly concerning for commonly used N95 respirators and powered-air purifying respirators (PAPRs). Recently, the US Occupational Safety and Health Administration (OSHA) 1 even temporarily suspended the requirement to perform annual fit testing of respirators to allow entities to conserve respirators and preserve them for patient care. These measures are unprecedented and highlight the urgent need for entities to develop solutions to proactively address what could be potentially a grave occupational health issue.At Duke University and Health System, we have evaluated and will begin using hydrogen peroxide vapor to decontaminate and reuse N95 respirators. In this communication, we briefly discuss the decontamination validation process and post-decontamination performance validation conducted at Duke. This validation, which is supported by previous laboratory testing, funded by the US Food and Drug Administration (FDA), demonstrated that N95 respirators still met performance requirements even after decontamination with hydrogen peroxide vapor in the laboratory setting for over 50 times. 2 While previous studies have shown the applicability of the hydrogen peroxide vapor process, we have also confirmed that the respirator still functions as designed, using our standardized human N95 fit testing methodology. We will now use this internally validated and Duke Institutional Biosafety Review Committee (IBRC)-approved laboratory decontamination process in the clinical setting to dramatically extend the life of our N95 respirators. We hope that sharing our processes through this brief communication can help other entities with access to hydrogen peroxide vapor to evaluate the potential applicability of this technology at their facility or partner with those who may already have this capability, including other private-sector life science organizations. Process/MethodWe, like others, have implemented many Centers for Disease Control and Prevention (CDC)-approved N95 reuse practices, including employees reusing their own N95s for the duration of their shifts. However, this alone may not be adequate to meet our anticipated need with various centers reporting multiplefold higher use of PPE as their caseload increases. In the interest of our workforce safety, the goal was thus to extend the life of our existing supply.
Although intra- and interindividual sources of variation in airborne exposures have been extensively studied, similar investigations examining variability in biological measures of exposure have been limited. Following a review of the world's published literature, biological monitoring data were abstracted from 53 studies that examined workers' exposures to metals, solvents, polycyclic aromatic hydrocarbons, and pesticides. Approximately 40% of the studies also reported personal sampling results, which were compiled as well. In this study, the authors evaluated the intra- and interindividual sources of variation in biological measures of exposure collected on workers employed at the same plant. In 60% of the data sets, there was more variation among workers than variation from day to day. Approximately one-fourth of the data were homogeneous with small differences among workers' mean exposure levels. However, an almost equal number of data sets exhibited moderate to extreme levels of heterogeneity in exposures among workers at the same facility. In addition, the relative magnitude of the intra- to interindividual source of variation was larger for biomarkers with short compared to long half-lives, which suggests that biomarkers with half-lives of 7 days or longer exhibit physiologic dampening of fluctuations in external levels of the workplace contaminant and thereby may offer advantages when compared to short-lived biomarkers or exposures assessed by air monitoring. The use of biological indices of exposure, however, places an additional burden on the strategy used to evaluate exposures, because data may be serially correlated as evidenced in this study, which could result in biased estimates of the variance components if autocorrelation is undetected or ignored in the statistical analyses.
Although personal sampling results were typically characterized by more intra-individual variability than inter-individual variability when compared to biological measurements, both types of data provided examples of exposure measures fraught with error. Our results also indicated substantial imprecision in the estimates of exposure measurement error, suggesting that greater emphasis needs to be given to studies that collect sufficient data to better characterize the attenuating effects of an error-prone exposure measure.
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