Background: Inadequate supply of filtering facepiece respirators (FFR) for healthcare workers during a global pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. Aim: The objective of this review was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) on N95 FFR decontamination. Methods: We conducted a systematic review on UVGI in N95 FFRs by using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted and verified predefined data fields. Original research reporting on N95 FFR function, decontamination, or mask fit following UVGI were included. Findings and Conclusions: Twelve studies were identified, comprising of 53 different UVGI intervention arms and 43 N95 FFR models. In all cases, FFRs maintained National Institute for Occupational Safety and Health (NIOSH) certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI treatment arms. All UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2 log reduction in viral load. A >3 log reduction was observed in 7 UVIG arms using a dose >40,000 J/m2. Impact of UVIG on fit was evaluated in two studies (16,200; 32,400 J/m2) and did not find evidence of compromise. Altogether, our findings suggest that further work in this area should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.
Background: In pandemic situations such as COVID-19, shortages of proper protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse.Aim: The aim of this review was to collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impact on mask function (aerosol penetration, airflow resistance) and fit.Methods: A systematic review (PROSPERO ID pending) of literature available on Medline, Embase, Global Health, JISRP and JEFF was conducted. Records were screened independently by two reviewers, and data was extracted and analyzed from studies that reported on the effects of microwave- or heat-based decontamination on N95 FFR performance and/or microbial load. Results: All interventions successfully destroyed viral/bacterial contaminants. Other than autoclaving, which significantly increased aerosol penetration, moist and dry microwave and heat conditions did not significantly impact functional parameters or fit. However, several conditions caused physical damage to at least one N95 model. Conclusions: Microwave irradiation and heat provides safe and effective decontamination options for N95 FFR reuse during critical shortages. However, autoclaving masks is not recommended by the evidence in this review. Any mask disinfected using these methods should be inspected for physical degradation before reuse.NOTE: The experiments summarized in this manuscript are performed under specialized laboratory conditions. Household appliances should not be used for any purposes that are not indicated in their manufacturer-supplied guidelines, including mask decontamination. Doing so may lead to damage or injury.
Background: Decontaminating and re-using filtering facepiece respirators (FFR) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic.Aim: The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFR. Methods: We conducted a systematic review on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted and verified predefined data fields. Original research reporting on N95 FFR function, decontamination, physical appearance, safety, or mask fit following decontamination with a disinfectant was included. Findings and Conclusions: A single cycle of vaporized hydrogen peroxide successfully removes infectious pathogens without affecting mask function or fit, and with little change in FFR physical appearance. Residual hydrogen peroxide levels following decontamination were below the safety limit. More than one decontamination cycle of vaporized hydrogen peroxide may be possible but further information is required on how multiple cycles would affect mask fit in a real world setting before the upper limit can be established. Although immersion in liquid hydrogen peroxide does not appear to adversely affect mask function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on mask fit. Sodium hypochlorite, ethanol, isopropyl alcohol and EtO are not recommended due to safety concerns or negative effects on mask function.
Background: The high demand for personal protective equipment (PPE) during the novel coronavirus outbreak has created global shortages and prompted the need to develop strategies to conserve supply. Surgical mask PPE have a broad application of use in a pandemic setting, but little is known regarding decontamination interventions to allow for their reuse. Objective: Identify and synthesize data from original published studies evaluating interventions to decontaminate surgical masks for the purpose of reuse. Methods: We searched MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8, 2020 for prospective original research on decontamination interventions for surgical mask PPE. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects. Results: Seven studies met eligibility criteria: one evaluated the effects of heat and chemical decontamination interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were both evaluated in heterogenous test conditions across a variety of mask samples (whole masks and pieces or individual mask layers). Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Germicidal effects were best in salt-, N-halamine- and nanoparticle-coated masks. Conclusion: There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogenous methods used in the studies to date, we are unable to draw conclusions on the most appropriate, safest intervention(s) for decontaminating surgical masks for the purpose of reuse.
During the COVID-19 pandemic, a shortage of 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 issue of PPE shortage is to decontaminate and re-use PPE. The 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 microwave and heat methods as an effective method for FFR decontamination for reuse, 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 microwave and heat-based decontamination of facemask PPE.This information will be used to contribute to PPE decontamination protocols at the Children’s Hospital of Eastern Ontario and shared with other hospitals in Ontario, Canada, and internationally.
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 Children’s Hospital of Eastern Ontario and shared with other hospitals in Ontario, Canada, and internationally.
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. The Centres for Disease Control and Prevention (CDC) specifically recommends N95 filtering facepiece respirators (FFRs) for healthcare workers who are interacting with patients with COVID-19 under aerosol precautions, and when performing aerosol generating medical procedures. In contrast, surgical masks have much broader use and are recommended for use by health care providers to protect against the risk of droplet transmission in inpatient healthcare settings and outpatient settings (e.g. COVID-19 assessment centres, long-term care facilities, and community care settings). One potential method of addressing the shortage and ensuring adequate protection for health care workers in accordance with the above recommendations would be to decontaminate and reuse N95 FFRs and surgical masks. Our group recently conducted a series of systematic reviews to synthesize the existing literature on N95 and surgical mask decontamination. However, literature in this area is rapidly evolving and these systematic reviews will require updates in order to provide clinicians, hospital administrators, and public health officials with the most up-to-date and comprehensive information available. The purpose of this living scoping review is to identify all original research on N95 and surgical mask decontamination and reuse, and to build an open-access database of the existing literature.
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