Decontamination Methods for Reuse of Filtering Facepiece Respirators

Abstract

ith each passing day, the novel coronavirus disease 2019 (COVID-19) pandemic escalates around the world. First identified in Wuhan, China, the disease is caused by a novel coronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1 Globally, health care professionals have been infected at high rates (63% of all cases in Wuhan as of February 11, 2020, were health care professionals; in Italy, 20% of health care professionals responding to the pandemic were reported to be infected) and are also dying of COVID-19. [1][2][3][4][5] These high rates are likely due to transmission of the virus through droplet, contact, and even airborne modalities, similar to the 2002-2003 SARS pandemic, 6 as well as by asymptomatic individuals. A study by Zou et al 7 has shown similar viral loads present in both asymptomatic and symptomatic patients, with the highest viral load being identified in the nasal cavity. Subsequently, it is not surprising that otolaryngologists have been identified as a high-risk group among health care professionals, given their level of exposure to the upper aerodigestive tract. [8][9][10] The risk of infection for health care professionals is compounded by shortages of personal protective equipment (PPE), including filtering facepiece respirators (FFRs), in particular, N95 respirators. 2,11 Early studies report that adequate PPE and hand hygiene provide good protection from infection, especially in cases of high-risk procedures in which SARS-CoV-2 can be aerosolized. 12,13 The N95 respirators were widely used in previous SARS and influenza outbreaks to prevent both droplet and airborne transmission. 6,14 At UCLA Health, the use of N95 respirators along with a gown and eye protection or face shield is required for any invasive otolaryngologic procedure involving mucosal surfaces, in line with recent guidelines based on international experience. 8 In the US, the supply of necessary PPE has been unable to keep up with the rapid increase in the number of patients with COVID-19 owing to the disruption of the global supply chain. 2,15 The Centers for Disease Control and Prevention (CDC) has estimated that more than 90 million respirators would be required for health care professionals alone in a pandemic lasting 42 days. 16 As of March 2020, the US Department of Health and Human Services estimated that 3.5 billion N95 respirators would be needed in a severe event, but only 35 million were available. 17 Previously, the CDC set guidance for extending the use of single-use PPE in times of high demand and more recently released new guidelines on decontamination methods for N95 IMPORTANCE The novel coronavirus disease 2019 (COVID-19) has proven to be highly infectious, putting health care professionals around the world at increased risk. Furthermore, there are widespread shortages of necessary personal protective equipment (PPE) for these individuals. Filtering facepiece respirators, such as the N95 respirator, intended for single use, can be reused in times of need. We explore the evidence for dec...

Surgical instrument disinfection during the era of COVID-19

“…Analyses of four different decontamination UV irradiation at 260-285nm, 70ºC dry heat, 70% ethanol, and vaporized hydrogen peroxide (VHP) at 59% indicates that 70°C dry heat for one hour was sufficient to reduce SARS-CoV-2 concentration on steel, and that VHP, ethanol, and UV yielded rapid virus inactivation [2]. The efficacy of VHP and UV germicidal irradiation has similarly been noted by other studies on N95 respirators [3].…”

“…In addition to utilizing personal protective equipment, proper instrument decontamination and sterilization strategies should be employed. Although many reports detail decontamination strategies for single-use N95 respirators [2,3], discussion of surgical instrument sterilization in the dermatologic literature is lacking.…”

The 2019 global pandemic and plastic pollution prevention measures: Playing catch-up

“…These, naturally, should be selected based upon not only the inherent associated implementation and maintenance costs, but also on the type of waste, material and subsequent fate. For PPE, including surgical masks and N95 respirators, as well as face shields, UV radiation (UV-C), ozonation, and heat- and microwave-based procedures appear to be valid decontamination protocols ( Cadnum et al, 2020 ; Dennis et al, 2020 ; Gertsman et al, 2020 ), as well as the use of ethylene oxide, vaporized hydrogen peroxide or bleach ( Su-Velez et al, 2020 ; Viscusi et al, 2009 ). However, as noted by different authors ( Narla et al, 2020 ; Ozog et al, 2020 ), such decontamination methods should be carefully evaluated and post-disinfection, as the myriad of currently types of protective equipment and the different materials used could react differently to such protocols, as evidenced in the case of UV-C, shown to degrade polymers in the masks/respirators and to have a negative impact on the elasticity of the bands ( Lindsley et al, 2015 ).…”

Conceptualizing a novel Hybrid Decontamination System (HDS) based on UV/H2O2 treatment for the enhanced decontamination and reuse of N95 FFRs

“…As shown in Table 2 , chemical sterilization using soap and water, alcohols, and bleach is not the ideal strategy for FFR decontamination as they render the respirator nonfunctional many times. Steam sterilization by autoclave or microwave though are effective, and non-toxic (with no hazardous residual), but may damage polymer fibers in the filter compromising its performance ( Su-Velez et al, 2020 ). Due to the strong viral inactivation efficiency and no disinfection or oxidation product production, vaporized hydrogen peroxide (VHP) cum UV irradiation appears to be viable options for successful decontamination.…”