Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review

Abstract

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.

Ultraviolet-C as a Viable Reprocessing Method for Disposable Masks and Filtering Facepiece Respirators

“…There are three common problems the UV-C sterilization process demonstrates: the possibility of thermal deformation, shadowing, and absorption effects [ 4 , 5 , 8 , 27 , 31 ]. As the first potential problem (changes in integrity) already discards reprocessed SUPPE, we opted to leave it on Table 1 column “Changes in integrity or fit.” From our SLR database, 30 studies (51.72%) assess it, of which 21 [ 33 , 35 , 37 , 40 , 44 , 48 , 49 , 51 , 53 , 61 , 62 , 64 , 65 , 67 , 70 , 71 , 73 , 80 , 81 , 82 , 87 ] observe no physical changes within different rounds of sterilization or extenuating conditions.…”

“…The chemical methods have some cons, such as their residues causing allergic reactions and having an intense odor. They depend on specific machinery, and VH 2 O 2 is highly unstable when vaporized, losing significant efficiency when condensed [ 3 , 5 , 7 , 9 , 12 , 25 , 31 ].…”

“…UV-C is suitable due to its low cost, high throughput, ease of use, and no chemical residues left [ 6 , 12 , 32 ]. UV-C has some limitations related to SUPPE thermal deformation, shadowing, and absorption effects [ 4 , 5 , 8 , 27 , 31 ].…”

Pragmatic Recommendations for Safety while Caring for Hospitalized Patients with Coronavirus Disease 2019 (COVID-19) in Low- and Middle-Income Countries

“…Nevertheless, the cited argument that extended use avoids the risk of selfcontamination during repeated donning and doffing seems plausible. 35 The use of homemade cloth masks of different fabrics has been studied as an alternative means to mitigate the challenges of shortages of surgical masks. A randomized control study comparing cloth masks with surgical masks found that cloth masks may increase the risk of infections possibly because of their reuse, moisture retention, and poor filtration.…”

JUNE: open-source individual-based epidemiology simulation

“…by multiplicatively reducing the β parameters in different locations. There is a significant body of literature on the effectiveness of mask wearing, including differences based on the material of the mask and the locations in which they are worn [54, 55, 56], as well as changes in efficiency due to re-using or washing them [57, 58]. In general, we focus on the wearing of masks by non-healthcare workers in settings outside the home and estimate mask effectiveness, E , to be 50% [59], irrespective of the specific of the location.…”