Review of aerosolized hydrogen peroxide, vaporized hydrogen peroxide, and hydrogen peroxide gas plasma in the decontamination of filtering facepiece respirators

Abstract

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to over 170 million cases worldwide with over 33.2 million cases and 594,000 deaths in the US alone as of May 31st, 2021.The pandemic has also created severe shortages of PPE, particularly of filtering facepiece respirators (FFRs). The Centers for Disease Control and Prevention (CDC) has issued recommendations to help conserve FFRs, as well as crisis standards, including four criteria required for decontamination of the traditionally single use respirators. This review is designed to provide an overview of the current literature on vaporized hydrogen peroxide (vHP), hydrogen peroxide gas plasma (HPGP), and aerosolized hydrogen peroxide (aHP) with respect to each of the four CDC decontamination criteria. Searches of PubMed and Medrxiv yielded 195 papers, of which, 79 were found to be relevant. Of those, 23 papers presented unique findings and 8 additional articles and technical papers were added to provide a comprehensive review. Overall, while there are potential concerns for all three decontamination methods, we found that vHP has the most evidence supporting its use in FFR decontamination consistent with CDC recommendation. Future research is recommended to evaluate biological inactivation and real world fit failures after FFR reuse.

Aerosolized Hydrogen Peroxide Decontamination of N95 Respirators, with Fit-Testing and Viral Inactivation, Demonstrates Feasibility for Reuse during the COVID-19 Pandemic

“…Only rarely have studies included extended use between multiple rounds of decontamination cycles ( 10 ), although this is a key aspect of reuse that warrants further study. Our study is unique in including multiple measures of respirator integrity via fit-testing, as well as filtration efficiency, and robust verification of viral inactivation using BIs, multiple surrogate viruses, and SARS-CoV-2 in parallel ( 22 ). The breadth of this study aims to extend its usefulness beyond the current pandemic.…”

“…Thus, many of the standard decontamination approaches deform, damage, or destroy the integrity of N95 respirator fabric, nosepiece materials, or elastic straps ( 4 – 8 ). Hydrogen peroxide (H 2 O 2 )-based methods have been successfully adapted for use in decontamination of N95 respirators ( 4 , 6 – 22 ), with indications that these methods are less damaging than other decontamination methods (e.g., chemical or steam) and can penetrate the densely woven fabric of respirator facepieces ( 4 , 6 – 8 , 14 , 22 ). In addition, the virucidal capability of H 2 O 2 decontamination methods has been previously demonstrated ( 23 – 25 ).…”

Filtration efficiency of N95 filtering facepiece respirators during multi-cycles of ‘8-hour simulated donning + disinfection’

“…Dry heating, UV radiation, and vaporized hydrogen peroxide are disinfection methods that have been proven to be effective in inactivating microorganisms without compromising the respirator filtration efficiency [ 19 ]. Among them, vaporized hydrogen peroxide, which requires specialized equipment [ [20] , [21] , [22] ], is not as convenient as microwave ovens for dry heating and ultraviolet lamps for UV radiation. Therefore, more studies have focused on the effect of multi-cycles dry heating and UV radiation on the filtration efficiency of respirators in order to provide guidance for the disinfectable frequency of respirators.…”

Aerosolized Hydrogen Peroxide Decontamination of N95 Respirators, with Fit-Testing and Viral Inactivation, Demonstrates Feasibility for Re-Use During the COVID-19 Pandemic

“…Hydrogen peroxide (H 2 O 2 )- based methods have been successfully adapted for use in decontamination of N95 respirators (4, 6–22), with indications that these methods are less damaging than other decontamination methods (e.g. chemical or steam) and can penetrate the densely-woven fabric of respirator facepieces (4, 6–8, 14, 22). In addition, the viricidal capability of H 2 O 2 decontamination methods has been previously demonstrated (23–25).…”

“…Thus many of the standard decontamination approaches deform, damage, or destroy the integrity of N95 respirator fabric, nosepiece materials, or elastic straps (4)(5)(6)(7)(8). Hydrogen peroxide (H2O2)based methods have been successfully adapted for use in decontamination of N95 respirators (4,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), with indications that these methods are less damaging than other decontamination methods (e.g. chemical or steam) and can penetrate the densely-woven fabric of respirator facepieces (4, 6-8, 14, 22).…”