Safety in the practice of decontaminating filtering facepiece respirators: A systematic review

Conservation Practices for Personal Protective Equipment: A Systematic Review with Focus on Lower-Income Countries

During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic approaches for conserving single-use PPE, expecting that lower-income countries or developing contexts may already be uniquely conserving PPE. However, of the 50 included studies, only 3 originated from middle-income countries and none originated from low-income countries. Data from the included studies suggest PPE remained effective with extended use and with multiple or repeated use in clinical settings, as long as donning and doffing were performed in a standard manner. Multiple decontamination techniques were effective in disinfecting single use PPE for repeated use. These findings can inform healthcare facilities and providers in establishing protocols for safe conservation of PPE supplies and updating existing protocols to improve sustainability and overall resilience. Future studies should evaluate conservation practices in low-resource settings during non-pandemic times to develop strategies for more sustainable and resilient healthcare worldwide.

Assessment of a novel, easy-to-implement, aerosolized H2O2 decontamination method for single-use filtering facepiece respirators in case of shortage

The COVID-19 pandemic has affected the world and caused a supply shortage of personal protection equipment, especially filtering facepiece respirators (FFP). This has increased the risk of many healthcare workers contracting SARS-CoV-2. Various strategies have been assessed to tackle these supply issues. In critical shortage scenarios, reusing single-use-designed respirators may be required. Thus, an easily applicable and reliable FFP2 (or alike) respirator decontamination method, allowing safe re-use of FFP2 respirators by healthcare personnel, has been developed and is presented in this study. A potent and gentle aerosolized hydrogen peroxide (12% wt) method was applied over 4 hr to decontaminate various brands of FFP2 respirators within a small common room, followed by adequate aeration and storage overnight. The microbial efficacy was tested on unused respirator pieces using spores of Geobacillus stearothermophilus. Further, decontamination effectiveness was tested on used respirators after one 12-hr shift by swabbing before and after the decontamination. The effects of up to ten decontamination cycles on the respirators' functionality were evaluated using material properties, the structural integrity of the respirators, and fit tests with subjects. The suggested H₂O₂ decontamination procedure was proven to be (a) sufficiently potent (no microbial recovery, total inactivation of biological indicators as well as spore inoculum on critical respirator surfaces), (b) gentle as no significant damage to the respirator structural integrity and acceptable fit factors were observed, and (c) safe as no H₂O₂ residue were detected after the defined aeration and storage. Thus, this easy-to-implement and scalable method could overcome another severe respirator shortage, providing enough flexibility to draft safe, effective, and logistically simple crisis plans. However, as highlighted in this study, due to the wealth of design and material used in different models and brands of respirators, the decontamination process should be validated for each FFP respirator model before its field implementation.

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

Background

Aerosol-borne diseases such as COVID-19 may outbreak occasionally in various regions of the world, inevitably resulting in short-term shortage and corresponding reuse of disposable respirators.

Aim

To investigate the effective disinfection methods, reusable duration and frequency of N95 respirators.

Methods

Based on the self-built respirator simulation test system, and under combinations of experimental conditions of three N95 respirators × 0–200 nm NaCl aerosols × three simulated breathing flow rates (15, 50 and 85 L/min) × two disinfection methods (dry heating and ultraviolet (UV) radiation), this study continuously measured the changes in filtration efficiency of all respirators during multi-cycles of ‘8-h simulated donning + disinfection’ until the penetration reached ≥5%.

Findings

Multi-cycles of dry heating and UV radiation treatments on the reused (i.e., multiple 8-h donning) N95 respirators had a minimal effect (<0.5%) on the respirator filtration efficiency, and even at 85 L/min, all tested N95 respirators were able to maintain filtration efficiencies ≥95% for at least 30 h or four reuse cycles of ‘8-h donning + disinfection’, while a lower breathing flow rate (15 L/min) plus the exhalation valve could further extend the N95 respirator's usability duration up to 140 h or 18 reuse cycles of ‘8-h donning + disinfection’. As the respirator wearing time extended, aerosol penetration slowly increased in a quadratic function with a negative second-order coefficient, and the penetration increment during each cycle of 8-h donning was less than 0.9%.

Conclusion

Multi-cycles of N95 respirator reuse in combination with dry heating or UV irradiation disinfection are feasible.

Non-targeted analysis of unknown volatile chemicals in medical masks

This paper reports the non-targeted analysis of unknown volatile chemicals in medical masks through headspace gas chromatography-Orbitrap high-resolution mass spectrometry. In view of the difficulties that may be encountered in the qualitative analysis of unknown substances, several typical cases and the corresponding reliable solutions are given from the perspective of comprehensive score and retention index, chemical ionization identification molecular formula, fragment ion detail comparison for distinguishing isomers, and identification of alkanes. With this method, 69 volatile substances were identified in 60 masks. The identified substances were divided into nine categories. Alkanes, esters, benzenes, and alcohols were the top four groups of substances identified in masks and accounted for 34.8%, 15.9%, 10.1%, and 7.2% of the total substances, respectively. In addition, ketones, ethers, phenolics, amides, and other substances were identified. Ethanol, 1,4-dichlorobenzene, toluene, m-xylene, dimethyl glutarate, and N,N-dimethylacetamide had high detection rates. The identified substances were further filtered and screened according to their detection rate, toxicity, and response intensity. Finally, 12 high-risk volatile chemicals in medical masks were listed. This study could serve as a reference for identifying unknown substances and a guide for monitoring volatile chemicals in masks and promoting chemical safety improvements in products.

Sterilization Induced Changes in Polypropylene-Based Ffp2 Masks

In the context of the SARS-CoV2 pandemic and because of the surgical and FFP2 mask (equivalent to the American N95 masks) shortages, studies on efficient sterilization protocols were initiated. As sterilization using irradiation is commonly used in the medical field, this method was among those that were evaluated. In this work, we tested irradiation under vacuum and under air (under both γ-rays and e-beams), but also, for acceptance purposes, undertook washing prior to the e-beam irradiation sterilization process. This article deals with the modifications induced by the sterilization processes at the molecular and the macromolecular scales on an FFP2 mask. Fourier transform infrared spectroscopy in attenuated total reflectance mode, size-exclusion chromatography and thermal-desorption–gas chromatography–mass spectrometry were used to characterize possible damage to the materials. It appeared that the modifications induced by the different sterilization processes under vacuum were relatively tenuous and became more significant when irradiation was performed using γ-rays under air.