Evaluation of decontamination methods for commercial and alternative respirator and mask materials - view from filtration aspect

Fiber-in-Tube Electrifiable Structure for Virus Filtration Self-Generated Static Electricity by Vibration/Sound

Fiber has been considered as an ideal material for virus insulation due to the readily available electrostatic adsorption. However, restricted by the electrostatic attenuation and filtration performance decline, their long-lasting applications are unable to satisfy the requirements of medical protective equipment for major medical and health emergencies such as global epidemics, which results in both a waste of resources and environmental pollution. We overcame these issues by constructing a fiber-in-tube structure, achieving the robust reusability of fibrous membranes. Core fibers within the hollow could form generators with tube walls of shell fibers to provide persistent, renewable static electricity via piezoelectricity and triboelectricity. The PM0.3 insulation efficiency achieved 98% even after 72 h of humidity and heat aging, through beating and acoustic waves, which is greatly improved compared with that of traditional nonwoven fabric (∼10% insulation). A mask spun with our fiber also has a low breathing resistance (differential pressure <24.4 Pa/cm2). We offer an approach to enrich multifunctional fiber for developing electrifiable filters, which make the fiber-in-tube filtration membrane able to durably maintain a higher level of protective performance to reduce the replacement and provide a new train of thought for the preparation of other high-performance protective products.

Evaluation and risk communication of the effects of alcohol exposure on disposable procedure masks and portable air purifiers in hospital environments

Electret technology was widely used to prevent the airborne transmission of bioaerosols during the COVID-19 pandemic and improve the filtration efficiency of masks and high-efficiency particulate air (HEPA) filters. As alcohol disinfectants are widely used in medical and welfare institutions, concerns about alcohol exposure inactivating electret exist. However, comprehensive alcohol exposure tests have not been conducted on masks and HEPA filters distributed in Japan. Twenty-five types of masks and five types of HEPA filters were subjected to a discharging process according to ISO 16890 to quantitatively elucidate the resistance to alcohol exposure. Measurements of changes in filtration efficiency and pressure drop before and after discharge show that 17 masks (68%) and four HEPA filters (80%) exhibited a significant decrease in filtration efficiency, confirming their vulnerability to alcohol. In addition, a survey (n = 500 Japanese adults, including 30 healthcare professionals) revealed that ∼90% of the general public were unaware that alcohol exposure could degrade masks and air purifiers. Furthermore, 36% of the surveyed healthcare professionals had sprayed alcohol directly onto their masks. The effectiveness of user warnings through product labels and instructions was investigated from the perspective of ensuring the safety of patients and healthcare professionals. Results revealed that the best approach was to describe the extent and duration of the adverse effects caused by disregarding precautions. Increase in awareness of healthcare professionals and general public by authorities and manufacturers through guidelines and warning labels would reduce the risk of inhaling bioaerosols caused by unintentional electret inactivation.

Do Surface Charges on Polymeric Filters and Airborne Particles Control the Removal of Nanoscale Aerosols by Polymeric Facial Masks?

The emergence of facial masks as a critical health intervention to prevent the spread of airborne disease and protect from occupational nanomaterial exposure highlights the need for fundamental insights into the interaction of nanoparticles (<200 nm) with modern polymeric mask filter materials. While most research focuses on the filtration efficiency of airborne particles by facial masks based on pore sizes, pressure drop, or humidity, only a few studies focus on the importance of aerosol surface charge versus filter surface charge and their role in the net particle filtration efficiency of mask filters. In this study, experiments were conducted to assess mask filter filtration efficiency using positively and negatively charged polystyrene particles (150 nm) as challenge aerosols at varying humidity levels. Commercial masks with surface potential (Ψf) in the range of -10 V to -800 V were measured by an electrostatic voltmeter and used for testing. Results show that the mask filtration efficiency is highly dependent on the mask surface potential as well as the charge on the challenge aerosol, ranging from 60% to 98%. Eliminating the surface charge results in a maximum 43% decrease in filtration efficiency, emphasizing the importance of electrostatic charge interactions during the particle capture process. Moreover, increased humidity can decrease the surface charge on filters, thereby decreasing the mask filtration efficiency. The knowledge gained from this study provides insight into the critical role of electrostatic attraction in nanoparticle capture mechanisms and benefits future occupational and environmental health studies.

Design of a syringe extension device (Chloe SED®) for low-resource settings in sub-Saharan Africa: a circular economy approach

Underfunded healthcare infrastructures in low-resource settings in sub-Saharan Africa have resulted in a lack of medical devices crucial to provide healthcare for all. A representative example of this scenario is medical devices to administer paracervical blocks during gynaecological procedures. Devices needed for this procedure are usually unavailable or expensive. Without these devices, providing paracervical blocks for women in need is impossible resulting in compromising the quality of care for women requiring gynaecological procedures such as loop electrosurgical excision, treatment of miscarriage, or incomplete abortion. In that perspective, interventions that can be integrated into the healthcare system in low-resource settings to provide women needing paracervical blocks remain urgent. Based on a context-specific approach while leveraging circular economy design principles, this research catalogues the development of a new medical device called Chloe SED® that can be used to support the provision of paracervical blocks. Chloe SED®, priced at US$ 1.5 per device when produced in polypropylene, US$ 10 in polyetheretherketone, and US$ 15 in aluminium, is attached to any 10-cc syringe in low-resource settings to provide paracervical blocks. The device is designed for durability, repairability, maintainability, upgradeability, and recyclability to address environmental sustainability issues in the healthcare domain. Achieving the design of Chloe SED® from a context-specific and circular economy approach revealed correlations between the material choice to manufacture the device, the device's initial cost, product durability and reuse cycle, reprocessing method and cost, and environmental impact. These correlations can be seen as interconnected conflicting or divergent trade-offs that need to be continually assessed to deliver a medical device that provides healthcare for all with limited environmental impact. The study findings are intended to be seen as efforts to make available medical devices to support women's access to reproductive health services.

The need for systematic quality controls in implementing N95 reprocessing and sterilization

BACKGROUND

Due to increased requirement for personal protective equipment during the coronavirus disease 2019 pandemic, many medical centres utilized sterilization systems approved under Food and Drug Administration Emergency Use Authorization for single-use N95 mask re-use. However, few studies have examined the real-world clinical challenges and the role of ongoing quality control measures in successful implementation.

AIMS

To demonstrate successful implementation of quality control measures in mask reprocessing, and the importance of continued quality assurance.

METHODS

A prospective quality improvement study was conducted at a tertiary care medical centre. In total, 982 3M 1860 masks and Kimberly-Clark Tecnol PFR95 masks worn by healthcare workers underwent sterilization using a vaporized hydrogen peroxide gas plasma-based reprocessing system. Post-processing qualitative fit testing (QFT) was performed on 265 masks. Mannequin testing at the National Institute for Occupational Safety and Health (NIOSH) laboratory was used to evaluate the impact of repeated sterilization on mask filtration efficacy and fit. A locally designed platform evaluated the filtration efficiency of clinically used and reprocessed masks.

FINDINGS

In total, 255 N95 masks underwent QFT. Of these, 240 masks underwent post-processing analysis: 205 were 3M 1860 masks and 35 were PFR95 masks. Twenty-five (12.2%) of the 3M masks and 10 (28.5%) of the PFR95 masks failed post-processing QFT. Characteristics of the failed masks included mask deformation (N=3, all 3M masks), soiled masks (N=3), weakened elastic bands (N=5, three PFR95 masks), and concern about mask shrinkage (N=3, two 3M masks). NIOSH testing demonstrated that while filter efficiency remained >98% after two cycles, mask strap elasticity decreased by 5.6% after reprocessing.

CONCLUSIONS

This study demonstrated successful quality control implementation for N95 mask disinfection, and highlights the importance of real-world clinical testing beyond laboratory conditions.

Photoactive decontamination and reuse of face masks

The corona virus disease 2019 (COVID-19) pandemic has led to global shortages in disposable respirators. Increasing the recycling rate of masks is a direct, low-cost strategy to mitigate COVID-19 transmission. Photoactive decontamination of used masks attracts great attention due to its fast response, remarkable virus inactivation effect and full protection integrity. Here, we review state-of-the-art situation of photoactive decontamination. The basic mechanism of photoactive decontamination is firstly discussed in terms of ultraviolet, photothermal or photocatalytic properties. Among which, ultraviolet radiation damages DNA and RNA to inactivate viruses and microorganisms, and photothermal method damages them by destroying proteins, while photocatalysis kills them by destroying the structure. The practical applications of photoactive decontamination strategies are then fully reviewed, including ultraviolet germicidal irradiation, and unconventional masks made of functional nanomaterials with photothermal or photocatalytic properties. Their performance requirements are elaborated together with the advantages of long-term recycle use. Finally, we put forward challenges and prospects for further development of photoactive decontamination technology.

Functional Textile Materials for Blocking COVID-19 Transmission

The outbreak of COVID-19 provided a warning sign for society worldwide: that is, we urgently need to explore effective strategies for combating unpredictable viral pandemics. Protective textiles such as surgery masks have played an important role in the mitigation of the COVID-19 pandemic, while revealing serious challenges in terms of supply, cross-infection risk, and environmental pollution. In this context, textiles with an antivirus functionality have attracted increasing attention, and many innovative proposals with exciting commercial possibilities have been reported over the past three years. In this review, we illustrate the progress of textile filtration for pandemics and summarize the recent development of antiviral textiles for personal protective purposes by cataloging them into three classes: metal-based, carbon-based, and polymer-based materials. We focused on the preparation routes of emerging antiviral textiles, providing a forward-looking perspective on their opportunities and challenges, to evaluate their efficacy, scale up their manufacturing processes, and expand their high-volume applications. Based on this review, we conclude that ideal antiviral textiles are characterized by a high filtration efficiency, reliable antiviral effect, long storage life, and recyclability. The expected manufacturing processes should be economically feasible, scalable, and quickly responsive.

A Review of Filtration Performance of Protective Masks

Masks are essential and effective small protective devices used to protect the general public against infections such as COVID-19. However, available systematic reviews and summaries on the filtration performance of masks are lacking. Therefore, in order to investigate the filtration performance of masks, filtration mechanisms, mask characteristics, and the relationships between influencing factors and protective performance were first analyzed through mask evaluations. The summary of filtration mechanisms and mask characteristics provides readers with a clear and easy-to-understand theoretical cognition. Then, a detailed analysis of influencing factors and the relationships between the influencing factors and filtration performance is presented in. The influence of the aerosol size and type on filtration performance is nonlinear and nonconstant, and filtration efficiency decreases with an increase in the gas flow rate; moreover, fitness plays a decisive role in the protective effects of masks. It is recommended that the public should wear surgical masks to prevent COVID-19 infection in low-risk and non-densely populated areas. Future research should focus on fitness tests, and the formulation of standards should also be accelerated. This paper provides a systematic review that will be helpful for the design of masks and public health in the future.

A review of disposable facemasks during the COVID-19 pandemic: A focus on microplastics release

The COVID-19 epidemic seriously threats the human society and provokes the panic of the public. Personal Protective Equipment (PPE) are widely utilized for frontline health workers to face the ongoing epidemic, especially disposable face masks (DFMs) to prevent airborne transmission of coronavirus. The overproduction and massive utilization of DFMs seriously challenge the management of plastic wastes. A huge amount of DFMs are discharged into environment, potentially induced the generation of microplastics (MPs) owing to physicochemical destruction. The MPs release will pose severe contamination burden on environment and human. In this review, environmental threats of DFMs regarding to DFMs fate in environment and DFMs threats to aquatic and terrestrial species were surveyed. A full summary of recent studies on MPs release from DFMs was provided. The knowledge of extraction and characterizations of MPs, the release behavior, and potential threats of MPs derived from DFMs was discussed. To confront the problem, feasible strategies for control DFMs pollution were analyzed from the perspective of source control and waste management. This review provides a better understanding the threats, fate, and management of DFMs linked to COVID-19 pandemic.

Effectiveness of a low-cost UVGI chamber for decontaminating filtering facepiece respirators to extend reuse

In emergencies like the COVID-19 pandemic, the reuse or reprocessing of filtering facepiece respirators (FFRs) may be required to mitigate exposure risk. Research gap: Only a few studies evaluated decontamination effectiveness against SARS-CoV-2 that are practical for low-resource settings. This study aimed to determine the effectiveness of a relatively inexpensive ultraviolet germicidal irradiation chamber to decontaminate FFRs contaminated with SARS-CoV-2. A custom-designed UVGI chamber was constructed to determine the ability to decontaminate seven FFR models including N95s, KN95, and FFP2s inoculated with SARS-CoV-2. Vflex was excluded due to design folds/pleats and UVGI shadowing inside the chamber. Structural and functional integrity tolerated by each FFR model on repeated decontamination cycles was assessed. Twenty-seven participants were fit-tested over 30 cycles for each model and passed if the fit factor was ≥100. Of the FFR models included for testing, only the KN95 model failed filtration. The 3M™ 3M 1860 and Halyard™ duckbill 46727 (formerly Kimberly Clark) models performed better on fit testing than other models for both pre-and-post decontaminations. Fewer participants (0.3 and 0.7%, respectively) passed fit testing for Makrite 9500 N95 and Greenline 5200 FFP2 and only two for the KN95 model post decontamination. Fit testing appeared to be more affected by donning & doffing, as some passed with adjustment and repeat fit testing. A ≥ 3 log reduction of SARS-CoV-2 was achieved for worn-in FFRs namely Greenline 5200 FFP2. Conclusion: The study showed that not all FFRs tested could withstand 30 cycles of UVGI decontamination without diminishing filtration efficiency or facial fit. In addition, SARS-CoV-2 log reduction varied across the FFRs, implying that the decontamination efficacy largely depends on the decontamination protocol and selection of FFRs. We demonstrated the effectiveness of a low-cost and scalable decontamination method for SARS-CoV-2 and the effect on fit testing using people instead of manikins. It is recognized that extensive experimental evidence for the reuse of decontaminated FFRs is lacking, and thus this study would be relevant and of interest in crisis-capacity settings, particularly in low-resource facilities.

Development and Performance Evaluation of Polytetrafluoroethylene-Membrane-Based Automotive Cabin Air Filter

A high-efficiency, long-life cabin filter unit is required for the effective purification of the air inside a vehicle. However, conventional cabin air filters that utilize electrostatic effects are less efficient and less effective owing to environmental factors. Polytetrafluoroethylene (PTFE) membranes exhibit a high porosity and surface-to-surface dust-removal performance, and maintain a stable pressure drop, indicating their good potential as filter materials. Therefore, in this study, the use of PTFE membranes for the fabrication of automobile filters and the filtration performance of the filters were examined. To this end, first, the properties of PTFE membranes mainly used in HEPA air conditioning filters and those of membranes used as vehicle cabin filters were compared. Next, the thickness, weight, stiffness, pore size, and filtration performance characteristics of filter media fabricated by blending melt-blown (MB) nonwoven, PTFE membranes, and supporting nonwoven into a total filtration layer were compared and analyzed. Lastly, the environmental change durability performance of the automobile cabin filter based on PTFE membrane and the results of the test after the installation of the filter in a vehicle were demonstrated.

Boundary conditions for exhaled airflow from a cough with a surgical or N95 mask

Wearing surgical or N95 masks is effective in reducing the infection risks of airborne infectious diseases. However, in the literature there are no detailed boundary conditions for airflow from a cough when a surgical or N95 mask is worn. These boundary conditions are essential for accurate prediction of exhaled particle dispersion by computational fluid dynamics (CFD). This study first constructed a coughing manikin with an exhalation system to simulate a cough from a person. The smoke visualization method was used to measure the airflow profile from a cough. To validate the setup of the coughing manikin, the results were compared with measured data from subject tests reported in the literature. The validated coughing manikin was then used to measure the airflow boundary conditions for a cough when a surgical mask was worn and when an N95 mask was worn, respectively. Finally, this study applied the developed airflow boundary conditions to calculate person-to-person particle transport from a cough when masks are worn. The calculated exhaled particle patterns agreed well with the smoke pattern in the visualization experiments. Furthermore, the calculated results indicated that, when the index person wore a surgical and a N95 mask, the total exposure of the receptor was reduced by 93.0% and 98.8%, respectively.

Design considerations for protective mask development: A remote mask usability evaluation

The design of N95 filtering facepiece respirators (FFRs) continues to pose usability concerns for healthcare workers, which have been exacerbated by the COVID-19 pandemic. The aim of this study was to develop a holistic model to guide mask design improvement. Dental students (n = 38) with experience wearing N95 FFRs participated in a randomized wear trial of three alternative protective masks. A mixed methods survey was used to examine usability of individual mask design components, the relationship of facial/head area to mask features, and overall mask design. Survey results indicated MNmask v1 demonstrated higher usability in seal confidence (M = 3.46), while MNmask v2 performed higher in satisfactory fit (M = 3.50). Design components of nose wire and head/neck bands were the most problematic, while conditions of skin irritation and tight/loose fit created an unfavorable wear experience. To consider healthcare workers' needs in improving the usability of protective masks, a model is presented to consider characteristics of fit, comfort, material, and design.

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-Solvent Induced Phase Separation (NIPS) for Fabricating High Filtration Efficiency (FE) Polymeric Membranes for Face Mask and Air Filtration Applications

Protection against airborne viruses has become very relevant since the outbreak of SARS-CoV-2. Nonwoven face masks along with heating, ventilation, and air conditioning (HVAC) filters have been used extensively to reduce infection rates; however, some of these filter materials provide inadequate protection due to insufficient initial filtration efficiency (FE) and FE decrease with time. Flat sheet porous membranes, which have been used extensively to filter waterborne microbes and particulate matter due to their high FE have the potential to filter air pollutants without compromising its FE over time. Therefore, in this study, single layer polysulfone (PSf) membranes were fabricated via non-solvent induced phase separation (NIPS) and were tested for airflow rate, pressure drop and FE. Polyethylene glycol (PEG) and glycerol were employed as pore-forming agents, and the effect of the primary polymer and pore-forming additive molecular weights (MW) on airflow rate and pressure drop were studied at different concentrations. The thermodynamic stability of dope solutions with different MWs of PSf and PEG in N-methylpyrrolidone (NMP) at different concentrations was determined using cloud-point measurements to construct a ternary phase diagram. Surface composition of the fabricated membranes was characterized using contact angle and X-ray photoelectron spectroscopy (XPS), while membrane morphology was characterized by SEM, and tensile strength experiments were performed to analyze the membrane mechanical strength (MS). It was observed that an increase in PSf and PEG molecular weight and concentration increased airflow and decreased pressure drop. PSf60:PEG20:NMP (15:15:70)% w/w showed the highest air flow rate and lowest pressure drop, but at the expense of the mechanical strength, which was improved significantly by attaching the membrane to a 3D-printed polypropylene support. Lastly, the FE values of the membranes were similar to those of double-layer N95 filters and significantly higher than those of single layer of N95, surgical mask and HVAC (MERV 11) filters.

Efficacy of dental evacuation systems for aerosol exposure mitigation in dental clinic settings

Dental personnel are ranked among the highest risk occupations for exposure to SARS-CoV-2 due to their close proximity to the patient's mouth and many aerosol generating procedures encountered in dental practice. One method to reduce aerosols in dental settings is the use of intraoral evacuation systems. Intraoral evacuation systems are placed directly into a patient's mouth and maintain a dry field during procedures by capturing liquid and aerosols. Although multiple intraoral dental evacuation systems are commercially available, the efficacy of these systems is not well understood. The objectives of this study were to evaluate the efficacy of four dental evacuation systems at mitigating aerosol exposures during simulated ultrasonic scaling and crown preparation procedures. We conducted real-time respirable (PM₄) and thoracic (PM₁₀) aerosol sampling during ultrasonic scaling and crown preparation procedures while using four commercially available evacuation systems: a high-volume evacuator (HVE) and three alternative intraoral systems (A, B, C). Four trials were conducted for each system. Respirable and thoracic mass concentrations were measured during procedures at three locations including (1) near the breathing zone (BZ) of the dentist, (2) edge of the dental operatory room approximately 0.9 m away from the mannequin mouth, and (3) hallway supply cabinet located approximately 1.5 m away from the mannequin mouth. Respirable and thoracic mass concentrations measured during each procedure were compared with background concentrations measured in each respective location. Use of System A or HVE reduced thoracic (System A) and respirable (HVE) mass concentrations near the dentist's BZ to median background concentrations most often during the ultrasonic scaling procedure. During the crown preparation, use of System B or HVE reduced thoracic (System B) and respirable (HVE or System B) near the dentist's BZ to median background concentrations most often. Although some differences in efficacy were noted during each procedure and aerosol size fraction, the difference in median mass concentrations among evacuation systems was minimal, ranging from 0.01 to 1.48 µg/m³ across both procedures and aerosol size fractions.

Speaking-Induced Charge-Laden Face Masks with Durable Protectiveness and Wearing Breathability

Face masks, which serve as personal protection equipment, have become ubiquitous for combating the ongoing COVID-19. However, conventional electrostatic-based mask filters are disposable and short-term effective with high breathing resistance, causing respiratory ailments and massive consumption (129 billion monthly), intensifying global environmental pollution. In an effort to address these challenges, the introduction of a piezoelectric polymer was adopted to realize the charge-laden melt-blown via the melt-blowing method. The charge-laden melt-blown could be applied to manufacture face masks and to generate charges triggered by mechanical and acoustic energy originated from daily speaking. Through an efficient and scalable industrial melt-blown process, our charge-laden mask is capable of overcoming the inevitable electrostatic attenuation, even in a high-humidity atmosphere by long-wearing (prolonging from 4 to 72 h) and three-cycle common decontamination methods. Combined with outstanding protective properties (PM2.5 filtration efficiency >99.9%), breathability (differential pressure <17 Pa/cm2), and mechanical strength, the resultant charge-laden mask could enable the decreased replacement of masks, thereby lowering to 94.4% of output masks worldwide (∼122 billion monthly) without substituting the existing structure or assembling process.

Effect of washing on quality, breathability performance and reusability of disposable face masks

Disposable face masks are among the personal protective equipment (PPE) that highly contribute to protecting people in the context of the current COVID-19 pandemic. Health authorities recommend wearing a mask as a barrier measure to limit the spread of viral respiratory diseases. During the first waves of the pandemic, besides professional high-quality PPE, decontaminated disposable mask reuse and homemade cloth masks were allowed due to scarcities. This work introduces a simple method based on-time history of the differential pressure, and an easy to use the setup for the testing of different kinds of respiratory protective masks for the purposes of quality control and evaluation of air permeability performance. The standard mask testing method and the new proposed approach were then used to evaluate the effect of machine washing on the widely used type of disposable masks; namely the surgical (medical) face masks. The objective is to determine the number of acceptable washing cycles that this kind of mask can withstand before losing its performance in terms of breathability and airflow resistance. Other quality characteristics such as material (fibres) degradation and hydrophobicity are investigated. Degradation mechanisms due to washing cycles for the different mask constituent layers were studied by scanning electron microscopy (SEM) imaging. This work is an attempt to contribute to the determination of the reusability threshold of general-purpose disposable surgical type face masks thereby contributing to the reduction of environmental concerns. Results in terms of the studied above parameters suggest limiting the reuse of standard type surgical masks to only one machine washing cycle.

Protective Masks Utilizing Nonendangered Components

At the beginning of the COVID-19 pandemic when traditional N95 respirators were in short supply in the United States, there was a need for alternative products that did not rely on traditional avenues of sourcing and manufacturing. The purpose of this research was to develop and test alternatives to N95 respirators that could be produced locally without specialized materials and processes. Through an interdisciplinary team of experts, new mask designs that use repurposed filtration media and commercially available components were developed and tested for filtration and fit against current N95 standards. Filtration efficiency test results showed that the filtration media can be used for high-quality facemasks and quantitative fit testing demonstrated that the new mask designs could be viable alternatives to traditional N95 facemasks when those masks are in short supply. Manufacturing viability was tested utilizing a workforce to create 6000 masks over 10 days. The ability to quickly produce masks at scale using a workforce without specialized skills demonstrated the feasibility of the mask designs and manufacturing approach to address shortages of critical healthcare equipment, mitigate risk for healthcare and essential workers, and minimize the transmission and spread of disease.

Liquid-Immersion Reprocessing Effects on Filtration Efficiency of 'Single-Use' Commercial Medical Face Masks

PURPOSE

Medical masks have inferior filtration efficiency and fit to filtering facepiece respirators (FFRs) but are widely used in healthcare and the community. These masks are intended for disposal after use but in the event of mask shortage re-use after reprocessing may be an option. We investigated eight reprocessing methods that each involved washing or soaking in liquid, are likely to eliminate respiratory viruses, and are safe and available in most community and healthcare settings.

METHODS

Three brands of EN 14683 standards-compliant commercial medical mask were each reprocessed 10 times by one of eight methods. We measured filtration efficiency for poly-dispersed sodium chloride particles and pressure differential.

RESULTS

Compared with new medical masks, reprocessed masks had significantly reduced filtration efficiency. The reduction was mild-moderate (6.5-25.8%) after warm water wash, hot water soak or boiling water soak; and moderate-large (24.1-51.5%) after detergent, soap or laundry machine wash, or bleach soak. There were mixed and minor changes in pressure differential. Most reprocessed standards-compliant masks had better filtration efficiency than new non-standard commercial masks and then cotton and cotton-polyester mix fabric samples, even triple-layered fabrics.

CONCLUSIONS

High-quality commercial medical masks reprocessed 10 times by water immersion methods had better filtration efficiency than new non-standard masks and washable fabrics. These findings have particular relevance for community and low-resource healthcare settings.

Effect of dry heat treatment between room temperature and 160 °C on surgical masks

The Covid-19 crisis has led to a high demand and use of surgical masks worldwide, causing risks of shortages and pollution. Therefore, decontamination of surgical masks could be an opportunity to reduce these risks. In our study, we applied dry heat to the masks for 15 min at different temperatures and studied the consequences of heat on surface chemistry and fiber morphology. We focus here on the effects of dry heat treatment on the masks and not on the verification of mask disinfection, which has been thoroughly studied in existing literature. The masks that were heated to 70 °C, 100 °C, 130 °C, 140 °C, 150 °C did not show significant changes at the nanometric scale and the standard deviation of the surface temperature of the worn masks is similar to that of the unheated control mask. However we show a slight heating altered the hydrophobicity of the surface, and induced a significative modification of the wetting angle of water droplets. The mask heated to 157 °C has a higher surface temperature standard deviation and fused fibers are observed by scanning electron microscopy. The mask heated to 160 °C melted and then hardened as it cooled making it completely unusable.

Impact of washing cycles on the performances of face masks

The tension on the supply of surgical and FFP2 masks during the first wave of the COVID-19 pandemic leads to study the potential reuse of these masks. As washing is easily adaptable at home, this treatment solution was retained. In this work, thirty-six references of surgical masks and four FFP2 masks were tested without being worn or washed and after several washing cycles. The results highlighted a great heterogeneity of performances depending on the mask trademarks, both for surgical masks and FFP2. The quality of the meltblown and spunbond layers and the presence/absence of electrostatic charges at the fiber surface are put forward to explain the variability of results, both on differential pressures and filtration efficiencies. The differential pressure and the particle filtration efficiency of the washed masks were maintained up to 10 washing cycles and met the standard requirements. However, an immersion in water with a detergent induces an efficiency decrease for submicronic particles. This lower performance, constant after the first washing cycle, can be explained by the loss of electrostatic charges during the washing cycle. The modifications of surface properties after washing also lead to a loss of the hydrophobic behavior of type IIR surgical masks, which can therefore no more be considered as resistant to blood projections.

The effects of face mask specifications on work of breathing and particle filtration efficiency

The outbreak of the ongoing coronavirus disease 2019 (COVID-19) pandemic has led to the recommended routine use of face masks to reduce exposure risk. In this study, the increase in work of breathing (WOB) imposed by face masks is theoretically studied for both normals and patients with obstructive and restrictive lung diseases at different levels of activity. The results show a significant increase in WOB due to face masks, which is more severe in higher activity levels. The added WOB is considerable during physical activity and may be intolerable for patients with preexisting lung disease and may contribute to inspiratory muscle fatigue and dyspnea. Moreover, in this study, the effects of the physical properties of a fibrous medium, including thickness, porosity, and fiber diameter, are analyzed on the particle filtration efficiency (PFE) and the added WOB. The relations between the physical properties of the fibrous medium and the added WOB and the PFE are shown on some contour plots as a quick and simple tool to select the desired physical properties for a single layer filter to ensure that the added WOB is comfortable while the PFE is sufficiently high.

Quantitative analysis of droplet deposition produced by an electrostatic sprayer on a classroom table by using fluorescent tracer

Due to the ongoing COVID-19 pandemic situation, measures to mitigate the risk of transmission of the SARS-CoV-2 virus in an indoor setting are urgently needed. Among the various types of disinfectant methods, electrostatic spraying is often applied to decontamination in public places. For quantitatively characterizing electrostatic spraying, we developed the novel evaluation method by using a fluorescent tracer. By applying this method, we performed three different experiment cases (static test on a table, static test on a cylinder, and dynamic test on a table) to figure out its unique characteristics (Coulombic fission and wraparound effect) and measure its performance in various aspects. To be specific, bimodal distribution with peak sizes of ~10 and ~100 μm was found due to Coulombic fission. Otherwise, a unimodal distribution with a peak size of ~100 μm occurred for the uncharged droplets. As a result, the effective contact area increased by 40-80 % due to small progeny droplets. The wraparound effect was examined on two different cylinders: copper (Cu) and polyvinyl chloride (PVC) pipe. When the target surface was not charged (Cu 0 kV and PVC 0 kV), the average normalized concentrations on the backside of the cylinder (θ = 180°) increased by around 67 % for charged droplets. Meanwhile, when the target surface was highly charged (PVC -19 kV), the average normalized concentrations at θ = 180° were increased more than two times for charged droplets.

Reusing and/or reprocessing the N95 face respirator mask or equivalent: An integrative review

OBJECTIVE

to analyze the scientific evidence available on the different reprocessing methods and the necessary conditions for reuse of the N95 face respirator mask or equivalent.

METHOD

an integrative literature review. The PICO strategy was used to elaborate the question. The search was conducted in four databases: PubMed, SciVerse Scopus, WebofScience and EMBASE, considering any period of time.

RESULTS

a total of 32 studies were included from the 561 studies identified, and they were presented in two categories: "Conditions for reuse" and "Reprocessing the masks". Of the evaluated research studies, seven(21.8%) addressed the reuse of the N95 face respirator mask or equivalent and 25(78.1%) evaluated different reprocessing methods, namely: ultraviolet germicidal irradiation(14); hydrogen peroxide(8); vapor methods(14); using dry heat(5) and chemical methods(sodium hypochlorite[6], ethanol[4] and sodium chloride with sodium bicarbonate and dimethyldioxirane[1]). We emphasize that different methods were used in one same article.

CONCLUSION

no evidence was found to support safe reprocessing of face respirator masks. In addition, reuse is contraindicated due to the risk of self-contamination and inadequate sealing.

Evaluation of at-home methods for N95 filtering facepiece respirator decontamination

N95 filtering facepiece respirators (FFRs) are essential for the protection of healthcare professionals and other high-risk groups against Coronavirus Disease of 2019 (COVID-19). In response to shortages in FFRs during the ongoing COVID-19 pandemic, the Food and Drug Administration issued an Emergency Use Authorization permitting FFR decontamination and reuse. However, although industrial decontamination services are available at some large institutions, FFR decontamination is not widely accessible. To be effective, FFR decontamination must (1) inactivate the virus; (2) preserve FFR integrity, specifically fit and filtering capability; and (3) be non-toxic and safe. Here we identify and test at-home heat-based methods for FFR decontamination that meet these requirements using common household appliances. Our results identify potential protocols for simple and accessible FFR decontamination, while also highlighting unsuitable methods that may jeopardize FFR integrity.

Characterization and mitigation of aerosols and spatters from ultrasonic scalers

BACKGROUND

Dental procedures often produce aerosols and spatter, which have the potential to transmit pathogens such as severe acute respiratory syndrome coronavirus 2. The existing literature is limited.

METHODS

Aerosols and spatter were generated from an ultrasonic scaling procedure on a dental manikin and characterized via 2 optical imaging methods: digital inline holography and laser sheet imaging. Capture efficiencies of various aerosol mitigation devices were evaluated and compared.

RESULTS

The ultrasonic scaling procedure generated a wide size range of aerosols (up to a few hundred μm) and occasional large spatter, which emit at low velocity (mostly < 3 m/s). Use of a saliva ejector and high-volume evacuator (HVE) resulted in overall reductions of 63% and 88%, respectively, whereas an extraoral local extractor (ELE) resulted in a reduction of 96% at the nominal design flow setting.

CONCLUSIONS

The study results showed that the use of ELE or HVE significantly reduced aerosol and spatter emission. The use of HVE generally requires an additional person to assist a dental hygienist, whereas an ELE can be operated hands free when a dental hygienist is performing ultrasonic scaling and other operations.

PRACTICAL IMPLICATIONS

An ELE aids in the reduction of aerosols and spatters during ultrasonic scaling procedures, potentially reducing transmission of oral or respiratory pathogens like severe acute respiratory syndrome coronavirus 2. Position and airflow of the device are important to effective aerosol mitigation.

Which strategy for using medical and community masks? A prospective analysis of their environmental impact

INTRODUCTION

The use of personal protective equipment, especially medical masks, increased dramatically during the COVID-19 crisis. Medical masks are made of synthetic materials, mainly polypropylene, and a majority of them are produced in China and imported to the European market. The urgency of the need has so far prevailed over environmental considerations.

OBJECTIVE

Assess the environmental impact of different strategies for the use of face mask.

METHOD

A prospective analysis was conducted to assess the environmental impact of different strategies for the use of medical and community masks. Eight scenarios, differentiating the typologies of masks and the modes of reuse are compared using three environmental impact indicators: the Global Warming Potential (GWP100), the ecological scarcity (UBP method, from German 'Umweltbelastungpunkte') and the plastic leakage (PL). This study attempts to provide clear recommendations that consider both the environmental impact and the protective effectiveness of face masks used in the community.

RESULTS

The environmental impact of single-use masks is the most unfavourable, with a GWP of 0.4-1.3 kg CO2 eq., depending on the transport scenario, and a PL of 1.8 g, for a 1 month protection against COVID-19. The use of home-made cotton masks and prolonged use of medical masks through wait-and-reuse are the scenarios with the lowest impact.

CONCLUSION

The use of medical masks with a wait and reuse strategy seems to be the most appropriate when considering both environmental impact and effectiveness. Our results also highlight the need to develop procedures and the legal/operational framework to extend the use of protective equipment during a pandemic.

Protection levels of N95-level respirator substitutes proposed during the COVID-19 pandemic: safety concerns and quantitative evaluation procedures

OBJECTIVE

The COVID-19 pandemic has precipitated widespread shortages of filtering facepiece respirators (FFRs) and the creation and sharing of proposed substitutes (novel designs, repurposed materials) with limited testing against regulatory standards. We aimed to categorically test the efficacy and fit of potential N95 respirator substitutes using protocols that can be replicated in university laboratories.

SETTING

Academic medical centre with occupational health-supervised fit testing along with laboratory studies.

PARTICIPANTS

Seven adult volunteers who passed quantitative fit testing for small-sized (n=2) and regular-sized (n=5) commercial N95 respirators.

METHODS

Five open-source potential N95 respirator substitutes were evaluated and compared with commercial National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirators as controls. Fit testing using the 7-minute standardised Occupational Safety and Health Administration fit test was performed. In addition, protocols that can be performed in university laboratories for materials testing (filtration efficiency, air resistance and fluid resistance) were developed to evaluate alternate filtration materials.

RESULTS

Among five open-source, improvised substitutes evaluated in this study, only one (which included a commercial elastomeric mask and commercial HEPA filter) passed a standard quantitative fit test. The four alternative materials evaluated for filtration efficiency (67%-89%) failed to meet the 95% threshold at a face velocity (7.6 cm/s) equivalent to that of a NIOSH particle filtration test for the control N95 FFR. In addition, for all but one material, the small surface area of two 3D-printed substitutes resulted in air resistance that was above the maximum in the NIOSH standard.

CONCLUSIONS

Testing protocols such as those described here are essential to evaluate proposed improvised respiratory protection substitutes, and our testing platform could be replicated by teams with similar cross-disciplinary research capacity. Healthcare professionals should be cautious of claims associated with improvised respirators when suggested as FFR substitutes.

Determination of hydrogen peroxide on N95 masks after sanitization using a colorimetric method

Hydrogen peroxide is commonly used as a sterilizing agent for medical devices and its use has recently been extended to N95 masks during PPE shortages as a result of the COVID-19 pandemic. The hydrogen peroxide remaining on the masks after sterilization could potentially pose a health hazard to the mask users. In the present study a colorimetric method was optimized for the determination of hydrogen peroxide on N95 masks following chemical sanitizations. The developed analytical method demonstrated an overall recovery of 98% ± 7%. The limit of detection ranged from 0.16 to 0.25 mg/mask, depending on the type of mask. The expanded measurement uncertainty was 13% (at a 95% confidence interval). The sanitization process itself introduced a significant variation in hydrogen peroxide load between masks. The ozone used in the sanitization process had no significant impact on analytical performance. Stamped and printed marks on the mask surfaces could induce biased readings. Hydrogen peroxide decomposes quickly on the mask surfaces so timing of analysis is an important factor in method standardization.•

The validation data demonstrated that the in-house method is reliable and fit for the intended purpose, offering a sensitive, simple, rapid, and inexpensive method of residue monitoring.

Size-Specific Filtration Performance of N95 Respirators After Decontamination by Moist Heat Incubation

Background: Decontamination and reuse of respirators have been proposed to mitigate the shortage of respirators during pandemics. The U.S. National Institute for Occupational Safety and Health (NIOSH)'s respirator filtration efficiency (FE) test has been used to confirm that decontamination procedures maintain minimum FE above 95% for N95s and similar respirators. However, it was hypothesized that the limited range of test particle sizes may not include the most penetrating particle size (MPPS) for all respirators, especially after decontamination by moist heat incubation (MHI). Materials and Methods: A custom-designed apparatus was used to measure size-specific FE for respirators across particle size bins between aerodynamic diameter of 0.07 and 1.97 μm using an electrical low-pressure impactor. FEs were measured for two N95 respirator models before and after 10 cycles of MHI. In addition, pressure drop through the respirator materials and scanning electron microscope (SEM) images of respirator layers were obtained before and after MHI. Results: For Kimtech™ brand N95 respirators, FE was not reduced at any size after MHI. For Safe Life brand N95s, FE was below 95% before MHI and decreased significantly after MHI. The MPPS for this respirator was outside the range defined in NIOSH test protocol, and increased after MHI. There was no appreciable change to the pressure drop through the two respirator models after MHI, nor was any deterioration in fiber integrity visible in SEM images. Conclusions: Based on the results of the present study and other studies in the literature, MHI can be used to decontaminate respirators without significant decrease in FE. However, potential effects of MHI on FE need to be assessed for each respirator model. The ability to evaluate size-specific FE across a wide range of particle sizes is important in identifying the MPPS and associated FE of respirators before and after MHI.

Thinking green: modelling respirator reuse strategies to reduce cost and waste

OBJECTIVES

To compare the impact of respirator extended use and reuse strategies with regard to cost and sustainability during the COVID-19 pandemic.

DESIGN

Cost analysis.

SETTING

USA.

PARTICIPANTS

All healthcare workers within the USA.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A model was developed to estimate usage, costs and waste incurred by several respirator usage strategies over the first 6 months of the pandemic in the USA. This model assumed universal masking of all healthcare workers. Estimates were taken from the literature, government databases and commercially available data from approved vendors.

RESULTS

A new N95 respirator per patient encounter would require 7.41 billion respirators, cost $6.38 billion and generate 84.0 million kg of waste in the USA over 6 months. One respirator per day per healthcare worker would require 3.29 billion respirators, cost $2.83 billion and generate 37.22 million kg of waste. Decontamination by ultraviolet germicidal irradiation would require 1.64 billion respirators, cost $1.41 billion and accumulate 18.61 million kg of waste. H2O2 vapour decontamination would require 1.15 billion respirators, cost $1.65 billion and produce 13.03 million kg of waste. One reusable respirator with daily disposable filters would require 18 million respirators, cost $1.24 billion and generate 15.73 million kg of waste. Pairing a reusable respirator with H2O2 vapour-decontaminated filters would reduce cost to $831 million and generate 1.58 million kg of waste. The use of one surgical mask per healthcare worker per day would require 3.29 billion masks, cost $460 million and generate 27.92 million kg of waste.

CONCLUSIONS

Decontamination and reusable respirator-based strategies decreased the number of respirators used, costs and waste generated compared with single-use or daily extended-use of disposable respirators. Future development of low-cost,simple technologies to enable respirator and/or filter decontamination is needed to further minimise the economic and environmental costs of masks.

Coating with Hypertonic Saline Improves Virus Protection of Filtering Facepiece Manyfold-Benefit of Salt Impregnation in Times of Pandemic

Recently, as is evident with the COVID-19 pandemic, virus-containing aerosols can rapidly spread worldwide. As a consequence, filtering facepieces (FFP) are essential tools to protect against airborne viral particles. Incorrect donning and doffing of masks and a lack of hand-hygiene cause contagion by the wearers' own hands. This study aimed to prove that hypertonic saline effectively reduces the infectious viral load on treated masks. Therefore, a hypertonic salt solution´s protective effect on surgical masks was investigated, specifically analyzing the infectivity of aerosolized Alphacoronavirus 1 in pigs (Transmissible Gastroenteritis Virus (TGEV)). Uncoated and hypertonic salt pre-coated FFPs were sprayed with TGEV. After drying, a defined part of the mask was rinsed with the medium, and the eluent was used for the infection of a porcine testicular cell line. Additionally, airborne microorganisms´ long-term infectivity of sodium-chloride in phosphate-buffered saline comprising 5% saccharose was investigated. In the results from an initial Median Tissue Culture Infectious Dose, infection rate of TGEV was minimally reduced by untreated FFP. In contrast, this could be reduced by a factor of 10⁴ if FFPs were treated with hypertonic salt solutions. Airborne pathogens did not contaminate the growth medium if salt concentrations exceeded 5%. We conclude that hypertonic saline is a vital tool for anti-virus protection, exponentially improving the impact of FFPs.

Role of additive manufacturing in medical application COVID-19 scenario: India case study

This paper reviews how the Additive Manufacturing (AM) industry played a key role in stopping the spread of the Coronavirus by providing customized parts on-demand quickly and locally, reducing waste and eliminating the need for an extensive manufacturer. The AM technology uses digital files for the production of crucial medical parts, which has been proven essential during the COVID-19 crisis. Going ahead, the 3D printable clinical model resources described here will probably be extended in various centralized model storehouses with new inventive open-source models. Government agencies, individuals, corporations and universities are working together to quickly development of various 3D-printed products especially when established supply chains are under distress, and supply cannot keep up with demand.

Advanced Research and Development of Face Masks and Respirators Pre and Post the Coronavirus Disease 2019 (COVID-19) Pandemic: A Critical Review

The outbreak of the COVID-19 pandemic, in 2020, has accelerated the need for personal protective equipment (PPE) masks as one of the methods to reduce and/or eliminate transmission of the coronavirus across communities. Despite the availability of different coronavirus vaccines, it is still recommended by the Center of Disease Control and Prevention (CDC), World Health Organization (WHO), and local authorities to apply public safety measures including maintaining social distancing and wearing face masks. This includes individuals who have been fully vaccinated. Remarkable increase in scientific studies, along with manufacturing-related research and development investigations, have been performed in an attempt to provide better PPE solutions during the pandemic. Recent literature has estimated the filtration efficiency (FE) of face masks and respirators shedding the light on specific targeted parameters that investigators can measure, detect, evaluate, and provide reliable data with consistent results. This review showed the variability in testing protocols and FE evaluation methods of different face mask materials and/or brands. In addition to the safety requirements needed to perform aerosol viral filtration tests, one of the main challenges researchers currently face is the inability to simulate or mimic true aerosol filtration scenarios via laboratory experiments, field tests, and in vitro/in vivo investigations. Moreover, the FE through the mask can be influenced by different filtration mechanisms, environmental parameters, filtration material properties, number of layers used, packing density, fiber charge density, fiber diameter, aerosol type and particle size, aerosol face velocity and concentration loadings, and infectious concentrations generated due to different human activities. These parameters are not fully understood and constrain the design, production, efficacy, and efficiency of face masks.

Face masks against COVID-19: Standards, efficacy, testing and decontamination methods

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the novel coronavirus disease 2019 (COVID-19), has caused a global pandemic on a scale not seen for over a century. Increasing evidence suggests that respiratory droplets and aerosols are likely the most common route of transmission for SARS-CoV-2. Since the virus can be spread by presymptomatic and asymptomatic individuals, universal face masking has been recommended as a straightforward and low-cost strategy to mitigate virus transmission. Numerous governments and public health agencies around the world have advocated for or mandated the wearing of masks in public settings, especially in situations where social distancing is not possible. However, the efficacy of wearing a mask remains controversial. This interdisciplinary review summarizes the current, state-of-the-art understanding of mask usage against COVID-19. It covers three main aspects of mask usage amid the pandemic: quality standards for various face masks and their fundamental filtration mechanisms, empirical methods for quantitatively determining mask integrity and particle filtration efficiency, and decontamination methods that allow for the reuse of traditionally disposable N95 and surgical masks. The focus is given to the fundamental physicochemical and engineering sciences behind each aspect covered in this review, providing novel insights into the current understanding of mask usage to curb COVID-19 spread.

Size-Dependent Filtration Efficiency of Alternative Facemask Filter Materials

The use of facemasks is proven to mitigate the spread of the coronavirus and other biological agents that cause disease. Various forms of facemasks, made using different materials, are being used extensively, and it is important to determine their performance characteristics. The size-dependent filtration efficiency and breathing resistance of household sterilization wrap fabrics, and isolation media (American Society for Testing and Materials (ASTM)- and non-ASTM-rated), were measured in filter-holder- and mannequin-in-chamber-based systems, focusing on particles sizes between 20 nm and 2 μm. Double-layer MERV-14 (Minimum Efficiency Reporting Values with rating 14) showed the highest filtration efficiency (94.9-73.3%) amongst household filter media, whereas ASTM-rated isolation masks showed the highest filtration efficiencies (95.6-88.7) amongst all the masks considered. Filtration efficiency of 3D-printed masks with replaceable filter media was found to depend on the degree of sealing around the media holder, which depended on the material's compressibility. Filtration efficiencies of triple-layer combinations (95.8-85.3%) follow a profile similar to single layers but with improved filtration efficiencies.

Gamma radiation sterilization of N95 respirators leads to decreased respirator performance

In response to personal protective equipment (PPE) shortages in the United States due to the Coronavirus Disease 2019, two models of N95 respirators were evaluated for reuse after gamma radiation sterilization. Gamma sterilization is attractive for PPE reuse because it can sterilize large quantities of material through hermetically sealed packaging, providing safety and logistic benefits. The Gamma Irradiation Facility at Sandia National Laboratories was used to irradiate N95 filtering facepiece respirators to a sterilization dose of 25 kGy(tissue). Aerosol particle filtration performance testing and electrostatic field measurements were used to determine the efficacy of the respirators after irradiation. Both respirator models exhibited statistically significant decreases in particle filtering efficiencies and electrostatic potential after irradiation. The largest decrease in capture efficiency was 40-50% and peaked near the 200 nm particle size. The key contribution of this effort is correlating the electrostatic potential change of individual filtration layer of the respirator with the decrease filtration efficiency after irradiation. This observation occurred in both variations of N95 respirator that we tested. Electrostatic potential measurement of the filtration layer is a key indicator for predicting filtration efficiency loss.

Filtering Facepiece Respirator (N95 Respirator) Reprocessing: A Systematic Review

IMPORTANCE

The COVID-19 pandemic has resulted in a persistent shortage of personal protective equipment; therefore, a need exists for hospitals to reprocess filtering facepiece respirators (FFRs), such as N95 respirators.

OBJECTIVE

To perform a systematic review to evaluate the evidence on effectiveness and feasibility of different processes used for decontaminating N95 respirators.

EVIDENCE REVIEW

A search of PubMed and EMBASE (through January 31, 2021) was completed for 5 types of respirator-decontaminating processes including UV irradiation, vaporized hydrogen peroxide, moist-heat incubation, microwave-generated steam, and ethylene oxide. Data were abstracted on process method, pathogen removal, mask filtration efficiency, facial fit, user safety, and processing capability.

FINDINGS

Forty-two studies were included that examined 65 total types of masks. All were laboratory studies (no clinical trials), and 2 evaluated respirator performance and fit with actual clinical use of N95 respirators. Twenty-seven evaluated UV germicidal irradiation, 19 vaporized hydrogen peroxide, 9 moist-heat incubation, 10 microwave-generated steam, and 7 ethylene oxide. Forty-three types of N95 respirators were treated with UV irradiation. Doses of 1 to 2 J/cm2 effectively sterilized most pathogens on N95 respirators (>103 reduction in influenza virus [4 studies], MS2 bacteriophage [3 studies], Bacillus spores [2 studies], Escherichia virus MS2 [1 study], vesicular stomatitis virus [1 study], and Middle East respiratory syndrome virus/SARS-CoV-1 [1 study]) without degrading respirator components. Doses higher than 1.5 to 2 J/cm2 may be needed based on 2 studies demonstrating greater than 103 reduction in SARS-CoV-2. Vaporized hydrogen peroxide eradicated the pathogen in all 7 efficacy studies (>104 reduction in SARS-CoV-2 [3 studies] and >106 reduction of Bacillus and Geobacillus stearothermophilus spores [4 studies]). Pressurized chamber systems with higher concentrations of hydrogen peroxide caused FFR damage (6 studies), while open-room systems did not degrade respirator components. Moist heat effectively reduced SARS-CoV-2 (2 studies), influenza virus by greater than 104 (2 studies), vesicular stomatitis virus (1 study), and Escherichia coli (1 study) and preserved filtration efficiency and facial fit for 11 N95 respirators using preheated containers/chambers at 60 °C to 85 °C (5 studies); however, diminished filtration performance was seen for the Caron incubator. Microwave-generated steam (1100-W to 1800-W devices; 40 seconds to 3 minutes) effectively reduced pathogens by greater than 103 (influenza virus [2 studies], MS2 bacteriophage [3 studies], and Staphylococcus aureus [1 study]) and maintained filtration performance in 10 N95 respirators; however, damage was noted in least 1 respirator type in 4 studies. In 6 studies, ethylene oxide preserved respirator components in 16 N95 respirator types but left residual carcinogenic by-product (1 study).

CONCLUSIONS AND RELEVANCE

Ultraviolet germicidal irradiation, vaporized hydrogen peroxide, moist heat, and microwave-generated steam processing effectively sterilized N95 respirators and retained filtration performance. Ultraviolet irradiation and vaporized hydrogen peroxide damaged respirators the least. More research is needed on decontamination effectiveness for SARS-CoV-2 because few studies specifically examined this pathogen.

Clinical Audit on Symptomatology of Covid-19 Healthcare Workers and Impact on Quality-of-Life (QOL) Due to Continuous Facemask Usage: A Prospective Study

Covid-19 due to Sars-Cov-2 infection has reached pandemic proportion. Many healthcare workers are involved in managing both COVID-suspected and confirmed cases. It is mandatory for healthcare workers to have droplet and contact precautions by means of Personal protective equipment (PPE), facemask, face shield or eye protection. Prolonged usage of medical mask results in various adverse effects. This study is an attempt to know the common effects of prolonged face mask in healthcare workers and its resultant quality-of-life (QOL). To study the common effects of prolonged face mask and its impact on QOL of healthcare workers during the COVID 19 crisis. This was a prospective cross-sectional study conducted over 6 months among 2750 healthcare workers. A questionnaire requesting demographic details and most common side effects after prolonged usage of face mask was circulated. We also attached a short form-12 (sf-12) questionnaire to assess its impact on QOL. Out of 2750 personnel, 299 were excluded. Male preponderance was noted. Study was conducted on candidates using 3ply mask or above. Age range was between 18 and 65 years with mean age being 37.61 ± 15.23 in mask users < 5 h per day, 32.2 ± 10.02 in 5–10 h group and 30.19 ± 8.15 in 10 h group. 8.48% (n = 174) had comorbidities. QOL impacted. The complaints with face mask use definitely are troublesome with increase in severity with duration of mask usage. This definitely has a proportional impact on the healthcare workers’ QOL.

Variation of Efficacy of Filtering Face Pieces Respirators over Time in a Dental Setting: A Pilot Study

Since aerosol continuously persists in dental settings, where different procedures and patients come in succession, the use of oronasal masks is highly recommended. Among them, respirators known as Filtering Face Pieces (FFP) show a protective superiority compared to surgical masks. Even concerning respirators classified as non-reusable, it is not known how many hours of use are necessary to compromise their filtering capacity. The aim of this study is to investigate the variations of filtering capacity of an FFP2 respirator over time, in order to safely optimize the timing of its use. Five respirators were worn by the same operator during clinical activity for different usage times (8, 16, 24, 32, 40 h), and one respirator was kept unused. All respirators underwent a bacterial filtration efficacy (BFE) test. T-test for paired data with Bootstrap technique and Wilcoxon test for paired data compared BFE values of the five tested FFP2s respectively at each time, and the areas with the corresponding values of the control respirator (FFp2-F). A generalized linear mixed effect model (GLM) was applied considering type of respirator and time as fixed effects and intercept as random effect. No significant statistical differences were present in the BFE of each time. Data obtained by the present study highlight the important ability of FFP2s to maintain their BFE over time, suggesting a long lasting protective function.

Plastics in the time of COVID-19 pandemic: Protector or polluter?

The COVID-19 pandemic has reemphasized the indispensable role of plastics in our daily life. Plastics in terms of personal protective equipment (PPEs) and other single-use medical equipment along with packaging solutions owing to their inherent properties have emerged as a life-savior for protecting the health and safety of the frontline health workers and the common citizens during the pandemic. However, plastics have been deemed as evil polluter due to their indiscriminate littering and mismanagement amid increased plastic usage and waste generation during this unprecedented crisis. This article reviews and assesses to dwell upon whether plastics in the time of pandemic are acting as protector of the public health or polluter of the environment. Considering the utilities and limitations of plastic along with its management or mismanagement, and the fate, an equitable appraisal suggests that the consumers' irresponsible behavior, and attitude and poor awareness, and the stress on waste management infrastructure in terms of collection, operation, and financial constraints as the major drivers, leading to mismanagement, turn plastic into an evil polluter of the environment. Plastic can be a protector if managed properly and complemented by the circular economy strategies in terms of reduction, recycle and recovery, and thereby preventing leakage into the environment. To safeguard the supply chain of PPEs, several decontamination techniques have been adopted worldwide ensuring their effective reprocessing to prioritize the circular economy within the system. Policy guidelines encouraging to adopt safer practices and sustainable technical solutions along with consumers' education for awareness creation are the need of the hour for preventing plastic to turn from protector with high utility to polluter.

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

In normal conditions, discarding single-use personal protective equipment after use is the rule for its users due to the possibility of being infected, particularly for masks and filtering facepiece respirators. When the demand for these protective tools is not satisfied by the companies supplying them, a scenario of shortages occurs, and new strategies must arise. One possible approach regards the disinfection of these pieces of equipment, but there are multiple methods. Analyzing these methods, Ultraviolet-C (UV-C) becomes an exciting option, given its germicidal capability. This paper aims to describe the state-of-the-art for UV-C sterilization in masks and filtering facepiece respirators. To achieve this goal, we adopted a systematic literature review in multiple databases added to a snowball method to make our sample as robust as possible and encompass a more significant number of studies. We found that UV-C's germicidal capability is just as good as other sterilization methods. Combining this characteristic with other advantages makes UV-C sterilization desirable compared to other methods, despite its possible disadvantages.

Evaluation of hydrogen peroxide and ozone residue levels on N95 masks following chemical decontamination

Background

Hydrogen peroxide and ozone have been used as chemical decontamination agents for N95 masks during supply shortages. If left behind on the masks, the residues of both chemicals represent a potential health hazard by skin contact and respiratory exposure.

Aim

Characterization of hydrogen peroxide and ozone residues on mask surfaces after chemical decontamination.

Methods

Various N95 masks were decontaminated using two commercial systems employing either aerosol spray or vaporization of hydrogen peroxide in the presence of ozone. Following the decontamination, the masks were aired out to eliminate moisture and potential chemical residues. The residual hydrogen peroxide and ozone were monitored in the gas phase above the mask surface, and hydrogen peroxide residue directly on mask surfaces using a colorimetric assay.

Findings

After decontamination, hydrogen peroxide and ozone were detectable in the gas phase in the vicinity of masks even after 5 h of aeration. Hydrogen peroxide was also detected on all studied masks, and levels up to 56 mg per mask were observed after 0.5 h of aeration. All residues gradually decreased with aeration, likely due to decomposition and vaporization.

Conclusion

Hydrogen peroxide and ozone were present on N95 masks after decontamination. With appropriate aeration, the gaseous residue levels in the vicinity of the masks decreased to permissible levels as defined by the US Occupational Safety and Health Administration. Reliable assays to monitor these residues are necessary to ensure the safety of the mask users.

Universal Use of Face Masks and Related Challenges During COVID-19 in Developing Countries

Background

Governments have imposed physical and social distancing measures together with hand hygiene to contain COVID-19. However, maintaining the recommended social distancing less likely applicable in developing countries where the majority of the people depend on daily income. Countries like Ethiopia imposed universal use of face masks as an additional measure.

Aim

This study aims to review and present the advantage and challenges of imposing universal use of face masks in the community and to forward possible recommendations.

Methods

The study was synthesized using a narrative literature review approach involving COVID-19 databases, published literature on COVID-19, and relevant news.

Results

The first confirmed case of COVID-19 in Ethiopia was reported on March 13, 2020. Consequently, the government has taken swift actions including social distancing and strict hygienic measures to contain its transmission. However, new cases have started to increase with local transmission. Hence, the country imposed additional measures including universal use of face masks at public places. The universal use of masks requires a sufficient supply of masks with affordable costs. Moreover, awareness of the proper use of face masks and its disposal is another challenge affecting its effectiveness against corona virus infection.

Conclusion

Universal use of face masks can contribute to the containment of the virus in the community if adequately available and properly used and managed after use. Encouraging local production with clear guidance, demonstration, and awareness creation helps to improve the accessibility and effectiveness of face masks particularly among the vulnerable population.

Unlocking the surge in demand for personal and protective equipment (PPE) and improvised face coverings arising from coronavirus disease (COVID-19) pandemic - Implications for efficacy, re-use and sustainable waste management

Currently, there is no effective vaccine for tackling the ongoing COVID-19 pandemic caused by SARS-CoV-2 with the occurrence of repeat waves of infection frequently stretching hospital resources beyond capacity. Disease countermeasures rely upon preventing person-to-person transmission of SARS-CoV2 so as to protect front-line healthcare workers (HCWs). COVID-19 brings enormous challenges in terms of sustaining the supply chain for single-use-plastic personal and protective equipment (PPE). Post-COVID-19, the changes in medical practice will drive high demand for PPE. Important countermeasures for preventing COVID-19 transmission include mitigating potential high risk aerosol transmission in healthcare setting using medical PPE (such as filtering facepiece respirators (FFRs)) and the appropriate use of face coverings by the general public that carries a lower transmission risk. PPE reuse is a potential short term solution during COVID-19 pandemic where there is increased evidence for effective deployment of reprocessing methods such as vaporized hydrogen peroxide (30 to 35% VH2O2) used alone or combined with ozone, ultraviolet light at 254 nm (2000 mJ/cm²) and moist heat (60 °C at high humidity for 60 min). Barriers to PPE reuse include potentially trust and acceptance by HCWs. Efficacy of face coverings are influenced by the appropriate wearing to cover the nose and mouth, type of material used, number of layers, duration of wearing, and potentially superior use of ties over ear loops. Insertion of a nose clip into cloth coverings may help with maintaining fit. Use of 60 °C for 60 min (such as, use of domestic washing machine and spin dryer) has been advocated for face covering decontamination. Risk of virus infiltration in improvised face coverings is potentially increased by duration of wearing due to humidity, liquid diffusion and virus retention. Future sustained use of PPE will be influenced by the availability of recyclable PPE and by innovative biomedical waste management.