Dry heat and microwave-generated steam protocols for the rapid decontamination of respiratory personal protective equipment in response to COVID-19-related shortages

Self-Sanitization in a Silk Nanofibrous Network for Biodegradable PM0.3 Filters with In Situ Joule Heating

In the contemporary way of life, face masks are crucial in managing disease transmission and battling air pollution. However, two key challenges, self-sanitization and biodegradation of face masks, need immediate attention, prompting the development of innovative solutions for the future. In this study, we present a novel approach that combines controlled acid hydrolysis and mechanical chopping to synthesize a silk nanofibrous network (SNN) seamlessly integrated with a wearable stainless steel mesh, resulting in the fabrication of self-sanitizable face masks. The distinct architecture of face masks showcases remarkable filtration efficiencies of 91.4, 95.4, and 98.3% for PM0.3, PM0.5, and PM1.0, respectively, while maintaining a comfortable level of breathability (ΔP = 92 Pa). Additionally, the face mask shows that a remarkable thermal resistance of 472 °C cm2 W-1 generates heat spontaneously at low voltage, deactivating Escherichia coli bacteria on the SNN, enabling self-sanitization. The SNN exhibited complete disintegration within the environment in just 10 days, highlighting the remarkable biodegradability of the face mask. The unique advantage of self-sanitization and biodegradation in a face mask filter is simultaneously achieved for the first time, which will open avenues to accomplish environmentally benign next-generation face masks.

N95 respirator hybrid decontamination method using Ultraviolet Germicidal Irradiation (UVGI) coupled with Microwave-Generated Steam (MGS)

The Coronavirus Disease 2019 (COVID-19) pandemic has induced a critical supply of personal protective equipment (PPE) especially N95 respirators. Utilizing respirator decontamination procedures to reduce the pathogen load of a contaminated N95 respirator can be a viable solution for reuse purposes. In this study, the efficiency of a novel hybrid respirator decontamination method of ultraviolet germicidal irradiation (UVGI) which utilizes ultraviolet-C (UV-C) rays coupled with microwave-generated steam (MGS) against feline coronavirus (FCoV) was evaluated. The contaminated 3M 1860 respirator pieces were treated with three treatments (UVGI-only, MGS-only, and Hybrid-UVGI + MGS) with variable time. The virucidal activity was evaluated using the TCID50 method. The comparison of decontamination efficiency of the treatments indicated that the hybrid method achieved at least a pathogen log reduction of 4 logs, faster than MGS and UVGI. These data recommend that the proposed hybrid decontamination system is more effective comparatively in achieving pathogen log reduction of 4 logs.

Influence of different treatment conditions on the filtration performance of conventional electret melt blown non-woven and novel nano FFP2 masks

To allow an efficient protection against viruses like the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), it is important to avoid their spreading by using filtering face pieces (FFP), which are categorized by different standards according to their filtration efficiency. In this study, we subjected six brands of FFP2 standard masks to three different conditions and subsequently analysed them for their filtration performance to evaluate potentials for reusability. The conditions comprised changes of temperature and air humidity, an exposure to isopropyl alcohol (IPA) and an autoclave sterilization. While four of six masks consisted of electrostatically treated melt blown non-wovens, two masks were fabricated using a nanofibrous multilayer system. Due to the absence of prior electrostatic treatment, the nano-masks did not show a significant change in filtration efficiency when discharged by IPA, unlike the melt blown nonwoven masks showing a significant decrease of filtration efficiency down to around 50% at a particle size of 0.3 μm. However, most melt blown masks maintained a sufficient filtration efficiency after all other treatments with even better results than the nanofibrous masks. This was particularly the case for the capacity to filter smallest particles/droplets with a size of around 0.1 μm, which is below the range of typical filtering standards and important for the retention of virally contaminated nano-aerosols or unattached viruses. After temperature/humidity variation and autoclave sterilization, melt blown masks were able to retain a filtration efficiency up to over 90% at 0.1 μm contrary to nano-masks showing a decrease down to around 70%. Based on their better filtration performance, lower price and potential reusability, we conclude that electret melt blown masks are the preferable type of FFP2 masks.

Effective inactivation of Bacillus atrophaeus spores and Escherichia coli on disposable face masks using ultraviolet laser irradiation

Due to the widespread emergence of COVID-19, face masks have become a common tool for reducing transmission risk between people, increasing the need for sterilization methods against mask-contaminated microorganisms. In this study, we measured the efficacy of ultraviolet (UV) laser irradiation (266 nm) as a sterilization technique against Bacillus atrophaeus spores and Escherichia coli on three different types of face mask. The UV laser source demonstrated high penetration of inner mask layers, inactivating microorganisms in a short time while maintaining the particle filtration efficiency of the masks. This study demonstrates that UV laser irradiation is an efficient sterilization method for removing pathogens from face masks.

Dry Heat as a Potential Decontamination Method on the Filtration Efficiency of Filtering Facepiece Respirators

Filtering facepiece respirators have been widely used in the fields of occupational health and public hygiene, especially during the COVID-19 pandemic. In particular, disposable respirators have been in high demand, and the waste generated from these disposable products poses a problem for the environment. Here, we aimed to test a practical decontamination method to allow for the reuse of KN95 respirators. In this study, three types of KN95 respirators were heated at 80 °C and 90 °C for different durations (15 min, 30 min, 45 min, 1 h, 2 h, 3 h, 4 h, 6 h, 8 h, 10 h, and 24 h). The filtration efficiencies of the tested KN95 respirators before and after heating were measured, and the changes in microstructure were imaged with a scanning electron microscope (SEM). In addition, a neural network model based on the nonlinear autoregressive with external input (NARX) to predict the filtration efficiency of the KN95 respirator was established. The results show that the temperature and time of dry heating affected particle prevention. The higher the temperature and the longer the heating time, the more obvious the decline in the filtration efficiency of the respirators. When the heating temperature reached 100 °C, the respirator may be no longer suitable for reuse. These results show that a dry heat temperature between 70 °C and 90 °C, and a heating time between 30 min and 2 h is assumed to be a suitable and effective decontamination method for respirators.

Evaluation of the Microbiological Effectiveness of Three Accessible Mask Decontamination Methods and Their Impact on Filtration, Air Permeability and Physicochemical Properties

The need to secure public health and mitigate the environmental impact associated with the massified use of respiratory protective devices (RPD) has been raising awareness for the safe reuse of decontaminated masks by individuals and organizations. Among the decontamination treatments proposed, in this work, three methods with the potential to be adopted by households and organizations of different sizes were analysed: contact with nebulized hydrogen peroxide (H2O2); immersion in commercial bleach (NaClO) (sodium hypochlorite, 0.1% p/v); and contact with steam in microwave steam-sanitizing bags (steam bag). Their decontamination effectiveness was assessed using reference microorganisms following international standards (issued by ISO and FDA). Furthermore, the impact on filtration efficiency, air permeability and several physicochemical and structural characteristics of the masks, were evaluated for untreated masks and after 1, 5 and 10 cycles of treatment. Three types of RPD were analysed: surgical, KN95, and cloth masks. Results demonstrated that the H2O2 protocol sterilized KN95 and surgical masks (reduction of >6 log10 CFUs) and disinfected cloth masks (reduction of >3 log10 CFUs). The NaClO protocol sterilized surgical masks, and disinfected KN95 and cloth masks. Steam bags sterilized KN95 and disinfected surgical and cloth masks. No relevant impact was observed on filtration efficiency.

Zinc Oxide Nanoparticle-Loaded Electrospun Polyvinylidene Fluoride Nanofibers as a Potential Face Protector against Respiratory Viral Infections

ZnO-NPs loaded polyvinylidene fluoride (PVDF) composite nanofibers were fabricated by electrospinning and optimized using different concentrations (0, 2, and 5 wt %) of ZnO-NPs. Characterization techniques, for example, FTIR, SEM, XRD, and tensile strength analysis were performed to analyze the composite nanofibers. Molecular docking calculations were performed to evaluate the binding affinity of PVDF and ZnO@PVDF against the hexon protein of adenovirus (PDB ID: 6CGV). The cytotoxicity of tested materials was evaluated using MTT assay, and nontoxic doses subjected to antiviral evaluation against human adenovirus type-5 as a human respiratory model were analyzed using quantitative polymerase chain reaction assay. IC50 values were obtained at concentrations of 0, 2, and 5% of ZnO-loaded PVDF; however, no cytotoxic effect was detected for the nanofibers. In 5% ZnO-loaded PVDF nanofibers, both the viral entry and its replication were inhibited in both the adsorption and virucidal antiviral mechanisms, making it a potent antiviral filter/mask. Therefore, ZnO-loaded PVDF nanofiber is a potentially prototyped filter embedded in a commercial face mask for use as an antiviral mask with a pronounced potential to reduce the spreading of infectious respiratory diseases, for example, COVID-19 and its analogues.

Decontamination of disposable respirators for reuse in a pandemic employing in-situ-generated peracetic acid

BACKGROUND

During shortages of filtering face pieces (FFP) in a pandemic, it is necessary to implement a method for safe reuse or extended use. Our aim was to develop a simple, inexpensive and ecological method for decontamination of disposable FFPs that preserves filtration efficiency and material integrity.

MATERIAL AND METHODS

Contamination of FFPs (3M Aura 9320+) with SARS-CoV-2 (1.15 × 10⁴ PFUs), Enterococcus faecium (>10⁶ CFUs), and physiological nasopharyngeal flora was performed prior to decontamination by submersion in a solution of 6 % acetic acid and 6 % hydrogen peroxide (6%AA/6%HP solution) over 30 minutes. Material integrity was assessed by testing the filtering efficiency, loss of fit and employing electron microscopy.

RESULTS AND DISCUSSION

Decontamination with the 6%AA/6%HP solution resulted in the complete elimination of SARS-CoV-2, E. faecium and physiological nasopharyngeal flora. Material characterization post-treatment showed neither critical material degradation, loss of fit or reduction of filtration efficiency. Electron microscopy revealed no damage to the fibers, and the rubber bands' elasticity was not affected by the decontamination procedure. No concerning residuals of the decontamination procedure were found.

CONCLUSION

The simple application and widespread availability of 6%AA/6%HP solution for decontaminating disposable FFPs make this solution globally viable, including developing and third world countries.

Ultraviolet-C Irradiation, Heat, and Storage as Potential Methods of Inactivating SARS-CoV-2 and Bacterial Pathogens on Filtering Facepiece Respirators

The arrival of SARS-CoV-2 to Aotearoa/New Zealand in February 2020 triggered a massive response at multiple levels. Procurement and sustainability of medical supplies to hospitals and clinics during the then upcoming COVID-19 pandemic was one of the top priorities. Continuing access to new personal protective equipment (PPE) was not guaranteed; thus, disinfecting and reusing PPE was considered as a potential alternative. Here, we describe part of a local program intended to test and implement a system to disinfect PPE for potential reuse in New Zealand. We used filtering facepiece respirator (FFR) coupons inoculated with SARS-CoV-2 or clinically relevant multidrug-resistant pathogens (Acinetobacter baumannii Ab5075, methicillin-resistant Staphylococcus aureus USA300 LAC and cystic-fibrosis isolate Pseudomonas aeruginosa LESB58), to evaluate the potential use of ultraviolet-C germicidal irradiation (UV-C) or dry heat treatment to disinfect PPE. An applied UV-C dose of 1000 mJ/cm2 was sufficient to completely inactivate high doses of SARS-CoV-2; however, irregularities in the FFR coupons hindered the efficacy of UV-C to fully inactivate the virus, even at higher UV-C doses (2000 mJ/cm2). Conversely, incubating contaminated FFR coupons at 65 °C for 30 min or 70 °C for 15 min, was sufficient to block SARS-CoV-2 replication, even in the presence of mucin or a soil load (mimicking salivary or respiratory secretions, respectively). Dry heat (90 min at 75 °C to 80 °C) effectively killed 106 planktonic bacteria; however, even extending the incubation time up to two hours at 80 °C did not completely kill bacteria when grown in colony biofilms. Importantly, we also showed that FFR material can harbor replication-competent SARS-CoV-2 for up to 35 days at room temperature in the presence of a soil load. We are currently using these findings to optimize and establish a robust process for decontaminating, reusing, and reducing wastage of PPE in New Zealand.

Management of donations of personal protective equipment in response to the massive shortage during the COVID-19 health crisis: providing quality equipment to health care workers

Background

In the COVID-19 pandemic context, a massive shortage of personal protective equipment occurred. To increase the available stocks, several countries appealed for donations from individuals or industries. While national and international standards to evaluate personal protective equipment exist, none of the previous research studied how to evaluate personal protective equipment coming from donations to healthcare establishments. Our aim was to evaluate the quality and possible use of the personal protective equipment donations delivered to our health care establishment in order to avoid a shortage and to protect health care workers throughout the COVID-19 crisis.

Methods

Our intervention focused on evaluation of the quality of donations for medical use through creation of a set of assessment criteria and analysis of the economic impact of these donations.

Results

Between 20th March 2020 and 11th May 2020, we received 239 donations including respirators, gloves, coveralls, face masks, gowns, hats, overshoes, alcohol-based hand rubs, face shields, goggles and aprons. A total of 448,666 (86.3%) products out of the 519,618 initially received were validated and distributed in health care units, equivalent to 126 (52.7%) donations out of the 239 received. The budgetary value of the validated donations was 32,872 euros according to the pre COVID-19 prices and 122,178 euros according to the current COVID-19 prices, representing an increase of 371.7%.

Conclusions

By ensuring a constant influx of personal protective equipment and proper stock management, shortages were avoided. Procurement and distribution of controlled and validated personal protective equipment is the key to providing quality care while guaranteeing health care worker safety.

Exploring Reusability of Disposable Face Masks: Effects of Disinfection Methods on Filtration Efficiency, Breathability, and Fluid Resistance

To curb the spread of the COVID-19 virus, the use of face masks such as disposable surgical masks and N95 respirators is being encouraged and even enforced in some countries. The widespread use of masks has resulted in global shortages and individuals are reusing them. This calls for proper disinfection of the masks while retaining their protective capability. In this study, the killing efficiency of ultraviolet-C (UV-C) irradiation, dry heat, and steam sterilization against bacteria (Staphylococcus aureus), fungi (Candida albicans), and nonpathogenic virus (Salmonella virus P22) is investigated. UV-C irradiation for 10 min in a commercial UV sterilizer effectively disinfects surgical masks. N95 respirators require dry heat at 100 °C for hours while steam treatment works within 5 min. To address the question on safe reuse of the disinfected masks, their bacteria filtration efficiency, particle filtration efficiency, breathability, and fluid resistance are assessed. These performance factors are unaffected after 5 cycles of steam (10 min per cycle) and 10 cycles of dry heat at 100 °C (40 min per cycle) for N95 respirators, and 10 cycles of UV-C irradiation for surgical masks (10 min per side per cycle). These findings provide insights into formulating the standard procedures for reusing masks without compromising their protective ability.

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.

Standard hospital blanket warming cabinets can be utilized for complete moist heat SARS-CoV2 inactivation of contaminated N95 masks for re-use

Shortages of personal protective equipment for use during the SARS-CoV-2 pandemic continue to be an issue among health-care workers globally. Extended and repeated use of N95 filtering facepiece respirators without adequate decontamination is of particular concern. Although several methods to decontaminate and re-use these masks have been proposed, logistic or practical issues limit adoption of these techniques. In this study, we propose and validate the use of the application of moist heat (70 °C with humidity augmented by an open pan of water) applied by commonly available hospital (blanket) warming cabinets to decontaminate N95 masks. This report shows that a variety of N95 masks can be repeatedly decontaminated of SARS-CoV-2 over 6 h moist heat exposure without compromise of their filtering function as assessed by standard fit and sodium chloride aerosol filtration efficiency testing. This approached can easily adapted to provide point-of-care N95 mask decontamination allowing for increased practical utility of mask recycling in the health care setting.

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.

Research on Dry Microwave Heating Infectious Aerosols or Droplets on Respirators

Dramatic shortages of filtering facepiece respirator supplies generally occur following the outbreak of a pandemic such as COVID-19. Here, the decontamination and reuse of respirators are considered. Among decontamination methods, microwave irradiation has great potential because of easy access of microwave ovens. However, can a respirator be heated in a microwave oven for a certain time and then be reused? Herein, we demonstrate that dry microwave irradiation cannot heat infectious aerosols or droplets up to their deactivation temperature. The microwave absorption performance of a single aerosol or droplet was analyzed theoretically. The multiphysics simulation results indicate that a single aerosol or droplet can be barely heated under dry microwave irradiation. Experiments were carried out using a traveling wave system to verify the simulation. Following this, we simulated multiple aerosols and droplets on a respirator material, with the results indicating that the aerosols and droplets were at the same temperature as that of the respirator. Experimental measurements using a microwave oven demonstrated that the temperature increase of an N95 respirator under dry heating is less than 10 °C, which is far less than the temperature required to deactivate the COVID-19 virus. Although dry microwave heating cannot be used to heat the aerosols or droplets, microwave-generated steam has proved effective in deactivating infectious biological organisms. Therefore, to successfully decontaminate a used respirator in a microwave oven, a reservoir with a small amount of water beneath the respirator (or a steam bag to accommodate it) is essential to the decontamination process.

Mask decontamination methods (model N95) for respiratory protection: a rapid review

BACKGROUND

N95 respiratory protection masks are used by healthcare professionals to prevent contamination from infectious microorganisms transmitted by droplets or aerosols.

METHODS

We conducted a rapid review of the literature analyzing the effectiveness of decontamination methods for mask reuse. The database searches were carried out up to September 2020. The systematic review was conducted in a way which simplified the stages of a complete systematic review, due to the worldwide necessity for reliable fast evidences on this matter.

RESULTS

A total of 563 articles were retrieved of which 48 laboratory-based studies were selected. Fifteen decontamination methods were included in the studies. A total of 19 laboratory studies used hydrogen peroxide, 21 studies used ultraviolet germicidal irradiation, 4 studies used ethylene oxide, 11 studies used dry heat, 9 studies used moist heat, 5 studies used ethanol, two studies used isopropanol solution, 11 studies used microwave oven, 10 studies used sodium hypochlorite, 7 studies used autoclave, 3 studies used an electric rice cooker, 1 study used cleaning wipes, 1 study used bar soap, 1 study used water, 1 study used multi-purpose high-level disinfection cabinet, and another 1 study used chlorine dioxide. Five methods that are promising are as follows: hydrogen peroxide vapor, ultraviolet irradiation, dry heat, wet heat/pasteurization, and microwave ovens.

CONCLUSIONS

We have presented the best available evidence on mask decontamination; nevertheless, its applicability is limited due to few studies on the topic and the lack of studies on real environments.

Monitoring SARS-CoV-2 decontamination by dry heat and ultraviolet treatment with a swine coronavirus as a surrogate

The critical need for reliable methods to validate decontamination protocols for personal protective equipment (PPE) for re-use during the SARS-CoV-2 pandemic is limited by the need for specialized containment facilities to handle the virus. Hence, we have herein validated the use of a swine coronavirus as a surrogate, and tested the effectiveness of dry heat and ultraviolet (UV) rays for PPE decontamination. Exposure of experimentally contaminated N95 masks and hospital gowns to 60°C for 20 min, and UVC at 1800 mJ/cm² resulted in a 4-log reduction and inactivation of the surrogate virus. This study provides a novel alternative to validate PPE reprocessing methods.

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.

Heat and Humidity for Bioburden Reduction of N95 Filtering Facepiece Respirators

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused a global shortage of single-use N95 filtering facepiece respirators (FFRs). A combination of heat and humidity is a promising method for N95 FFR decontamination in crisis-capacity conditions; however, an understanding of its effect on viral inactivation and N95 respirator function is crucial to achieving effective decontamination. Objective: We reviewed the scientific literature on heat-based methods for decontamination of N95 FFRs contaminated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and viral analogues. We identified key parameters for SARS-CoV-2 bioburden reduction while preserving N95 fit and filtration, as well as methods that are likely ineffective. Key Findings: Viral inactivation by humid heat is highly sensitive to temperature, humidity, duration of exposure, and the local microenvironment (e.g., dried saliva). A process that achieves temperatures of 70-85°C and relative humidity >50% for at least 30 min is likely to inactivate SARS-CoV-2 (>3-log reduction) on N95 respirators while maintaining fit and filtration efficiency for three to five cycles. Dry heat is significantly less effective. Microwave-generated steam is another promising approach, although less studied, whereas 121°C autoclave treatments may damage some N95 FFRs. Humid heat will not inactivate all microorganisms, so reprocessed N95 respirators should be reused only by the original user. Conclusions: Effective bioburden reduction on N95 FFRs during the COVID-19 pandemic requires inactivation of SARS-CoV-2 and preservation of N95 fit and filtration. The literature suggests that humid heat protocols can achieve effective bioburden reduction. Proper industrial hygiene, biosafety controls, and clear protocols are required to reduce the risks of N95 reprocessing and reuse.

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

BACKGROUND

Considering the new SARS-CoV-2 pandemic and the potential scarcity of material resources, the reuse of personal protective equipment such as filtering facepiece respirators (FFRs) for N95 filtering or higher is being discussed, mainly regarding the effectiveness and safety of cleaning, disinfection and sterilization processes.

AIM

To analyze the available evidence in the literature on the safety in processing FFRs.

METHODS

A systematic review conducted by searching for studies in the following databases: PubMed, CINAHL, LILACS, CENTRAL, EMBASE, Web of Science, and Scopus.

RESULTS

Forty studies were included in this review. The disinfectant/sterilizing agents most frequently tested at different concentrations and exposure periods were ultraviolet irradiation, vaporized hydrogen peroxide and steam sterilization. Microbial reduction was assessed in 21 (52.5%) studies. The only disinfectants/sterilizers that did not caused degradation of the material-integrity were alcohol, electric cooker, ethylene oxide, and peracetic acid fogging. Exposure to ultraviolet irradiation or microwave generated-steam resulted in a nonsignificant reduction in filter performance.

CONCLUSION

There is a complex relationship between the FFR raw materials and the cycle conditions of the decontamination methods, evidencing the need for validating FFRs by models and manufacturers, as well as the process. Some methods may require additional tests to demonstrate the safety of FFRs for use due to toxicity.

PPE decontamination to overcome PPE shortage in rural area during pandemic

Despite remarkable developments in healthcare, the world was not ready to stop the spread of the novel COVID-19 pandemic almost a century after the great influenza pandemic. The explosive increase in the number of patients stalled the healthcare system, and the first and apparent issue was the shortage of personal protective equipment (PPE). Our group established a system using a hydrogen peroxide vaporization method to decontaminate and reuse N95 respirators for healthcare workers. The system decontaminated over 12,000 units of PPE to cover institutions in West Texas. This service provided support at the most needed time during the pandemic.

Promotion of Surgical Masks Antimicrobial Activity by Disinfection and Impregnation with Disinfectant Silver Nanoparticles

BACKGROUND

The COVID-19 pandemic is requesting highly effective protective personnel equipment, mainly for healthcare professionals. However, the current demand has exceeded the supply chain and, consequently, shortage of essential medical materials, such as surgical masks. Due to these alarming limitations, it is crucial to develop effective means of disinfection, reusing, and thereby applying antimicrobial shielding protection to the clinical supplies.

PURPOSE

Therefore, in this work, we developed a novel, economical, and straightforward approach to promote antimicrobial activity to surgical masks by impregnating silver nanoparticles (AgNPs).

METHODS

Our strategy consisted of fabricating a new alcohol disinfectant formulation combining special surfactants and AgNPs, which is demonstrated to be extensively effective against a broad number of microbial surrogates of SARS-CoV-2.

RESULTS

The present nano-formula reported a superior microbial reduction of 99.999% against a wide number of microorganisms. Furthermore, the enveloped H5N1 virus was wholly inactivated after 15 min of disinfection. Far more attractive, the current method for reusing surgical masks did not show outcomes of detrimental amendments, suggesting that the protocol does not alter the filtration effectiveness.

CONCLUSION

The nano-disinfectant provides a valuable strategy for effective decontamination, reuse, and even antimicrobial promotion to surgical masks for frontline clinical personnel.

A Practical Approach to Filtering Facepiece Respirator Decontamination and Reuse: Ultraviolet Germicidal Irradiation

Purpose of review

Prior outbreaks of respiratory viruses have demonstrated the need for adequate personal protective equipment (PPE) for healthcare workers, particularly filtering facepiece respirators (FFR). Due to shortfalls of PPE during the SARS CoV-2 pandemic, the need for FFR decontamination and reuse (FFR-DR) strategies is paramount. This paper aims to discuss primary decontamination strategies, with an in-depth analysis of ultraviolet germicidal irradiation (UVGI), arriving at the decontamination strategy utilized at the Nebraska Medical Center (NMC).

Methods

Review of the primary literature in regard to FFR-DR as well as a synopsis of the current protocol for FFR-DR at NMC.

Recent findings

UVGI demonstrates effective decontamination of multiple pathogens-including several human respiratory viruses-while maintaining mask integrity and filtering capacity. UVGI was associated with degradation of strap integrity at higher doses than that utilized for decontamination or with reuse beyond 20 times.

Summary

UVGI effectively decontaminates N95 FFRs without significant reduction to fit or strap integrity and can be employed as a strategy for FFR-DR in times of emergency.

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.

Is it possible to decontaminate N95 masks in pandemic times? integrative literature review

OBJECTIVE

To evaluate the protocols on decontamination/reuse of N95 masks available in the literature in times of the Covid-19 pandemic.

METHOD

Integrative literature review, in the period from 2010 to 2020, on the databases MEDLINE/PubMed, Science Direct, Cochrane, SAGE journals, Web of Science, Scopus, Embase and Wiley, with the descriptors Masks AND Respiratory protective devices; Mask OR N95 AND Covid-19; N95 AND Respirators; Decontamination AND N95 AND Coronavirus; Facemask OR Pandemic.

RESULTS

Twelve studies were included, of which 3 (30.0%) used ultraviolet germicidal irradiation and indicated mask deterioration between 2 and 10 cycles, 4 (40.0%) used hydrogen peroxide vapor, and seal loss varied from 5 to 20 cycles, 4 (33.3%) evaluated the structural integrity of the N95 mask through visual inspection and 6 (54.4%), its filtration efficiency.

CONCLUSION

Reuse strategies to overcome a shortage of devices in the face of the pandemic challenge the current concept for good practices in health-product processing.

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.

Decontamination of N95 and surgical masks using a treatment based on a continuous gas phase-Advanced Oxidation Process

A gas-phase Advanced Oxidation Process (gAOP) was evaluated for decontaminating N95 and surgical masks. The continuous process was based on the generation of hydroxyl-radicals via the UV-C (254 nm) photo-degradation of hydrogen peroxide and ozone. The decontamination efficacy of the gAOP was dependent on the orientation of the N95 mask passing through the gAOP unit with those positioned horizontally enabling greater exposure to hydroxyl-radicals compared to when arranged vertically. The lethality of gAOP was independent of the applied hydrogen peroxide concentration (2-6% v/v) but was significantly (P<0.05) higher when H2O2 was introduced into the unit at 40 ml/min compared to 20 ml/min. A suitable treatment for N95 masks was identified as 3% v/v hydrogen peroxide delivered into the gAOP reactor at 40 ml/min with continuous introduction of ozone gas and a UV-C dose of 113 mJ/cm2 (30 s processing time). The treatment supported >6 log CFU decrease in Geobacillus stearothermophilus endospores, > 8 log reduction of human coronavirus 229E, and no detection of Escherichia coli K12 on the interior and exterior of masks. There was no negative effect on the N95 mask fitting or particulate efficacy after 20 passes through the gAOP system. No visual changes or hydrogen peroxide residues were detected (<1 ppm) in gAOP treated masks. The optimized gAOP treatment could also support >6 log CFU reduction of endospores inoculated on the interior or exterior of surgical masks. G. stearothermophilus Apex spore strips could be applied as a biological indicator to verify the performance of gAOP treatment. Also, a chemical indicator based on the oxidative polymerization of pyrrole was found suitable for reporting the generation of hydroxyl-radicals. In conclusion, gAOP is a verifiable treatment that can be applied to decontaminate N95 and surgical masks without any negative effects on functionality.

Inactivation of Human Coronavirus by FATHHOME's Dry Sanitizer Device: Rapid and Eco-Friendly Ozone-Based Disinfection of SARS-CoV-2

The pandemic of SARS-CoV-2/COVID-19 was reported in December 2019 in Wuhan, China. Pertaining to its high transmissibility and wide host adaptability, this unique human coronavirus spread across the planet inflicting 115 million people and causing 2.5 million deaths (as of March 3rd, 2021). Limited or negligible pre-existing immunity to multiple SARS-CoV-2 variants has resulted in severe morbidity and mortality worldwide, as well as a record-breaking surge in the use of medical-surgical supplies and personal protective equipment. In response to the global need for effective sterilization techniques, this study evaluated the virucidal efficacy of FATHHOME's self-contained, ozone-based dry-sanitizing device, by dose and time response assessment. We tested inactivation of human coronavirus, HCoV-OC43, a close genetic model of SARS-CoV-2, on porous (N95 filtering facepiece respirator/FFR) and nonporous (glass) surfaces. We started our assays with 20 ppm-10 min ozone exposure, and effectively reduced 99.8% and 99.9% of virus from glass and N95 FFR surfaces, respectively. Importantly, the virus was completely inactivated, below the detection limit (over 6-log10 reduction) with 25 ppm-15 min ozone exposure on both tested surfaces. As expected, a higher ozone exposure (50 ppm-10 min) resulted in faster inactivation of HCoV-OC43 with 100% inactivation from both the surfaces, with no residual ozone present after completion of the 5-min post exposure recapture cycle and no measurable increase in ambient ozone levels. These results confirmed that FATHHOME's device is suitable for rapid decontamination of SARS-CoV-2- from worn items, frequently touched items, and PPE including N95 FFRs, face shields, and other personal items.

Decontamination Strategies for Filtering Facepiece Respirators (FFRs) in Healthcare Organizations: A Comprehensive Review

Filtering facepiece respirators (FFRs) are made for one-time use. A massive shortage of FFRs is widespread during pandemic events and has forced many healthcare organizations to decontaminate them and re-use for a limited time. Many decontamination methods have been proposed for the decontamination of FFRs. This review highlights various aspects of decontamination methods available in the literature. Among various methods available, vaporized hydrogen peroxide, ultraviolet irradiation, and dry heat seem to be the most promising decontaminants for FFRs. On the other hand, microwave, bleach, ethylene oxide, alcohol, hydrogen peroxide liquid, sanitizing wipes, and soap and water are not recommended methods for FFR decontamination.

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.

Graphene: A Disruptive Opportunity for COVID-19 and Future Pandemics?

The graphene revolution, which has taken place during the last 15 years, has represented a paradigm shift for science. The extraordinary properties possessed by this unique material have paved the road to a number of applications in materials science, optoelectronics, energy, and sensing. Graphene-related materials (GRMs) are now produced in large scale and have found niche applications also in the biomedical technologies, defining new standards for drug delivery and biosensing. Such advances position GRMs as novel tools to fight against the current COVID-19 and future pandemics. In this regard, GRMs can play a major role in sensing, as an active component in antiviral surfaces or in virucidal formulations. Herein, the most promising strategies reported in the literature on the use of GRM-based materials against the COVID-19 pandemic and other types of viruses are showcased, with a strong focus on the impact of functionalization, deposition techniques, and integration into devices and surface coatings.

Comparative evaluation of four hydrogen peroxide-based systems to decontaminate N95 respirators

Objective:

Protocols designed to facilitate N95 filtering facepiece respirator (FFR) decontamination by commercial sterilization devices do not recommend that operators verify the device’s performance against pathogens deposited on FFRs. Here, we compared the treatment efficacy of 4 hydrogen peroxide-based systems that were authorized for N95 decontamination during the COVID-19 pandemic.

Methods:

Suspensions prepared from S. aureus ATCC 29213 and 44300, B. subtilis ATCC 6633, a vancomycin-resistant E. faecium isolate (VRE), E. coli ATCC 25922, and P. aeruginosa ATCC 27853 colonies were inoculated onto nine 1-cm² areas on a 3M 1805, 1860, 1860S, 1870+, 8210, 8110S, or 9105S FFR. Contaminated respirators were treated according to protocols recommended by the STERRAD 100NX, Bioquell Z-2, Sterizone VP4, or Clēan Works Mini systems. Decontamination efficacy was determined by comparing colony counts cultured from excised segments of treated and untreated FFR.

Results:

All devices achieved a 6-log reduction in bacterial burden and met FDA sterilization criteria. The Bioquell Z-2 device demonstrated 100% efficacy against both gram-positive and gram-negative organisms with all FFRs tested. Colonies of S. aureus ATCC 29213 and 44300 and VRE were cultivable from up to 9 (100%) of 9 STERRAD 100NX– and Sterizone VP4–treated segments. Viable B. subtilis ATCC 6633 organisms were recovered from 76.0% of STERRAD 100NX–treated FFR segments.

Conclusions:

Variability in decontamination efficacy was noted across devices and FFR types. gram-positive organisms were more difficult to completely eliminate than were gram-negative organisms. Prior to initiating FFR decontamination practices, institutions should verify the effectiveness of their devices and the safety of treated FFR.

Decontamination of N95 respirators against SARS-CoV-2: A scoping review

OBJECTIVES

This scoping review aimed to map and compile the available evidence regarding the effectiveness of decontaminating N95 respirators against the novel coronavirus (SARS-CoV-2).

DATA

We selected studies written in English assessing or discussing the decontamination strategies of N95 respirators against SARS-CoV-2. Two independent researchers performed the search and study screening. A descriptive analysis was carried out considering the study design of the included studies.

SOURCES

PubMed, SCOPUS, and Preprint platforms (bioRxiv and medRxiv).

STUDY SELECTION

We included 55 reports from PubMed and SCOPUS. Nine articles were letters to the editors, 21 were in vitro studies, 16 were literature reviews, and 9 were classified as other study designs. We included 37 preprints. Two articles were letters to the editors, 24 were in vitro studies, 3 were literature reviews, and 8 were classified as other study designs. In general, vaporized hydrogen peroxide and ultraviolet irradiation were the strategies most cited and most promising. However, there is a lack of evidence and consensus related to the best method of N95 respirator decontamination.

CONCLUSION

The evidence regarding decontamination strategies of N95 respirators against SARS-CoV-2 remains scarce. Vaporized hydrogen peroxide and ultraviolet irradiation seem to be the current standard for N95 respirator decontamination.

CLINICAL SIGNIFICANCE

Vaporized hydrogen peroxide and ultraviolet irradiation appear to be the most promising methods for N95 respirator decontamination.

Reusability of filtering facepiece respirators after decontamination through drying and germicidal UV irradiation

Introduction

During pandemics, such as the SARS-CoV-2, filtering facepiece respirators plays an essential role in protecting healthcare personnel. The recycling of respirators is possible in case of critical shortage, but it raises the question of the effectiveness of decontamination as well as the performance of the reused respirators.

Method

Disposable respirators were subjected to ultraviolet germicidal irradiation (UVGI) treatment at single or successive doses of 60 mJ/cm² after a short drying cycle (30 min, 70°C). The germicidal efficacy of this treatment was tested by spiking respirators with two staphylococcal bacteriophages (vB_HSa_2002 and P66 phages). The respirator performance was investigated by the following parameters: particle penetration (NaCl aerosol, 10–300 nm), scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry and mechanical tensile tests.

Results

No viable phage particles were recovered from any of the respirators after decontamination (log reduction in virus titre >3), and no reduction in chemical or physical properties (SEM, particle penetrations <5%–6%) were observed. Increasing the UVGI dose 10-fold led to chemical alterations of the respirator filtration media (FTIR) but did not affect the physical properties (particle penetration), which was unaltered even at 3000 mJ/cm² (50 cycles). When respirators had been used by healthcare workers and undergone decontamination, they had particle penetration significantly greater than never donned respirators.

Conclusion

This decontamination procedure is an attractive method for respirators in case of shortages during a SARS pandemic. A successful implementation requires a careful design and particle penetration performance control tests over the successive reuse cycles.

Decontamination of SARS-CoV-2 and Other RNA Viruses from N95 Level Meltblown Polypropylene Fabric Using Heat under Different Humidities

In March of 2020, the World Health Organization declared a pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pandemic led to a shortage of N95-grade filtering facepiece respirators (FFRs), especially surgical-grade N95 FFRs for protection of healthcare professionals against airborne transmission of SARS-CoV-2. We and others have previously reported promising decontamination methods that may be applied to the recycling and reuse of FFRs. In this study we tested disinfection of three viruses, including SARS-CoV-2, dried on a piece of meltblown fabric, the principal component responsible for filtering of fine particles in N95-level FFRs, under a range of temperatures (60-95 °C) at ambient or 100% relative humidity (RH) in conjunction with filtration efficiency testing. We found that heat treatments of 75 °C for 30 min or 85 °C for 20 min at 100% RH resulted in efficient decontamination from the fabric of SARS-CoV-2, human coronavirus NL63 (HCoV-NL63), and another enveloped RNA virus, chikungunya virus vaccine strain 181/25 (CHIKV-181/25), without lowering the meltblown fabric's filtration efficiency.

Decontamination of SARS-CoV-2 and other RNA viruses from N95 level meltblown polypropylene fabric using heat under different humidities

In March of 2020, the World Health Organization declared a pandemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The pandemic led to a shortage of N95-grade filtering facepiece respirators (FFRs), especially for protection of healthcare professionals against airborne transmission of SARS-CoV-2. We and others have previously reported promising decontamination methods that may be applied to the recycling and reuse of FFRs. In this study we tested disinfection of three viruses including SARS-CoV-2, dried on a piece of meltblown fabric, the principal component responsible for filtering of fine particles in N95-level FFRs, under a range of temperatures (60-95°C) at ambient or 100% relative humidity (RH) in conjunction with filtration efficiency testing. We found that heat treatments of 75°C for 30 min or 85°C for 20 min at 100% RH resulted in efficient decontamination from the fabric of SARS-CoV-2, human coronavirus NL63 (HCoV-NL63) and chikungunya virus vaccine strain 181 (CHIKV-181), without lowering the meltblown fabric's filtration efficiency.