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S S Schneider D, de Magalhães AMM, de Oliveira JLC, Costanzi AP, Nora CRD, Trevilato DD. Integrity and filtration efficiency of decontaminated N95/PFF2 masks to protect health care professionals against COVID-19: A systematic literature review and meta-analysis. Am J Infect Control 2024; 52:751-758. [PMID: 38342344 DOI: 10.1016/j.ajic.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/27/2024] [Accepted: 01/31/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND To evaluate the evidence related to maintaining the integrity and filtration efficiency of N95 and/or PFF2 respirators after decontamination in health care professionals' protection against COVID-19. METHODS Systematic review, developed based on the guidelines from Joanna Briggs Institute for syntheses focusing on effectiveness evidence. The protocol was registered on the International Prospective Register of Ongoing Systematic Reviews platform, under the number CRD42022354256. This study report was developed in accordance with the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Publications between January 2020 and August 2022 were selected of Embase, Medline, CINAHL, Web of Science, Cochrane, SciELO and Virtual Health Library databases. Joanna Briggs critical appraisal tool for nonrandomized experimental tests was used to evaluate the evidence quality. RESULTS Seven articles were included in the data extraction and critical evaluation, and 3 in the meta-analysis. Four studies evaluated the integrity by visual inspection and 2 by electron microscopy. There was no association between the number of cycles increase and the reduction in filtration in up to 10 cycles. None study was considered of high methodological quality. CONCLUSIONS There is some evidence that integrity and filtration capacity were maintained after decontamination of N95/PFF2 respirators to prevent COVID-19.
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Affiliation(s)
- Daniela S S Schneider
- PhD in Nursing at the Federal University of Rio Grande do Sul (UFRGS), Master in Genetics and Toxicology, Specialist in Operations Management for Health, Nursing Manager of the Central sterile services department (CSSD) of the Hospital de Clínicas de Porto Alegre (HCPA), Member of the Center for Nursing Management Studies (NEGE), Porto Alegre, Rio Grande do Sul, Brazil; PhD student in Nursing at the Federal University of Rio Grande do Sul (UFRGS), Master in Health Teaching, Nurse Assistant of the Surgical Center department of the Hospital Moinhos de Vento (RS), Assistant Professor of the Undergraduate Nursing Course of the Moinhos de Vento Health Sciences College, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ana M M de Magalhães
- Director of the School of Nursing of the Federal University of Rio Grande do Sul (UFRGS), Associate Professor of the Department of Assistance and Professional Orientation, DAOP, Permanent Professor of the Postgraduate Program in Nursing (PPGENF-UFRGS), Coordinator of the Center for Nursing Management Studies (NEGE), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Joao L C de Oliveira
- Adjunct Professor, Department of Assistance and Professional Guidance, DAOP of the School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Assistant Professor of the Service of Clinical Nursing of the Nursing Department of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | | | - Carlise R D Nora
- Adjunct Professor, Department of Assistance and Professional Guidance, DAOP, School of Nursing, Federal University of Rio Grande do Sul (UFRGS), Advisory Professor at the Nursing Service in Surgical Center (SECC) of the Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Denilse D Trevilato
- PhD student in Nursing at the Federal University of Rio Grande do Sul (UFRGS), Master in Health Teaching, Nurse Assistant of the Surgical Center department of the Hospital Moinhos de Vento (RS), Assistant Professor of the Undergraduate Nursing Course of the Moinhos de Vento Health Sciences College, Porto Alegre, Rio Grande do Sul, Brazil.
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Sekhar SC, Pabba M, Tallam A, Fatima S, Butti SK, Vani B, Sahu N, Sundergopal S. Development of a reusable low-cost facemask with a recycled hydrophobic layer for preventive health care. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:36325-36336. [PMID: 36547833 PMCID: PMC9773657 DOI: 10.1007/s11356-022-24807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
The current work focuses on designing a low-cost, reusable, and highly efficient facemask for protection from respiratory droplets that cause COVID-19, other infection-causing organisms, and dust allergies. Several masks available in the market are single-use that would choke the environment through plastic pollution or are expensive for the commoner to afford. In the present study, the facemask incorporates a waste-derived polyethylene terephthalate (PET) layer and a non-woven polypropylene (PP) layer sandwiched between two tightly woven cotton layers. Combining these layers provides comfort and breathability, besides high bacterial and particulate filtration efficiency. Moreover, the unique PET layer provides mechanical strength and a 3D shape that enables hindrance-free speaking and prevents spectacle fogging. Compared to commercial N95 masks, the developed mask can be reused up to 30 washes and recycled with zero waste discharge ensuing green technology. Moreover, the mask was produced at an affordable cost of Rs. 17 (0.22 USD), including labor charges, and sold at a 100% profit margin @ Rs.35 (0.45 USD) per unit. Further, the mask was certified by neutral testing agencies and provided to a population of more than 6 lakhs, thus significantly contributing to the mitigation of COVID-19.
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Affiliation(s)
- Sugali Chandra Sekhar
- Membrane Separations Laboratory, PETT Department, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Manideep Pabba
- Membrane Separations Laboratory, PETT Department, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
| | - Aarti Tallam
- Membrane Separations Laboratory, PETT Department, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
| | - Saeed Fatima
- Membrane Separations Laboratory, PETT Department, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
| | - Sai Kishore Butti
- Membrane Separations Laboratory, PETT Department, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
| | - Bukke Vani
- Membrane Separations Laboratory, PETT Department, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
| | - Nivedita Sahu
- Membrane Separations Laboratory, PETT Department, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India
| | - Sridhar Sundergopal
- Membrane Separations Laboratory, PETT Department, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500 007, India.
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India.
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Turgeon N, Pagé M, Robillard J, Goulet V, Bahloul A, Brochot C, Saidi MN, Dumont-Leblond N, Duchaine C. Filtration performance, fit test and side effects of respiratory personal protective equipment following decontamination: Observations for user safety and comfort. PLoS One 2023; 18:e0280426. [PMID: 36689487 PMCID: PMC9870121 DOI: 10.1371/journal.pone.0280426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE While facing personal protective equipment (PPE) shortages during the COVID-19 pandemic, several institutions looked to PPE decontamination and reuse options. This study documents the effect of two hydrogen peroxide treatments on filtration efficiency and fit tests as well as the side effects for volunteers after the decontamination of N95 filtering facepiece respirators (FFRs). We also propose an efficient and large-scale treatment protocol that allows for the traceability of this protective equipment in hospitals during PPE shortages. METHODS The effects of low-temperature hydrogen peroxide sterilization and hydrogen peroxide vapor (HPV) on two FFR models (filtration, decontamination level, residual emanation) were evaluated. Ten volunteers reported comfort issues and side effects after wearing 1h FFRs worn and decontaminated up to five times. RESULTS The decontamination process does not negatively affect FFR efficiency, but repeated use and handling tend to lead to damage, limiting the number of times FFRs can be reused. Moreover, the recommended 24-h post-treatment aeration does not sufficiently eliminate residual hydrogen peroxide. Prolonged aeration time increased user comfort when using decontaminated FFRs. CONCLUSIONS HPV and low-temperature hydrogen peroxide sterilization seem to be appropriate treatments for FFR decontamination when the PPE is reused by the same user. PPE decontamination and reuse methods should be carefully considered as they are critical for the comfort and safety of healthcare workers.
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Affiliation(s)
- Nathalie Turgeon
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval, Quebec City, Quebec, Canada
| | - Mélissa Pagé
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval, Quebec City, Quebec, Canada
| | - Justin Robillard
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval, Quebec City, Quebec, Canada
| | - Véronique Goulet
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval, Quebec City, Quebec, Canada
| | - Ali Bahloul
- Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, Montreal, Quebec, Canada
- Department of Building, Civil and Environmental Engineering, Concordia University, Montreal, Quebec, Canada
| | - Clothilde Brochot
- Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, Montreal, Quebec, Canada
- Department of Building, Civil and Environmental Engineering, Concordia University, Montreal, Quebec, Canada
| | - Mohamed Nejib Saidi
- Institut de Recherche Robert-Sauvé en Santé et en Sécurité du Travail, Montreal, Quebec, Canada
| | - Nathan Dumont-Leblond
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval, Quebec City, Quebec, Canada
| | - Caroline Duchaine
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval, Quebec City, Quebec, Canada
- Département de Biochimie, de Microbiologie et de Bio-informatique, Faculté des Sciences et de Génie, Université Laval, Quebec City, Quebec, Canada
- Canada Research Chair on Bioaerosols, Quebec City, QC, Canada
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Cooper J, Csapó A, Ranasinghe R, Jeronimo M, Brockington-Tyhy T, Alawfi S, Wong T. Filtration performance of three models of N95 filtering facepiece respirators following clinical usage and vaporized hydrogen peroxide decontamination. J Hosp Infect 2023; 131:122-125. [PMID: 36272553 DOI: 10.1016/j.jhin.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND N95 filtering facepiece respirators (FFRs) are essential personal protective equipment (PPE) for protecting healthcare workers from airborne pathogens. AIM To perform the first large-scale evaluation of particulate filtration efficiency (PFE) of three models of N95 FFRs following clinical usage and vaporized hydrogen peroxide (VHP) decontamination. METHODS Three variables were assessed for effect on PFE following VHP decontamination: VHP sterilizer model, N95 respirator model, and prior N95 clinical usage. FINDINGS The VHP sterilizer model and N95 FFR model impacted PFE performance. Worn N95 FFRs had a 91% lower odds of exhibiting ≥95% PFE compared with the control. CONCLUSION This work highlights the importance of validating any N95 FFR decontamination programme in its entirety, including prior clinical usage.
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Affiliation(s)
- J Cooper
- VCH People Safety, Vancouver Coastal Health Authority, Vancouver, BC, Canada; VCH PPE Testing Laboratory, Vancouver, BC, Vancouver Coastal Health Authority, Vancouver, BC, Canada.
| | - A Csapó
- VCH Medical Device Reprocessing Department, Vancouver, BC, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - R Ranasinghe
- Provincial Infection Control Network of BC (PICNet), Vancouver, BC, Canada
| | - M Jeronimo
- School of Population and Public Health, Occupational and Environmental Health, University of British Columbia, Vancouver, BC, Canada
| | - T Brockington-Tyhy
- VCH PPE Testing Laboratory, Vancouver, BC, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - S Alawfi
- VCH Infection Prevention and Control, Vancouver Coastal Health Authority, Vancouver, BC, Canada
| | - T Wong
- VCH PPE Testing Laboratory, Vancouver, BC, Vancouver Coastal Health Authority, Vancouver, BC, Canada; VCH Quality, Patient Safety, Risk, and Infection Prevention and Control, Vancouver, BC, Canada; Department of Pathology & Laboratory Medicine, UBC, Vancouver Coastal Health Authority, Vancouver, BC, Canada
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Aerosolized Hydrogen Peroxide Decontamination of N95 Respirators, with Fit-Testing and Viral Inactivation, Demonstrates Feasibility for Reuse during the COVID-19 Pandemic. mSphere 2022; 7:e0030322. [PMID: 36040048 PMCID: PMC9599425 DOI: 10.1128/msphere.00303-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In response to the demand for N95 respirators by health care workers during the COVID-19 pandemic, we evaluated decontamination of N95 respirators using an aerosolized hydrogen peroxide (aHP) system. This system is designed to dispense a consistent atomized spray of aerosolized, 7% hydrogen peroxide (H2O2) solution over a treatment cycle. Multiple N95 respirator models were subjected to 10 or more cycles of respirator decontamination, with a select number periodically assessed for qualitative and quantitative fit testing. In parallel, we assessed the ability of aHP treatment to inactivate multiple viruses absorbed onto respirators, including phi6 bacteriophage, herpes simplex virus 1 (HSV-1), coxsackievirus B3 (CVB3), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For pathogens transmitted via respiratory droplets and aerosols, it is critical to address respirator safety for reuse. This study provided experimental validation of an aHP treatment process that decontaminates the respirators while maintaining N95 function. External National Institute for Occupational Safety & Health (NIOSH) certification verified respirator structural integrity and filtration efficiency after 10 rounds of aHP treatment. Virus inactivation by aHP was comparable to the decontamination of commercial spore-based biological indicators. These data demonstrate that the aHP process is effective, with successful fit-testing of respirators after multiple aHP cycles, effective decontamination of multiple virus species, including SARS-CoV-2, successful decontamination of bacterial spores, and filtration efficiency maintained at or greater than 95%. While this study did not include extended or clinical use of N95 respirators between aHP cycles, these data provide proof of concept for aHP decontamination of N95 respirators before reuse in a crisis-capacity scenario. IMPORTANCE The COVID-19 pandemic led to unprecedented pressure on health care and research facilities to provide personal protective equipment. The respiratory nature of the SARS-CoV2 pathogen makes respirator facepieces a critical protective measure to limit inhalation of this virus. While respirator facepieces were designed for single use and disposal, the pandemic increased overall demand for N95 respirators, and corresponding manufacturing and supply chain limitations necessitated the safe reuse of respirators when necessary. In this study, we repurposed an aerosolized hydrogen peroxide (aHP) system that is regularly utilized to decontaminate materials in a biosafety level 3 (BSL3) facility, to develop a method for decontamination of N95 respirators. Results from viral inactivation, biological indicators, respirator fit testing, and filtration efficiency testing all indicated that the process was effective at rendering N95 respirators safe for reuse. This proof-of-concept study establishes baseline data for future testing of aHP in crisis-capacity respirator-reuse scenarios.
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Sung YJ, Song S, Sim SJ. A Rapid and High-Throughput Assay for Light Scattering of SARS-CoV-2 Virion-Sized Particulates via Microfluidic Spray Device Reveals the Protection Performance of Face Masks against Virus Infection. NANO LETTERS 2022; 22:6744-6752. [PMID: 35930264 DOI: 10.1021/acs.nanolett.2c02278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To prevent interhuman transmission of viruses, new mask types─claiming improved filtration─require careful performance characterization. Here, a microfluidic spray device that can effectively simulate droplets emitted during coughing or sneezing was developed to spray droplets containing gold nanoparticles (AuNPs) that mimic SARS-CoV-2 to overcome the shortcomings associated with using biosamples. The light scattered by the AuNPs passing through the mask is successfully analyzed by using an automated scattering light mapping system within a duration of 2 min, thereby enabling high-throughput analysis of the filtering efficiency of various types of commercial masks. The differences in efficiency in terms of same mask type from different manufacturers, double masking, and prolonged usage, which are challenging to analyze with conventional testing systems, can also be assessed. AuNP-mediated mask performance evaluation enables the rapid determination of mask efficiency according to particle size and can contribute to the rapid response to counter new emerging infectious biohazards.
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Affiliation(s)
- Young Joon Sung
- Department of Chemical and Biological Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sojin Song
- Department of Chemical and Biological Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Sang Jun Sim
- Department of Chemical and Biological Engineering, Korea University, 145, Anam-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Laatikainen K, Mesilaakso M, Kulmala I, Mäkelä E, Ruutu P, Lyytikäinen O, Tella S, Humppi T, Salo S, Haataja T, Helminen K, Karppinen H, Kähkönen H, Vainiola T, Blomqvist K, Laitinen S, Peltonen K, Laaksonen M, Ristimäki T, Koivisto J. Large-scale decontamination of disposable FFP2 and FFP3 respirators by hydrogen peroxide vapour, Finland, April to June 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35301980 PMCID: PMC8971915 DOI: 10.2807/1560-7917.es.2022.27.11.2100119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The shortage of FFP2 and FFP3 respirators posed a serious threat to the operation of the healthcare system at the onset of the COVID-19 pandemic. Aim Our aim was to develop and validate a large-scale facility that uses hydrogen peroxide vapour for the decontamination of used respirators. Methods A multidisciplinary and multisectoral ad hoc group of experts representing various organisations was assembled to implement the collection and transport of used FFP2 and FFP3 respirators from hospitals covering 86% of the Finnish population. A large-scale decontamination facility using hydrogen peroxide vapour was designed and constructed. Microbiological tests were used to confirm efficacy of hydrogen peroxide vapour decontamination together with a test to assess the effect of decontamination on the filtering efficacy and fit of respirators. Bacterial and fungal growth in stored respirators was determined by standard methods. Results Large-scale hydrogen peroxide vapour decontamination of a range of FFP2 and FFP3 respirator models effectively reduced the recovery of biological indicators: Geobacillus stearothermophilus and Bacillus atrophaeus spores, as well as model virus bacteriophage MS2. The filtering efficacy and facial fit after hydrogen peroxide vapour decontamination were not affected by the process. Microbial growth in the hydrogen peroxide vapour-treated respirators indicated appropriate microbial cleanliness. Conclusions Large-scale hydrogen peroxide vapour decontamination was validated. After effective decontamination, no significant changes in the key properties of the respirators were detected. European Union regulations should incorporate a facilitated pathway to allow reuse of appropriately decontaminated respirators in a severe pandemic when unused respirators are not available.
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Affiliation(s)
- Katri Laatikainen
- LAB University of Applied Science, Lappeenranta and Lahti, Finland.,Department of Separation Science, Lappeenranta-Lahti University of Technology LUT, Lappeenranta, Finland
| | | | - Ilpo Kulmala
- VTT Technical Research Centre of Finland Ltd, Espoo and Tampere, Finland
| | - Erja Mäkelä
- Finnish Institute of Occupational Health, Helsinki, Kuopio and Oulu, Finland
| | - Petri Ruutu
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Susanna Tella
- LAB University of Applied Science, Lappeenranta and Lahti, Finland
| | - Tarmo Humppi
- Finnish Defense Research Agency, Ylöjärvi, Finland
| | - Satu Salo
- VTT Technical Research Centre of Finland Ltd, Espoo and Tampere, Finland
| | | | | | - Henri Karppinen
- LAB University of Applied Science, Lappeenranta and Lahti, Finland
| | - Heli Kähkönen
- Finnish Institute of Occupational Health, Helsinki, Kuopio and Oulu, Finland
| | | | - Kirsimarja Blomqvist
- LUT School of Business and Management, Lappeenranta-Lahti University of Technology LUT, Lappeenranta, Finland
| | - Sirpa Laitinen
- Finnish Institute of Occupational Health, Helsinki, Kuopio and Oulu, Finland
| | - Kati Peltonen
- LAB University of Applied Science, Lappeenranta and Lahti, Finland
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Falaise C, Bouvattier C, Larigauderie G, Lafontaine V, Berchebru L, Marangon A, Vaude-Lauthier V, Raynaud F, Taysse L. Hydrogen Peroxide Vapor Decontamination of Hazard Group 3 Bacteria and Viruses in a Biosafety Level 3 Laboratory. APPLIED BIOSAFETY 2022; 27:15-22. [PMID: 36032319 PMCID: PMC9402245 DOI: 10.1089/apb.2021.0022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aim This study aimed to validate the efficacy of hydrogen peroxide vapor (HPV) decontamination technology set up in a biosafety level 3 (BSL-3) laboratory on surrogates and hazard group 3 (HG3) agents. Methods and Results The HPV decontamination system (Bioquell) was assessed with both qualitative and quantitative methods on (1) spore surrogates (Geobacillus stearothermophilus, Bacillus atrophaeus, and Bacillus thuringiensis) in the BSL-3 laboratory and in the material airlock and on (2) HG3 agents (Bacillus anthracis; SARS-CoV-2, Venezuelan equine encephalitis virus [VEE], and Vaccinia virus) in the BSL-3 laboratory. Other HG3 bacteria likely to be handled in the BSL-3 laboratory (Yersinia pestis, Burkholderia mallei, Brucella melitensis, and Francisella tularensis) were excluded from the HPV decontamination assays as preliminary viability tests demonstrated the total inactivation of these agents after 48 h drying on different materials. Conclusions The efficacy of HPV decontamination was validated with a reduction in viability of 5-7 log10 for the spores (surrogates and B. anthracis), and for the enveloped RNA viruses. Vaccinia showed a higher resistance to the decontamination process, being dependent on the biological indicator location in the BSL-3 laboratory.
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Affiliation(s)
- Charlotte Falaise
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France.,Address correspondence to: Charlotte Falaise, DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit 91710, France,
| | - Cécile Bouvattier
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France
| | - Guilhem Larigauderie
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France
| | - Valérie Lafontaine
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France
| | - Laurent Berchebru
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France
| | - Audrey Marangon
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France
| | - Valérie Vaude-Lauthier
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France
| | - Françoise Raynaud
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France
| | - Laurent Taysse
- DGA CBRN Defence Center, Biology Division, French Ministry of the Armed Forces, Vert-le-Petit, France
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Levine H, Baranchuk N, Li T, Garra G, Nagarajan MS, Garg N. An emergency medicine physician well-being study focusing on gender differences and years of practice during the COVID-19 pandemic. Am J Emerg Med 2022; 55:84-88. [PMID: 35287093 PMCID: PMC8891117 DOI: 10.1016/j.ajem.2022.02.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/22/2022] [Accepted: 02/26/2022] [Indexed: 12/20/2022] Open
Affiliation(s)
- Heidi Levine
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America.
| | - Nadia Baranchuk
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America.
| | - Timmy Li
- North Shore University Hospital/Northwell Health Zucker School of Medicine, 300 Community Drive, Manhasset, NY 11030, United States of America.
| | - Gabrielle Garra
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America
| | - Mohanapriya Sayeen Nagarajan
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America.
| | - Nidhi Garg
- South Shore University Hospital, Department of Emergency Medicine, 301 East Main Street, Bay Shore, New York 11706, United States of America.
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Berger D, Gundermann G, Sinha A, Moroi M, Goyal N, Tsai A. Review of aerosolized hydrogen peroxide, vaporized hydrogen peroxide, and hydrogen peroxide gas plasma in the decontamination of filtering facepiece respirators. Am J Infect Control 2022; 50:203-213. [PMID: 34182069 PMCID: PMC8233052 DOI: 10.1016/j.ajic.2021.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to over 170?million cases worldwide with over 33.2?million cases and 594,000 deaths in the US alone as of May 31st, 2021. The pandemic has also created severe shortages of personal protective equipment, particularly of filtering facepiece respirators (FFRs). The Centers for Disease Control and Prevention (CDC) has issued recommendations to help conserve FFRs, as well as crisis standards, including four criteria required for decontamination of the traditionally single use respirators. This review is designed to provide an overview of the current literature on vaporized hydrogen peroxide (vHP), hydrogen peroxide gas plasma (HPGP), and aerosolized hydrogen peroxide (aHP) with respect to each of the four CDC decontamination criteria. METHODS PubMed and Medrxiv were queried for relevant articles. All articles underwent a title and abstract screen as well as subsequent full text screen by two blinded reviewers if indicated. RESULTS Searches yielded 195 papers, of which, 79 were found to be relevant. Of those, 23 papers presented unique findings and 8 additional articles and technical papers were added to provide a comprehensive review. Overall, while there are potential concerns for all 3 decontamination methods, we found that vHP has the most evidence supporting its use in FFR decontamination consistent with CDC recommendation. CONCLUSIONS Future research is recommended to evaluate biological inactivation and real world fit failures after FFR reuse.
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Affiliation(s)
| | | | | | - Morgan Moroi
- Penn State College of Medicine, Hershey, PA,Division of Cardiac, Thoracic, and Vascular Surgery, Department of Surgery, New York-Presbyterian Hospital/Columbia University Medical Center, New York, NY
| | | | - Anthony Tsai
- Penn State College of Medicine, Hershey, PA,Address correspondence to Anthony Tsai, MD, Mail Code H113, 500 University Drive P.O. Box 850, Hershey, PA 17033
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11
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Lynch JB, Davitkov P, Anderson DJ, Bhimraj A, Cheng VCC, Guzman-Cottrill J, Dhindsa J, Duggal A, Jain MK, Lee GM, Liang SY, McGeer A, Varghese J, Lavergne V, Murad MH, Mustafa RA, Sultan S, Falck-Ytter Y, Morgan RL. Infectious Diseases Society of America Guidelines on Infection Prevention for Healthcare Personnel Caring for Patients with Suspected or Known COVID-19. Clin Infect Dis 2021:ciab953. [PMID: 34791102 PMCID: PMC8767890 DOI: 10.1093/cid/ciab953] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Since its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators. OBJECTIVE Develop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19. METHODS IDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations. RESULTS The IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included. CONCLUSIONS Using a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.
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Affiliation(s)
- John B Lynch
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington
| | - Perica Davitkov
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Deverick J Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University School of Medicine, Durham, North Carolina
| | - Adarsh Bhimraj
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, Ohio
| | - Vincent Chi-Chung Cheng
- Queen Mary Hospital, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Judith Guzman-Cottrill
- Department of Pediatrics, Division of Infectious Diseases, Oregon Health and Science University, Portland, Oregon
| | | | - Abhijit Duggal
- Department of Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Mamta K Jain
- Department of Internal Medicine, Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas
| | - Grace M Lee
- Department of Pediatrics-Infectious Disease, Stanford University School of Medicine, Stanford, California
| | - Stephen Y Liang
- Division of Infectious Diseases and Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, University of Toronto, Toronto, Ontario
| | - Jamie Varghese
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
| | - Valery Lavergne
- Department of Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Shahnaz Sultan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Yngve Falck-Ytter
- VA Northeast Ohio Healthcare System, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario
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12
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Stokes K, Peltrini R, Bracale U, Trombetta M, Pecchia L, Basoli F. Enhanced Medical and Community Face Masks with Antimicrobial Properties: A Systematic Review. J Clin Med 2021; 10:4066. [PMID: 34575177 PMCID: PMC8472488 DOI: 10.3390/jcm10184066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 01/04/2023] Open
Abstract
Face masks help to limit transmission of infectious diseases entering through the nose and mouth. Beyond reprocessing and decontamination, antimicrobial treatments could extend the lifetime of face masks whilst also further reducing the chance of disease transmission. Here, we review the efficacy of treatments pertaining antimicrobial properties to medical face masks, filtering facepiece respirators and non-medical face masks. Searching databases identified 2113 studies after de-duplication. A total of 17 relevant studies were included in the qualitative synthesis. Risk of bias was found to be moderate or low in all cases. Sixteen articles demonstrated success in avoiding proliferation (if not elimination) of viruses and/or bacteria. In terms of methodology, no two articles employed identical approaches to efficacy testing. Our findings highlight that antimicrobial treatment is a promising route to extending the life and improving the safety of face masks. In order to reach significant achievements, shared and precise methodology and reporting is needed.
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Affiliation(s)
- Katy Stokes
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK;
| | - Roberto Peltrini
- Department of Public Health, Federico II University Hospital, 80131 Naples, Italy;
| | - Umberto Bracale
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy;
| | - Marcella Trombetta
- Department of Engineering, University Campus Bio-Medico di Roma, 00128 Rome, Italy;
| | - Leandro Pecchia
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK;
| | - Francesco Basoli
- Department of Engineering, University Campus Bio-Medico di Roma, 00128 Rome, Italy;
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13
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Probst LF, Guerrero ATG, Cardoso AIDQ, Grande AJ, Croda MG, Venturini J, Fonseca MCDC, Paniago AMM, Barreto JOM, de Oliveira SMDVL. Mask decontamination methods (model N95) for respiratory protection: a rapid review. Syst Rev 2021; 10:219. [PMID: 34364396 PMCID: PMC8349237 DOI: 10.1186/s13643-021-01742-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 06/13/2021] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Livia Fernandes Probst
- Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Ana Tereza Gomes Guerrero
- Institute of Technology in Immunobiologicals: Bio-Manguinhos. Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Antonio Jose Grande
- Faculty of Medicine , State University of Mato Grosso do Sul, Campo Grande, Brazil
| | | | - James Venturini
- Federal University of Mato Grosso do Sul , Campo Grande, Brazil
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Schumm MA, Hadaya JE, Mody N, Myers BA, Maggard-Gibbons M. Filtering Facepiece Respirator (N95 Respirator) Reprocessing: A Systematic Review. JAMA 2021; 325:1296-1317. [PMID: 33656543 DOI: 10.1001/jama.2021.2531] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Max A Schumm
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Joseph E Hadaya
- Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California
| | - Nisha Mody
- Louise M. Darling Biomedical Library, UCLA Library, University of California, Los Angeles
| | - Bethany A Myers
- Louise M. Darling Biomedical Library, UCLA Library, University of California, Los Angeles
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