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Vimieiro VL, Vimieiro CBS, de Oliveira AC. Reuse of N95/PFF2 masks in clinical practice: morphological and structural analysis. Rev Lat Am Enfermagem 2024; 32:e4209. [PMID: 38985043 PMCID: PMC11251686 DOI: 10.1590/1518-8345.7045.4209] [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: 09/05/2023] [Accepted: 02/25/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE to analyze the integrity of N95/PFF2 masks in relation to fiber morphology, porosity, cracks and micro holes, as well as identify visible damage to their structure and components, after seven- and fifteen-day reuse protocols. METHOD cross-sectional study. Structural and morphological characteristics of a new N95/PFF2 mask were analyzed in comparison with N95/PFF2 masks (n=10) used in seven- and fifteen-day protocols, through visual inspection and scanning electron microscopy. RESULTS upon visual inspection, following the seven-day protocol, 40% and 60% of the N95/PFF2 masks showed, respectively, personal identification marks and external and internal dirt. Additionally, 20% exhibited loosening and/or tearing of the straps, while 100% showed some type of damage to the nose clips. In the fifteen-day protocol, all N95/PFF2 masks had dirt, loose straps and damaged nose clips, and 80% had folds. Electronic microscopy revealed an increase in pores and loosening in the weaves from seven days onwards, extending up to fifteen days, with the presence of micro holes and residues. CONCLUSION the reuse of N95/PFF2 masks affects their structural and morphological integrity. It is crucial to carry out tests to measure the impact of this practice on the safety of health professionals.
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Affiliation(s)
- Viviane Lopes Vimieiro
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
- Scholarship holder at the Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil
| | - Claysson Bruno Santos Vimieiro
- Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, MG, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Fakherpour A, Jahangiri M, Jansz J. A systematic review of passing fit testing of the masks and respirators used during the COVID-19 pandemic: Part 1-quantitative fit test procedures. PLoS One 2023; 18:e0293129. [PMID: 37883443 PMCID: PMC10602271 DOI: 10.1371/journal.pone.0293129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND During respiratory infection pandemics, masks and respirators are highly sought after, especially for frontline healthcare workers and patients carrying respiratory viruses. The objective of this study was to systematically review fit test pass rates and identify factors influencing the fitting characteristics. METHODS Potentially relevant studies were identified using PubMed, Scopus, Web of Science, and Science Direct during the COVID-19 pandemic from February 5, 2020, to March 21, 2023. The search strategy using the following keywords was conducted: Quantitative Fit Test, Condensation Nuclei Counter, Controlled Negative Pressure, PortaCount, Sibata, Accufit, Fit, Seal, Mask, Respirator, Respiratory Protective Device, Respiratory Protective Equipment, Protective Device, Personal Protective Equipment, COVID-19, Coronavirus, and SARS-CoV-2. The quality of the included studies was also assessed using the Newcastle-Ottawa scale. RESULTS A total of 137 articles met the eligibility criteria. Fifty articles had a quality score of less than 7 (good quality). A total of 21 studies had a fit test pass rate of less than 50%. 26 studies on disposable respirators and 11 studies on reusable respirators had an FF of less than 50 and less than 200, respectively. The most influential factors include respirator brand/model, style, gender, ethnicity, facial dimensions, facial hair, age, reuse, extensive movement, seal check, comfort and usability assessment, and training. CONCLUSION 37.36% of the disposable respirator studies and 43% of the reusable respirator studies did not report fit test results. 67.86% of the disposable respirator studies had a fit test pass rate greater than 50%, and 35.84% of these studies had an FF greater than 100. Also, 85.71% of the reusable respirator studies had a fit test pass rate greater than 50%, and 52.77% of these studies had an FF greater than 1000. Overall, the fit test pass rate was relatively acceptable. Newly developed or modified respirators must undergo reliable testing to ensure the protection of HCWs. Subject and respirator characteristics should be considered when implementing fit testing protocols. An optimal fit test panel should be developed prior to respirator design, certification, procurement decisions, and selection procedures.
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Affiliation(s)
- Anahita Fakherpour
- Student Research Committee, Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Jahangiri
- Department of Occupational Health and Safety Engineering, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Janis Jansz
- School of Mines: Minerals, Energy and Chemical Engineering, Faculty of Science and Engineering, Curtin University, Perth, Australia
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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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Winkler ML, Hooper DC, Shenoy ES. Infection Prevention and Control of Severe Acute Respiratory Syndrome Coronavirus 2 in Health Care Settings. Infect Dis Clin North Am 2022; 36:309-326. [PMID: 35636902 PMCID: PMC8806155 DOI: 10.1016/j.idc.2022.01.001] [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: 01/25/2023]
Abstract
The authors describe infection prevention and control approaches to severe acute respiratory syndrome coronavirus 2 in the health care setting, including a review of the chain of transmission and the hierarchy of controls, which are cornerstones of infection control and prevention. The authors also discuss lessons learned from nosocomial transmission events.
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Affiliation(s)
- Marisa L. Winkler
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA,Corresponding author. Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA, 02114
| | - David C. Hooper
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Erica S. Shenoy
- Infection Control Unit, Massachusetts General Hospital, 55 Fruit Street, Bulfinch 334, Boston, MA 02114, USA,Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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Cadnum JL, Pearlmutter BS, Li DF, Jencson AL, Scott JG, Charnas IC, Donskey CJ. Evaluation of 2 Ultraviolet-C Light Boxes for Decontamination of N95 Respirators. Pathog Immun 2021; 6:104-115. [PMID: 34136729 PMCID: PMC8201793 DOI: 10.20411/pai.v6i1.432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/10/2021] [Indexed: 12/20/2022] Open
Abstract
Background: Ultraviolet-C (UV-C) light devices are effective in reducing contamination on N95 filtering facepiece respirators. However, limited information is available on whether UV-C devices meet the Food and Drug Administration's (FDA) microbiological requirements for Emergency Use Authorization (EUA) for respirator bioburden reduction. Methods: We tested the ability of 2 UV-C light boxes to achieve the 3-log10 microorganism reductions required for EUA for reuse by single users. Whole 3M 1860 or Moldex 1513 respirators were inoculated on the exterior facepiece, interior facepiece, and internal fibers with bacteriophage MS2 and/or 4 strains of bacteria and treated with UV-C cycles of 1 or 20 minutes. Colorimetric indicators were used to assess penetration of UV-C through the respirators. Results: For 1 UV-C box, a 20-minute treatment achieved the required bioburden reduction for Moldex 1513 but not 3M 1860 respirators. For the second UV-C box, a 1-minute treatment achieved the required bioburden reduction in 4 bacterial strains for the Moldex 1513 respirator. Colorimetric indicators demonstrated penetration of UV-C through all layers of the Moldex 1513 respirator but not the 3M 1860 respirator. Conclusions: Our findings demonstrate that UV-C box technologies can achieve bioburden reductions required by the FDA for EUA for single users but highlight the potential for variable efficacy for different types of respirators.
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Affiliation(s)
- Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | | | - Daniel F Li
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Annette L Jencson
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Jacob G Scott
- Cleveland Clinic Lerner Research Institute, Cleveland, Ohio.,Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Ian C Charnas
- Case Western Reserve University School of Engineering and Sears think[box], Cleveland, Ohio
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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