Reuse of Filtering Facepiece Respirators in the COVID-19 Era

The current COVID-19 pandemic has resulted in an immense and unforeseen increase in demand for personal protective equipment (PPE) for healthcare workers worldwide. Amongst other products, respirator masks are crucial to protect the users against transmission of the virus. Decontamination and reuse of the existing stock could be a solution to the shortage of new respirators. Based upon existing studies, it was found that (I) a solid quality control method is essential to test product reuse, (II) in-depth evaluation of the different parts of the filtering facepiece respirator (FFR) should be considered, and (III) communication of the reuse cycle is essential to take track of the amount of reuse, as this is limited to ensure quality. The goal of this paper is two-fold. First, we identify the impact of decontamination on the different parts of the FFRs and how the quality control should be performed. Two different types of FFRs are analysed within this paper, resulting in the recommendation of combining quantitative respirator mask fit testing with a thorough sensory evaluation of decontaminated FFRs to qualify them for reuse. Secondly, the possibilities of communication of this reuse to the eventual user are mapped through in-depth reasoning.

[1]  Dennis J. Viscusi,et al.  Evaluation of Multiple (3-Cycle) Decontamination Processing for Filtering Facepiece Respirators , 2010 .

[2]  M. Key National Institute for Occupational Safety and Health; occupational exposure to inorganic lead: request for comments and information; republication--NIOSH. Request for comments and information relevant to occupational exposure to inorganic lead. , 1997, Federal register.

[3]  C. Donskey,et al.  Effectiveness of Ultraviolet-C Light and a High-Level Disinfection Cabinet for Decontamination of N95 Respirators , 2020, Pathogens & immunity.

[4]  J. Wander,et al.  Analysis of Residual Chemicals on Filtering Facepiece Respirators After Decontamination , 2010, Journal of occupational and environmental hygiene.

[5]  Tiina Reponen,et al.  Performance of an N95 Filtering Facepiece Particulate Respirator and a Surgical Mask During Human Breathing: Two Pathways for Particle Penetration , 2009, Journal of occupational and environmental hygiene.

[6]  Qing-Xia Ma,et al.  Decontamination of face masks with steam for mask reuse in fighting the pandemic COVID‐19: Experimental supports , 2020, Journal of medical virology.

[7]  K. Subbarao,et al.  Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV , 2004, Journal of Virological Methods.

[8]  Jiao Wang,et al.  Disinfection technology of hospital wastes and wastewater: Suggestions for disinfection strategy during coronavirus Disease 2019 (COVID-19) pandemic in China , 2020, Environmental Pollution.

[9]  J. Gardecki,et al.  Vapor H2O2 sterilization as a decontamination method for the reuse of N95 respirators in the COVID-19 emergency , 2020, medRxiv.

[10]  R. Shaffer,et al.  Effect of Decontamination on the Filtration Efficiency of Two Filtering Facepiece Respirator Models , 2008 .

[11]  A. V. D. Eijk,et al.  Sterilization of disposable face masks by means of standardized dry and steam sterilization processes; an alternative in the fight against mask shortages due to COVID-19 , 2020, Journal of Hospital Infection.

[12]  Wen-Yinn Lin,et al.  Filter quality of electret masks in filtering 14.6–594 nm aerosol particles: Effects of five decontamination methods , 2017, PloS one.

[13]  J. Szepietowski,et al.  Increased Prevalence of Face Mask—Induced Itch in Health Care Workers , 2020, Biology.

[14]  Cheng-Ping Chang,et al.  Ethylene oxide sterilization in the medical-supply manufacturing industry: assessment and control of worker exposure. , 2007, Journal of biomedical materials research. Part B, Applied biomaterials.

[15]  H. Ginsberg,et al.  Inactivation of Several Viruses by Liquid Ethylene Oxide , 1950, Proceedings of the Society for Experimental Biology and Medicine. Society for Experimental Biology and Medicine.

[16]  R. Shaffer,et al.  Evaluation of Five Decontamination Methods for Filtering Facepiece Respirators , 2009, The Annals of occupational hygiene.

[17]  Stanley A. Brown,et al.  Residual ethylene oxide in medical devices and device material. , 2003, Journal of biomedical materials research. Part B, Applied biomaterials.

[18]  K. Kortright,et al.  Hydrogen Peroxide Vapor sterilization of N95 respirators for reuse , 2020, medRxiv.

[19]  A. Cramer,et al.  Assessment of the Qualitative Fit Test and Quantitative Single-Pass Filtration Efficiency of Disposable N95 Masks Following Gamma Irradiation , 2020, JAMA network open.

[20]  Qifa Song,et al.  Decontamination of surgical face masks and N95 respirators by dry heat pasteurization for one hour at 70°C , 2020, American Journal of Infection Control.

[21]  L. Poon,et al.  Stability of SARS-CoV-2 in different environmental conditions , 2020, The Lancet Microbe.

[22]  Juliane Junker,et al.  Sterilisation Of Biomaterials And Medical Devices , 2016 .

[23]  S. Chu,et al.  Can N95 Respirators Be Reused after Disinfection? How Many Times? , 2020, ACS nano.

[24]  W. L. Shupert,et al.  Gamma Irradiation as an Effective Method for Inactivation of Emerging Viral Pathogens. , 2019, The American journal of tropical medicine and hygiene.

[25]  Zhipeng Lei,et al.  Recommended test methods and pass/fail criteria for a respirator fit capability test of half-mask air-purifying respirators , 2017, Journal of occupational and environmental hygiene.

[26]  Stephen B Martin,et al.  Effects of Ultraviolet Germicidal Irradiation (UVGI) on N95 Respirator Filtration Performance and Structural Integrity , 2015, Journal of occupational and environmental hygiene.

[27]  R. Evans European Centre for Disease Prevention and Control. , 2014, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[28]  Dennis J. Viscusi,et al.  Impact of Three Biological Decontamination Methods on Filtering Facepiece Respirator Fit, Odor, Comfort, and Donning Ease , 2011, Journal of occupational and environmental hygiene.

[29]  Alex N. Nguyen Ba,et al.  Microwave-Generated Steam Decontamination of N95 Respirators Utilizing Universally Accessible Materials , 2020, mBio.

[30]  T. Huber,et al.  Principles and Practice of SARS-CoV-2 Decontamination of N95 Masks with UV-C , 2020, medRxiv.

[31]  Feng Wang,et al.  Products that go round: exploring product life extension through design , 2014 .

[32]  Wei Wei,et al.  Study on the resistance of severe acute respiratory syndrome-associated coronavirus , 2005, Journal of Virological Methods.

[33]  A. Chin,et al.  Effect of moist heat reprocessing of N95 respirators on SARS-CoV-2 inactivation and respirator function , 2020, Canadian Medical Association Journal.

[34]  J. Lackmann,et al.  Improvement of Biological Indicators by Uniformly Distributing Bacillus subtilis Spores in Monolayers To Evaluate Enhanced Spore Decontamination Technologies , 2016, Applied and Environmental Microbiology.

[35]  S. Prahl,et al.  Effect of various decontamination procedures on disposable N95 mask integrity and SARS-CoV-2 infectivity , 2020, Journal of Clinical and Translational Science.

[36]  N. Bocken,et al.  Product design and business model strategies for a circular economy , 2016 .

[37]  N. Zíková,et al.  Size-Resolved Penetration of Filtering Materials from CE-Marked Filtering Facepiece Respirators , 2017 .

[38]  Yi Cui,et al.  A scalable method of applying heat and humidity for decontamination of N95 respirators during the COVID-19 crisis , 2020, PloS one.

[39]  H. Doerr,et al.  Stability and inactivation of SARS coronavirus , 2004, Medical Microbiology and Immunology.

[40]  G. Kampf,et al.  Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents , 2020, Journal of Hospital Infection.

[41]  Ronald E Shaffer,et al.  Evaluation of the filtration performance of 21 N95 filtering face piece respirators after prolonged storage , 2009, American Journal of Infection Control.

[42]  Shu-An Lee,et al.  Effectiveness of N95 Facepiece Respirators in Filtering Aerosol Following Storage and Sterilization , 2020 .

[43]  T. Moore,et al.  Viruses adsorbed on musculoskeletal allografts are inactivated by terminal ethylene oxide disinfection , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[44]  Urs Pauli,et al.  The Importance of Fit-Testing Particulate Filtering Facepiece Respirators! , 2014 .

[45]  Chang-Yu Wu,et al.  A pandemic influenza preparedness study: use of energetic methods to decontaminate filtering facepiece respirators contaminated with H1N1 aerosols and droplets. , 2011, American journal of infection control.

[46]  G. Gordon,et al.  Chlorine Dioxide: The Current State of the Art , 2005 .