A Practical Approach to Filtering Facepiece Respirator Decontamination and Reuse: Ultraviolet Germicidal Irradiation
Tóm tắt
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). Review of the primary literature in regard to FFR-DR as well as a synopsis of the current protocol for FFR-DR at NMC. 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. 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.
Tài liệu tham khảo
Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: a systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses. 2020;14(4):365–73. https://doi.org/10.1111/irv.12745.
• Mills D, Harnish DA, Lawrence C, Sandoval-Powers M, Heimbuch BK. Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators. Am J Infect Control. 2018;46(7):e49–55. https://doi.org/10.1016/j.ajic.2018.02.018. Comprehensive testing of effectiveness of UVGI decontamination of 15 N95 FFR models when contaminated with influenza and soiling agent.
• Centers for Disease Control and Prevention. Implementing filtering facepiece respirator (FFR) reuse, including reuse after decontamination, when there are known shortages of N95 respirators. 2020; Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html. Accessed 11/10, 2020. CDC strategy for optimizing supply of N95 FFRs in crisis situations.
Kapust PJ. Enforcement guidance for respiratory protection and the N95 shortage due to the coronavirus disease 2019 (COVID-19) pandemic 2020; Available at: https://www.osha.gov/memos/2020-04-03/enforcement-guidance-respiratory-protection-and-n95-shortage-due-coronavirus. Accessed 11/10, 2020.
Emergency Use Authorization (EUA) information, and list of all current EUAs. 2020; Available at: https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization#covidppe. Accessed 11/10, 2020.
Viscusi DJ, Bergman MS, Eimer BC, Shaffer RE. Evaluation of five decontamination methods for filtering facepiece respirators. Ann Occup Hyg. 2009;53(8):815–27. https://doi.org/10.1093/annhyg/mep070.
Lore MB, Heimbuch BK, Brown TL, Wander JD, Hinrichs SH. Effectiveness of three decontamination treatments against influenza virus applied to filtering facepiece respirators. Ann Occup Hyg. 2012;56(1):92–101.
Pascoe MJ, Robertson A, Crayford A, Durand E, Steer J, Castelli A, et al. Dry heat and microwave-generated steam protocols for the rapid decontamination of respiratory personal protective equipment in response to COVID-19-related shortages. J Hosp Infect. 2020;106(1):10–9. https://doi.org/10.1016/j.jhin.2020.07.008.
Widmer AF, Richner G. Proposal for a EN 149 acceptable reprocessing method for FFP2 respirators in times of severe shortage. Antimicrob Resist Infect Control. 2020;9(1):88.
•• Heimbuch B HD. Research to mitigate a shortage of respiratory protection devices during public health emergencies. Report prepared for Food and Drug Administration. Contract number:HHSF223201400158C. 2019; Available at: https://www.ara.com/wp-content/uploads/MitigateShortageofRespiratoryProtectionDevices_3.pdf. Accessed 11/28, 2020. Comprehensive summary of research regarding effectiveness of UVGI decontamination of N95 FFRs.
Heimbuch BK, Kinney K, Lumley AE, Harnish DA, Bergman M, Wander JD. Cleaning of filtering facepiece respirators contaminated with mucin and Staphylococcus aureus. Am J Infect Control. 2014;42(3):265–70. https://doi.org/10.1016/j.ajic.2013.09.014.
NPPTL Respirator Assessments to Support the COVID-19 Response. 2020; Available at: https://www.cdc.gov/niosh/npptl/respirators/testing/default.html. Accessed 11/10, 2020, DOI: https://doi.org/10.1097/QAI.0000000000002609.
Lowe JJ, Paladino KD, Farke JD, Boulter K, Cawcutt K, Emodi M, et al. N95 Filtering facepiece respirator ultraviolet germicidal irradiation (UVGI) process for decontamination and reuse. 2020; Available at: https://www.nebraskamed.com/sites/default/files/documents/covid-19/n-95-decon-process.pdf. Accessed October 19, 2020, DOI: https://doi.org/10.11604/pamj.supp.2020.35.2.22794.
Viscusi DJ, Bergman MS, Novak DA, Faulkner KA, Palmiero A, Powell J, et al. Impact of three biological decontamination methods on filtering facepiece respirator fit, odor, comfort, and donning ease. J Occup Environ Hyg. 2011;8(7):426–36. https://doi.org/10.1080/15459624.2011.585927.
Bergman MS, Viscusi DJ, Heimbuch BK, Wander JD, Sambol AR, Shaffer RE. Evaluation of multiple (3-Cycle) decontamination processing for filtering facepiece respirators. J Eng Fibers Fabr 2010 12/01; 2020/11;5(4):155892501000500405.
Lindsley WG, Martin SB Jr, Thewlis RE, Sarkisian K, Nwoko JO, Mead KR, et al. Effects of ultraviolet germicidal irradiation (UVGI) on N95 respirator filtration performance and structural integrity. J Occup Environ Hyg. 2015;12(8):509–17. https://doi.org/10.1080/15459624.2015.1018518.
Viscusi DJ, King WP, Shaffer RE. Effect of decontamination on the filtration efficiency of two filtering facepiece respirator models. J Int Soc Respir Prot. 2007;24(3/4):93.
O'Hearn K, Gertsman S, Sampson M, Webster R, Tsampalieros A, Ng R, et al. Decontaminating N95 and SN95 masks with ultraviolet germicidal irradiation does not impair mask efficacy and safety. J Hosp Infect. 2020;106(1):163–75. https://doi.org/10.1016/j.jhin.2020.07.014.
Bergman MS, Viscusi DJ, Zhuang Z, Palmiero AJ, Powell JB, Shaffer RE. Impact of multiple consecutive donnings on filtering facepiece respirator fit. Am J Infect Control. 2012;40(4):375–80. https://doi.org/10.1016/j.ajic.2011.05.003.
Degesys NF, Wang RC, Kwan E, Fahimi J, Noble JA, Raven MC. Correlation between N95 extended use and reuse and fit failure in an emergency department. JAMA. 2020;324(1):94–6. https://doi.org/10.1001/jama.2020.9843.
Fisher EM, Shaffer RE. Considerations for recommending extended use and limited reuse of filtering facepiece respirators in health care settings. J Occup Environ Hyg. 2014;11(8):D115–28. https://doi.org/10.1080/15459624.2014.902954.