Assessing Mask Integrity and Fit of N95 Masks after 5 Cycles of Decontamination and Reuse in a Simulated Clinical Setting

Aim: To evaluate the effect of decontamination and reuse on N95 masks. Background(s): The coronavirus disease (COVID-19) pandemic has strained the global availability of masks. Such shortage represents a threat to healthcare workers (HCWs). Mask reprocessing and reuse may alleviate the shortage. Many laboratory studies have proven the effectiveness and feasibility of decontaminating N95 masks. However, very few had HCWs wearing them between cycles of decontamination. Our study evaluated mask integrity (assessed by qualitative mask fitting [QMF], as well as technical measures like bacterial filtration efficacy [BFE]) through five cycles of decontamination using four different modalities - steam, moist heat (MH), UV-C irradiation (UVCI), and hydrogen peroxide vaporization (HPV). Method(s): Each study cycle involved a HCW wearing a N95 mask for two hours, followed by the assigned decontamination process, and then a QMF. This was repeated for a maximum of 5 cycles, as long as the wearer passed QMF. 40 HCWs were recruited for each of the four decontamination modalities. The technical measures of mask integrity assessed were: BFE, Particulate Filtration Efficiency (PFE), Pressure Drop and Splash Resistance. Result(s): 60.6% (HPV) to 77.5% (MH) of the masks passed five cycles of wear and decontamination, as assessed by the wearers passing QMF all five times. MH-decontaminated masks retained all technical measures of integrity through all 5 cycles. HPV reduced masks' BFE after the fourth cycle while UVCI tended to increase the Pressure Drop. Conclusion(s): The results suggest that MH is a promising method for decontaminating N95 masks without compromising fit and integrity. [Figure presented] [Table presented]Copyright © 2023 Southern Society for Clinical Investigation.

Mentoring in palliative medicine in the time of COVID-19

Background and aim: The COVID-19 pandemic has had significant ramifications upon clinical medical education. Restrictions on in-person face-to-face meetings and the limited mentoring support from redeployed physicians have compromised mentoring relationships and jeopardised mentoring programs in palliative medicine. The evidenced success of combined novice, peer-, near-peer and electronic-mentoring (CNEP) and interprofessional mentoring (IPM), together with palliative medicine's emphasis on interprofessional teamwork for holistic patient care, suggest that the concurrent application of CNEP and IPM (CNEPIPM) may be effective in addressing the continued geographical and manpower constraints in palliative medicine training amidst the COVID- 19 pandemic. This study thus aims to assess the viability and suitability of a CNEP-IPM mentoring approach in palliative medicine. Methods: With little known about this form of mentoring, a systematic scoping review (SSR) was carried out studying published accounts of CNEP and IPM. The Systematic Evidence Based Approach (SEBA) was adopted to enhance the trustworthiness, transparency and reproducibility of SSRs. Results: A total of 15,121 abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Concurrent content and thematic analysis revealed 4 themes/categories: characteristics of CNEP and IPM, stages of CNEP and IPM, the roles of host organizations and assessment methods and criteria. Conclusions: This SSR evidences the viability of a CNEP-IPM approach and forwards an evidence-based framework for the design, implementation and evaluation of a CNEP-IPM mentoring program in palliative medicine. Further prospective studies and research into the program design, mentoring process, complex CNEP-IPM mentoring relationships, and the validation of robust evaluation tools are still required.

N95 respirator decontamination: a study in reusability.

The coronavirus disease 2019 (COVID-19) pandemic had caused a severe depletion of the worldwide supply of N95 respirators. The development of methods to effectively decontaminate N95 respirators while maintaining their integrity is crucial for respirator regeneration and reuse. In this study, we systematically evaluated five respirator decontamination methods using vaporized hydrogen peroxide (VHP) or ultraviolet (254 nm wavelength, UVC) radiation. Through testing the bioburden, filtration, fluid resistance, and fit (shape) of the decontaminated respirators, we found that the decontamination methods using BioQuell VHP, custom VHP container, Steris VHP, and Sterrad VHP effectively inactivated Cardiovirus (3-log10 reduction) and bacteria (6-log10 reduction) without compromising the respirator integrity after 2-15 cycles. Hope UVC system was capable of inactivating Cardiovirus (3-log10 reduction) but exhibited relatively poorer bactericidal activity. These methods are capable of decontaminating 10-1000 respirators per batch with varied decontamination times (10-200 min). Our findings show that N95 respirators treated by the previously mentioned decontamination methods are safe and effective for reuse by industry, laboratories, and hospitals.