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1.
Nurs Stand ; 35(5): 45-50, 2020 04 29.
Article in English | MEDLINE | ID: covidwho-1835710

ABSTRACT

Decontamination using hand hygiene remains one of the most important and effective methods for reducing healthcare-associated infections and cross-infection between patients. In 1860, Florence Nightingale wrote that nurses should wash their hands frequently throughout the day, demonstrating an early awareness of the effectiveness of this simple procedure. The COVID-19 pandemic has demonstrated that effectively applied hand hygiene is a vital intervention that can be used to prevent the spread of disease. This article details the correct procedure required for effective hand hygiene and emphasises the need for nurses to keep up to date with evidence-based guidelines. The article also outlines the differences between hand decontamination using alcohol-based hand gels and soap and water, and the complex factors that can interfere with effective hand hygiene compliance.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection , Guideline Adherence , Hand Hygiene , Infection Control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Cross Infection/prevention & control , Hand Disinfection/methods , Humans , Infection Control/methods , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , SARS-CoV-2
2.
Photochem Photobiol Sci ; 20(7): 955-965, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1384775

ABSTRACT

The pandemic created by SARS-CoV-2 has caused a shortage in the supplies of N95 filtering facepiece respirators (FFRs), disposable respirators with at least 95% efficiency to remove non-oily airborne particles, due to increasing cases all over the world. The current article reviewed various possible decontamination methods for FFR reuse including ultraviolet germicidal irradiation (UVGI), hydrogen peroxide vapor (HPV), microwave-generated steam (MGS), hydrogen peroxide gas plasma (HPGP), and 70% or higher ethanol solution. HPV decontamination was effective against bacterial spores (6 log10 reduction of Geobacillus stearothermophilus spores) on FFRs and viruses (> 4 log10 reduction of various types of viruses) on inanimate surfaces, and no degradation of respirator materials and fit has been reported. 70% or higher ethanol decontamination showed high efficacy in inactivation of coronaviruses on inanimate surfaces (> 3.9 log10 reduction) but it was lower on FFRs which filtration efficiency was also decreased. UVGI method had good biocidal efficacy on FFRs (> 3 log10 reduction of H1N1 virus) combined with inexpensive, readily available equipment; however, it was more time-consuming to ensure sufficient reduction in SARS-CoV-2. MGS treatment also provided good viral decontamination on FFRs (> 4 log10 reduction of H1N1 virus) along with less time-intensive process and readily available equipment while inconsistent disinfection on the treated surfaces and deterioration of nose cushion of FFRs were observed. HPGP was a good virucidal system (> 6 log10 reduction of Vesicular stomatitis virus) but filtration efficiency after decontamination was inconsistent. Overall, HPV appeared to be one of the most promising methods based on the high biocidal efficacy on FFRs, preservation of respirator performance after multiple cycles, and no residual chemical toxicity. Nonetheless, equipment cost and time of the HPV process and a suitable operating room need to be considered.


Subject(s)
COVID-19 , Decontamination/methods , N95 Respirators/microbiology , N95 Respirators/virology , Bacteria/drug effects , Bacteria/isolation & purification , Bacteria/radiation effects , COVID-19/epidemiology , Disinfection/methods , Ethanol/pharmacology , Humans , Hydrogen Peroxide/pharmacology , Microwaves , Ultraviolet Rays , Viruses/drug effects , Viruses/isolation & purification , Viruses/radiation effects
3.
BMJ Glob Health ; 5(10)2020 10.
Article in English | MEDLINE | ID: covidwho-1388494

ABSTRACT

INTRODUCTION: During pandemics, such as the SARS-CoV-2, filtering facepiece respirators plays an essential role in protecting healthcare personnel. The recycling of respirators is possible in case of critical shortage, but it raises the question of the effectiveness of decontamination as well as the performance of the reused respirators. METHOD: Disposable respirators were subjected to ultraviolet germicidal irradiation (UVGI) treatment at single or successive doses of 60 mJ/cm2 after a short drying cycle (30 min, 70°C). The germicidal efficacy of this treatment was tested by spiking respirators with two staphylococcal bacteriophages (vB_HSa_2002 and P66 phages). The respirator performance was investigated by the following parameters: particle penetration (NaCl aerosol, 10-300 nm), scanning electron microscopy (SEM), Fourier-transform infrared spectroscopy (FTIR), differential scanning calorimetry and mechanical tensile tests. RESULTS: No viable phage particles were recovered from any of the respirators after decontamination (log reduction in virus titre >3), and no reduction in chemical or physical properties (SEM, particle penetrations <5%-6%) were observed. Increasing the UVGI dose 10-fold led to chemical alterations of the respirator filtration media (FTIR) but did not affect the physical properties (particle penetration), which was unaltered even at 3000 mJ/cm2 (50 cycles). When respirators had been used by healthcare workers and undergone decontamination, they had particle penetration significantly greater than never donned respirators. CONCLUSION: This decontamination procedure is an attractive method for respirators in case of shortages during a SARS pandemic. A successful implementation requires a careful design and particle penetration performance control tests over the successive reuse cycles.


Subject(s)
Decontamination/methods , Equipment Contamination/prevention & control , Equipment Reuse , Respiratory Protective Devices , Ultraviolet Rays , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Equipment Failure Analysis , Humans , Infection Control/methods , Materials Testing , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , SARS-CoV-2
4.
Infect Control Hosp Epidemiol ; 43(7): 876-885, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1275836

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in shortages of personal protective equipment (PPE), underscoring the urgent need for simple, efficient, and inexpensive methods to decontaminate masks and respirators exposed to severe acute respiratory coronavirus virus 2 (SARS-CoV-2). We hypothesized that methylene blue (MB) photochemical treatment, which has various clinical applications, could decontaminate PPE contaminated with coronavirus. DESIGN: The 2 arms of the study included (1) PPE inoculation with coronaviruses followed by MB with light (MBL) decontamination treatment and (2) PPE treatment with MBL for 5 cycles of decontamination to determine maintenance of PPE performance. METHODS: MBL treatment was used to inactivate coronaviruses on 3 N95 filtering facepiece respirator (FFR) and 2 medical mask models. We inoculated FFR and medical mask materials with 3 coronaviruses, including SARS-CoV-2, and we treated them with 10 µM MB and exposed them to 50,000 lux of white light or 12,500 lux of red light for 30 minutes. In parallel, integrity was assessed after 5 cycles of decontamination using multiple US and international test methods, and the process was compared with the FDA-authorized vaporized hydrogen peroxide plus ozone (VHP+O3) decontamination method. RESULTS: Overall, MBL robustly and consistently inactivated all 3 coronaviruses with 99.8% to >99.9% virus inactivation across all FFRs and medical masks tested. FFR and medical mask integrity was maintained after 5 cycles of MBL treatment, whereas 1 FFR model failed after 5 cycles of VHP+O3. CONCLUSIONS: MBL treatment decontaminated respirators and masks by inactivating 3 tested coronaviruses without compromising integrity through 5 cycles of decontamination. MBL decontamination is effective, is low cost, and does not require specialized equipment, making it applicable in low- to high-resource settings.


Subject(s)
COVID-19 , Virus Diseases , COVID-19/prevention & control , Decontamination/methods , Equipment Reuse , Humans , Masks , Methylene Blue/pharmacology , N95 Respirators , Personal Protective Equipment , SARS-CoV-2
5.
Antimicrob Resist Infect Control ; 10(1): 83, 2021 05 29.
Article in English | MEDLINE | ID: covidwho-1247602

ABSTRACT

BACKGROUND: With the current SARS-CoV-2 pandemic, many healthcare facilities are lacking a steady supply of masks worldwide. This emergency situation warrants the taking of extraordinary measures to minimize the negative health impact from an insufficient supply of masks. The decontamination, and reuse of healthcare workers' N95/FFP2 masks is a promising solution which needs to overcome several pitfalls to become a reality. AIM: The overall aim of this article is to provide the reader with a quick overview of the various methods for decontamination and the potential issues to be taken into account when deciding to reuse masks. Ultraviolet germicidal irradiation (UVGI), hydrogen peroxide, steam, ozone, ethylene oxide, dry heat and moist heat have all been methods studied in the context of the pandemic. The article first focuses on the logistical implementation of a decontamination system in its entirety, and then aims to summarize and analyze the different available methods for decontamination. METHODS: In order to have a clear understanding of the research that has already been done, we conducted a systematic literature review for the questions: what are the tested methods for decontaminating N95/FFP2 masks, and what impact do those methods have on the microbiological contamination and physical integrity of the masks? We used the results of a systematic review on the methods of microbiological decontamination of masks to make sure we covered all of the recommended methods for mask reuse. To this systematic review we added articles and studies relevant to the subject, but that were outside the limits of the systematic review. These include a number of studies that performed important fit and function tests on the masks but took their microbiological outcomes from the existing literature and were thus excluded from the systematic review, but useful for this paper. We also used additional unpublished studies and internal communication from the University of Geneva Hospitals and partner institutions. RESULTS: This paper analyzes the acceptable methods for respirator decontamination and reuse, and scores them according to a number of variables that we have defined as being crucial (including cost, risk, complexity, time, etc.) to help healthcare facilities decide which method of decontamination is right for them. CONCLUSION: We provide a resource for healthcare institutions looking at making informed decisions about respirator decontamination. This informed decision making will help to improve infection prevention and control measures, and protect healthcare workers during this crucial time. The overall take home message is that institutions should not reuse respirators unless they have to. In the case of an emergency situation, there are some safe ways to decontaminate them.


Subject(s)
COVID-19/prevention & control , Decontamination/methods , Equipment Reuse , N95 Respirators/standards , SARS-CoV-2 , Ethylene Oxide/pharmacology , Health Personnel , Humans , Hydrogen Peroxide/pharmacology , N95 Respirators/virology , SARS-CoV-2/drug effects , SARS-CoV-2/radiation effects , Steam , Ultraviolet Rays
6.
Curr Treat Options Infect Dis ; 13(2): 35-46, 2021.
Article in English | MEDLINE | ID: covidwho-1173372

ABSTRACT

Purpose of review: 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). Methods: Review of the primary literature in regard to FFR-DR as well as a synopsis of the current protocol for FFR-DR at NMC. Recent findings: 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. Summary: 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.

7.
Photodiagnosis Photodyn Ther ; 33: 102161, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-985387

ABSTRACT

BACKGROUND: Surface decontamination of hospital environments is essential to ensure the safety of health professionals and patients. This process is usually performed through active chemicals substances with high toxicity, and new decontamination technologies that do not leave residues have been currently used, such as UV-C light. Thus, the objective of the present study is to evaluate the effectiveness of a portable UV-C light device on the viability of standard pathogenic strains and other microorganisms isolated from different surfaces of a public health hospital. METHODS: In vitro decontamination was performed by applying Biosept Home© UV-C to Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, Salmonella enterica and Candida albicans. In real conditions, the application was made on different surfaces of a hospital. The device used in the experiment haa a 254 nm UV-C light and a radiation intensity of 45.6 mW/cm2 over a distance of 1 cm from the surfaces. The light dose was 0.912 J/cm2 for 20 s of application in both conditions (in vitro and hospital). RESULTS: After in vitro decontamination with UV-C light no bacterial growth was observed, demonstrating 100 % of bacterial inactivation under the conditions tested. Additionally, there was a reduction of approximately 4 logs for the yeast C. albicans. In all hospital surfaces, the number of colonies of microorganisms was significantly reduced after the procedure. CONCLUSION: The results suggest that Biosept Home© UV-C is efficient and constitutes a promosing intervention for disinfection protocols in hospitals and clinics.


Subject(s)
Decontamination , Photochemotherapy , Disinfection , Hospitals , Humans , Photochemotherapy/methods , Photosensitizing Agents , Ultraviolet Rays
8.
Ther Adv Infect Dis ; 8: 2049936121998548, 2021.
Article in English | MEDLINE | ID: covidwho-1153916

ABSTRACT

BACKGROUND: Cleaning is a major control component for outbreaks of infection. However, for the SARS-CoV-2 pandemic, there is limited specific guidance regarding the proper disinfection methods that should be used. METHODS: We conducted a systematic review of the literature on cleaning, disinfection or decontamination methods in the prevention of SARS-CoV-2. RESULTS: A total of 27 studies were included, reporting a variety of methods with which the effectiveness of interventions were assessed. Virus was inoculated onto different types of material including masks, nasopharyngeal swabs, serum, laboratory plates and simulated saliva, tears or nasal fluid and then interventions were applied in an attempt to eliminate the virus including chemical, ultraviolet (UV) light irradiation, and heat and humidity. At body temperature (37°C) there is evidence that the virus will not be detectable after 2 days but this can be reduced to non-detection at 30 min at 56°C, 15 min at 65°C and 2 min at 98°C. Different experimental methods testing UV light have shown that it can inactivate the virus. Light of 254-365 nm has been used, including simulated sunlight. Many chemical agents including bleach, hand sanitiser, hand wash, soap, ethanol, isopropanol, guandinium thiocynate/t-octylphenoxypolyethoxyethanol, formaldehyde, povidone-iodine, 0.05% chlorhexidine, 0.1% benzalkonium chloride, acidic electrolysed water, Clyraguard copper iodine complex and hydrogen peroxide vapour have been shown to disinfect SARS-CoV-2. CONCLUSIONS: Heating, UV light irradiation and chemicals can be used to inactivate SARS-CoV-2 but there is insufficient evidence to support one measure over others in clinical practice.

9.
Am J Trop Med Hyg ; 104(5): 1703-1708, 2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-1136576

ABSTRACT

With shortages of face masks being reported worldwide, it is critical to consider alternatives to commercially manufactured face masks. This study aimed to test and compare the efficacy of various makes of locally made or homemade cloth face masks obtained from face-mask vendors in Kampala, Uganda, during the COVID-19 pandemic. The testing was performed to assess the bacterial filtration efficiency (BFE), breathability, distance-dependent fitness, and reusability of the locally made or homemade cloth face masks, while considering the most commonly used non-published face-mask decontamination approaches in Uganda. During laboratory experimentation, modified protocols from various face-mask testing organizations were adopted. Ten different face-mask types were experimented upon; each face-mask type was tested four times for every single test, except for the decontamination protocols involving washing where KN95 and surgical face masks were not included. Among the locally made or homemade cloth face masks, the double-layered cloth face masks (described as F) had better BFE and distance-dependent fitness characteristics, they could be reused, and had good breathability, than the other locally made or homemade cloth face masks. Despite these good qualities, the certainty of these face masks protecting wearers against COVID-19 remains subject to viral filtration efficiency testing.


Subject(s)
COVID-19/prevention & control , Masks , SARS-CoV-2 , COVID-19/epidemiology , Humans , Laboratories , Uganda
10.
Infect Control Hosp Epidemiol ; 43(1): 45-47, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1072055

ABSTRACT

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has led to global shortages of N95 respirators. Reprocessing of used N95 respirators may provide a higher filtration crisis alternative, but whether effective sterilization can be achieved for a virus without impairing respirator function remains unknown. We evaluated the viricidal efficacy of Bioquell vaporized hydrogen peroxide (VHP) on contaminated N95 respirators and tested the particulate particle penetration and inhalation and exhalation resistance of respirators after multiple cycles of VHP. METHODS: For this study, 3M 1870 N95 respirators were contaminated with 3 aerosolized bacteriophages: T1, T7, and Pseudomonas phage phi-6 followed by 1 cycle of VHP decontamination using a BQ-50 system. Additionally, new and unused respirators were sent to an independent laboratory for particulate filter penetration testing and inhalation and exhalation resistance after 3 and 5 cycles of VHP. RESULTS: A single VHP cycle resulted in complete eradication of bacteriophage from respirators (limit of detection 10 PFU). Respirators showed acceptable limits for inhalation/exhalation resistance after 3 and 5 cycles of VHP. Respirators demonstrated a filtration efficiency >99 % after 3 cycles, but filtration efficiency fell below 95% after 5 cycles of HPV. CONCLUSION: Bioquell VHP demonstrated high viricidal activity for N95 respirators inoculated with aerosolized bacteriophages. Bioquell technology can be scaled for simultaneous decontamination of a large number of used but otherwise intact respirators. Reprocessing should be limited to 3 cycles due to concerns both about impact of clinical wear and tear on fit, and to decrement in filtration after 3 cycles.


Subject(s)
COVID-19 , Hydrogen Peroxide , Decontamination , Equipment Reuse , Humans , Hydrogen Peroxide/pharmacology , N95 Respirators , SARS-CoV-2
11.
J Hosp Infect ; 108: 113-119, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1014625

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic has caused problems with respirator supplies. Re-use may minimize the impact of the shortage, but requires the availability of an efficient and safe decontamination method. AIM: To determine whether low-temperature-steam-2%-formaldehyde (LTSF) sterilization is effective, preserves the properties of filtering facepiece (FFP) respirators and allows safe re-use. METHODS: Fourteen unused FFP2, FFP3 and N95 respirator models were subjected to two cycles of decontamination cycles. After the second cycle, each model was inspected visually and accumulated residual formaldehyde levels were analysed according to EN 14180. After one and two decontamination cycles, the fit factor (FF) of each model was tested, and penetration tests with sodium chloride aerosols were performed on five models. FINDINGS: Decontamination physically altered three of the 14 models. All of the residual formaldehyde values were below the permissible threshold. Irregular decreases and increases in FF were observed after each decontamination cycle. In the sodium chloride aerosol penetration test, three models obtained equivalent or superior results to those of the FFP classification with which they were marketed, both at baseline and after one and two cycles of decontamination, and two models had lower filtering capacity. CONCLUSION: One and two decontamination cycles using LTSF did not alter the structure of most (11/14) respirators tested, and did not degrade the fit or filtration capacity of any of the analysed respirators. The residual formaldehyde levels complied with EN 14180. This reprocessing method could be used in times of shortage of personal protective equipment.


Subject(s)
Decontamination/methods , Formaldehyde/pharmacology , Respiratory Protective Devices/virology , Sterilization/methods , Adult , Aerosols/adverse effects , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/virology , Equipment Reuse , Formaldehyde/analysis , Humans , Male , Masks/trends , Masks/virology , Personal Protective Equipment/supply & distribution , Respiratory Protective Devices/supply & distribution , SARS-CoV-2/genetics , Sodium Chloride/analysis , Steam/adverse effects , Ventilators, Mechanical/supply & distribution , Ventilators, Mechanical/virology
12.
J Hosp Infect ; 109: 52-57, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-988366

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused a severe shortage of personal protective equipment (PPE), especially N95 respirators. Efficient, effective and economically feasible methods for large-scale PPE decontamination are urgently needed. AIMS: (1) to develop protocols for effectively decontaminating PPE using vaporized hydrogen peroxide (VHP); (2) to develop novel approaches that decrease set-up and take-down time while also increasing decontamination capacity; (3) to test decontamination efficiency for N95 respirators heavily contaminated by make-up or moisturizers. METHODS: We converted a decommissioned Biosafety Level 3 laboratory into a facility that could be used to decontaminate N95 respirators. N95 respirators were hung on metal racks, stacked in piles, placed in paper bags or covered with make-up or moisturizer. A VHP® VICTORY™ unit from STERIS was used to inject VHP into the facility. Biological and chemical indicators were used to validate the decontamination process. FINDINGS: N95 respirators individually hung on metal racks were successfully decontaminated using VHP. N95 respirators were also successfully decontaminated when placed in closed paper bags or if stacked in piles of up to six. Stacking reduced the time needed to arrange N95 respirators for decontamination by approximately two-thirds while almost tripling facility capacity. Make-up and moisturizer creams did not interfere with the decontamination process. CONCLUSIONS: Respirator stacking can reduce the hands-on time and increase decontamination capacity. When personalization is needed, respirators can be decontaminated in labelled paper bags. Make up or moisturizers do not appear to interfere with VHP decontamination.


Subject(s)
COVID-19/prevention & control , Decontamination/methods , Equipment Reuse , N95 Respirators/standards , Decontamination/economics , Humans , Hydrogen Peroxide/pharmacology , N95 Respirators/supply & distribution , SARS-CoV-2 , Volatilization
13.
Lett Appl Microbiol ; 72(4): 366-374, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-991631

ABSTRACT

Decontamination of N95 filtering facepiece respirators (FFRs) is a crisis capacity strategy allowed when there are known shortages of FFRs. The application of moist heat is one decontamination method that has shown promise and is the approach approved in the Steris Steam Emergency Use Authorization (EUA). This effort examines the use of multicookers to apply moist heat, as they are available in retail stores and more affordable than methods requiring more sophisticated equipment. Four of five multicooker models examined met the acceptance criteria for the test and one model was selected for inactivation testing. Tests were performed on four different FFR models with SARS-CoV-2 suspended in culture media, simulated saliva or simulated lung fluid. Moist heat treatment reduced recoverable titres of SARS-CoV-2 virus to levels below the limit of detection in all tests. Furthermore, these four FFR models showed no loss in collection efficiency, inhalation resistance or visual damage after up to 10 decontamination cycles. Two (2) FFR models showed a slight change in strap elasticity (<9%). These data show that moist heat treatment using a multicooker is a viable option for FFR decontamination in a crisis capacity strategy.


Subject(s)
COVID-19/prevention & control , Decontamination/methods , Equipment Reuse , Hot Temperature , N95 Respirators , Humans , SARS-CoV-2/isolation & purification
14.
Exp Biol Med (Maywood) ; 246(6): 740-748, 2021 03.
Article in English | MEDLINE | ID: covidwho-978883

ABSTRACT

Shortages of N95 respirators for use by medical personnel have driven consideration of novel conservation strategies, including decontamination for reuse and extended use. Decontamination methods listed as promising by the Centers for Disease Control and Prevention (CDC) (vaporous hydrogen peroxide (VHP), wet heat, ultraviolet irradiation (UVI)) and several methods considered for low resource environments (bleach, isopropyl alcohol and detergent/soap) were studied for two commonly used surgical N95 respirators (3M™ 1860 and 1870+ Aura™). Although N95 filtration performance depends on the electrostatically charged electret filtration layer, the impact of decontamination on this layer is largely unexplored. As such, respirator performance following decontamination was assessed based on the fit, filtration efficiency, and pressure drop, along with the relationship between (1) surface charge of the electret layer, and (2) elastic properties of the straps. Decontamination with VHP, wet heat, UVI, and bleach did not degrade fit and filtration performance or electret charge. Isopropyl alcohol and soap significantly degraded fit, filtration performance, and electret charge. Pressure drop across the respirators was unchanged. Modest degradation of N95 strap elasticity was observed in mechanical fatigue testing, a model for repeated donnings and doffings. CDC recommended decontamination methods including VHP, wet heat, and UV light did not degrade N95 respirator fit or filtration performance in these tests. Extended use of N95 respirators may degrade strap elasticity, but a loss of face seal integrity should be apparent during user seal checks. NIOSH recommends performing user seal checks after every donning to detect loss of appropriate fit. Decontamination methods which degrade electret charge such as alcohols or detergents should not be used on N95 respirators. The loss of N95 performance due to electret degradation would not be apparent to a respirator user or evident during a negative pressure user seal check.


Subject(s)
COVID-19/prevention & control , Decontamination/methods , N95 Respirators/supply & distribution , 2-Propanol/pharmacology , Detergents/pharmacology , Humans , Hydrogen Peroxide/pharmacology , SARS-CoV-2 , Sodium Hypochlorite/pharmacology , Static Electricity , Ultraviolet Rays
15.
J Int Soc Respir Prot ; 37(2): 71-86, 2020.
Article in English | MEDLINE | ID: covidwho-955110

ABSTRACT

During the current COVID-19 infectious disease pandemic, the demand for NIOSH-approved filtering facepiece respirators (FFR) has exceeded supplies and decontamination and reuse of FFRs has been implemented by various user groups. FFR decontamination and reuse is only intended to be implemented as a crisis capacity strategy. This paper provides a review of decontamination procedures in the published literature and calls attention to their benefits and limitations. In most cases, the data are limited to a few FFR models and a limited number of decontamination cycles. Institutions planning to implement a decontamination method must understand its limitations in terms of the degree of inactivation of the intended microorganisms and the treatment's effects on the fit and filtration of the device.

16.
J Dent ; 104: 103534, 2021 01.
Article in English | MEDLINE | ID: covidwho-943308

ABSTRACT

OBJECTIVES: This scoping review aimed to map and compile the available evidence regarding the effectiveness of decontaminating N95 respirators against the novel coronavirus (SARS-CoV-2). DATA: We selected studies written in English assessing or discussing the decontamination strategies of N95 respirators against SARS-CoV-2. Two independent researchers performed the search and study screening. A descriptive analysis was carried out considering the study design of the included studies. SOURCES: PubMed, SCOPUS, and Preprint platforms (bioRxiv and medRxiv). STUDY SELECTION: We included 55 reports from PubMed and SCOPUS. Nine articles were letters to the editors, 21 were in vitro studies, 16 were literature reviews, and 9 were classified as other study designs. We included 37 preprints. Two articles were letters to the editors, 24 were in vitro studies, 3 were literature reviews, and 8 were classified as other study designs. In general, vaporized hydrogen peroxide and ultraviolet irradiation were the strategies most cited and most promising. However, there is a lack of evidence and consensus related to the best method of N95 respirator decontamination. CONCLUSION: The evidence regarding decontamination strategies of N95 respirators against SARS-CoV-2 remains scarce. Vaporized hydrogen peroxide and ultraviolet irradiation seem to be the current standard for N95 respirator decontamination. CLINICAL SIGNIFICANCE: Vaporized hydrogen peroxide and ultraviolet irradiation appear to be the most promising methods for N95 respirator decontamination.


Subject(s)
COVID-19 , SARS-CoV-2 , Decontamination , Equipment Reuse , Humans , N95 Respirators
17.
Infect Control Hosp Epidemiol ; 42(6): 678-687, 2021 06.
Article in English | MEDLINE | ID: covidwho-932192

ABSTRACT

BACKGROUND: Critical shortages of personal protective equipment, especially N95 respirators, during the coronavirus disease 2019 (COVID-19) pandemic continues to be a source of concern. Novel methods of N95 filtering face-piece respirator decontamination that can be scaled-up for in-hospital use can help address this concern and keep healthcare workers (HCWs) safe. METHODS: A multidisciplinary pragmatic study was conducted to evaluate the use of an ultrasonic room high-level disinfection system (HLDS) that generates aerosolized peracetic acid (PAA) and hydrogen peroxide for decontamination of large numbers of N95 respirators. A cycle duration that consistently achieved disinfection of N95 respirators (defined as ≥6 log10 reductions in bacteriophage MS2 and Geobacillus stearothermophilus spores inoculated onto respirators) was identified. The treated masks were assessed for changes to their hydrophobicity, material structure, strap elasticity, and filtration efficiency. PAA and hydrogen peroxide off-gassing from treated masks were also assessed. RESULTS: The PAA room HLDS was effective for disinfection of bacteriophage MS2 and G. stearothermophilus spores on respirators in a 2,447 cubic-foot (69.6 cubic-meter) room with an aerosol deployment time of 16 minutes and a dwell time of 32 minutes. The total cycle time was 1 hour and 16 minutes. After 5 treatment cycles, no adverse effects were detected on filtration efficiency, structural integrity, or strap elasticity. There was no detectable off-gassing of PAA and hydrogen peroxide from the treated masks at 20 and 60 minutes after the disinfection cycle, respectively. CONCLUSION: The PAA room disinfection system provides a rapidly scalable solution for in-hospital decontamination of large numbers of N95 respirators during the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Decontamination/methods , Disinfectants/therapeutic use , Equipment Contamination/prevention & control , N95 Respirators/virology , Peracetic Acid/therapeutic use , SARS-CoV-2 , Aerosols , Cross Infection/prevention & control , Cross Infection/virology , Disinfectants/administration & dosage , Geobacillus stearothermophilus , Humans , Hydrogen Peroxide/administration & dosage , Hydrogen Peroxide/therapeutic use , Levivirus , N95 Respirators/adverse effects , N95 Respirators/microbiology , Peracetic Acid/administration & dosage
18.
Am J Infect Control ; 49(4): 424-429, 2021 04.
Article in English | MEDLINE | ID: covidwho-917197

ABSTRACT

BACKGROUND: Filtering facepiece respirators (FFR) are critical for protecting essential personnel and limiting the spread of disease. Due to the current COVID-19 pandemic, FFR supplies are dwindling in many health systems, necessitating re-use of potentially contaminated FFR. Multiple decontamination solutions have been developed to meet this pressing need, including systems designed for bulk decontamination of FFR using vaporous hydrogen peroxide or ultraviolet-C (UV-C) radiation. However, the large scale on which these devices operate may not be logistically practical for small or rural health care settings or for ad hoc use at points-of-care. METHODS: Here, we present the Synchronous UV Decontamination System, a novel device for rapidly deployable, point-of-care decontamination using UV-C germicidal irradiation. We designed a compact, easy-to-use device capable of delivering over 2 J cm2 of UV-C radiation in one minute. RESULTS: We experimentally tested Synchronous UV Decontamination System' microbicidal capacity and found that it eliminates near all virus from the surface of tested FFRs, with less efficacy against pathogens embedded in the inner layers of the masks. CONCLUSIONS: This short decontamination time should enable care-providers to incorporate decontamination of FFR into a normal donning and doffing routine following patient encounters.


Subject(s)
COVID-19/prevention & control , Decontamination/instrumentation , Point-of-Care Systems , Respiratory Protective Devices/virology , SARS-CoV-2 , Ultraviolet Rays , COVID-19/virology , Decontamination/methods , Equipment Reuse , Humans
19.
Med Pr ; 72(1): 39-48, 2021 Feb 03.
Article in English | MEDLINE | ID: covidwho-874967

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19) generated a huge pressure on health care systems worldwide and exposed their lack of preparation for a major health crisis. In the times of a respiratory disease pandemic, members of the dental profession, due to having a direct contact with the patients' oral cavity, body fluids and airborne pathogens, are exposed to a great occupational hazard of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The authors carried out a systematic literature search using the main online databases (PubMed, Google Scholar, MEDLINE, UpToDate, Embase, and Web of Science) with the following keywords: "COVID-19," "2019-nCoV," "coronavirus," "SARS-CoV-2," "dental COVID-19," "dentistry COVID-19," "occupational hazards dentistry," "ventilation," "air disinfection," "airborne transmission," "hydrogen peroxide disinfection," "UV disinfection," "ozone disinfection," "plasma disinfection," and "TiO2 disinfection." They included publications focused on COVID-19 features, occupational hazards for dental staff during COVID-19 pandemic, and methods of air disinfection. They found that due to the work environment conditions, if appropriate measures of infection control are not being implemented, dental offices and dental staff can become a dangerous source of COVID-19 transmission. That is why the work safety protocols in dentistry have to be revised and additional methods of decontamination implemented. The authors specifically advise on the utilization of wildly accepted methods like ultraviolet germicidal irradiation with additional disinfection systems, which have not been introduced in dentistry yet, like vaporized hydrogen peroxide, non-thermal plasma and air filters with photocatalytic disinfection properties. Due to its toxicity, ozone is not the first-choice method for air decontamination of enclosed clinical settings. Med Pr. 2021;72(1):39-48.


Subject(s)
Air , COVID-19/prevention & control , Dental Offices , Disinfection/methods , Infection Control/methods , COVID-19/epidemiology , COVID-19/transmission , Humans , Pandemics
20.
J Hosp Infect ; 107: 50-56, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-866875

ABSTRACT

BACKGROUND: Coronavirus disease 2019 has stretched the ability of many institutions to supply needed personal protective equipment, especially N95 respirators. N95 decontamination and re-use programmes provide one potential solution to this problem. Unfortunately, a comprehensive evaluation of the effects of decontamination on the fit of various N95 models using a quantitative fit test (QNFT) approach is lacking. AIMS: To investigate the effects of up to eight rounds of vaporized hydrogen peroxide (VHP) decontamination on the fit of N95 respirators currently in use in a hospital setting, and to examine if N95 respirators worn by one user can adapt to the face shape of a second user with no compromise to fit following VHP decontamination. METHODS: The PortaCount Pro+ Respirator Fit Tester Model 8038 was used to quantitatively define functional integrity, measured by fit, of N95 respirators following decontamination with VHP. FINDINGS: There was an observable downward trend in the functional integrity of Halyard Fluidshield 46727 N95 respirators throughout eight cycles of decontamination with VHP. Functional integrity of 3M 1870 N95 respirators was reduced significantly after the respirator was worn, decontaminated with VHP, and then quantitatively fit tested on a second user. Furthermore, inconsistencies between qualitative fit test and QNFT results were uncovered that may have strong implications on the fit testing method used by institutions. CONCLUSIONS: The data revealed variability in the functional integrity of different N95 models after VHP decontamination, and exposed potential limitations of N95 decontamination and re-use programmes.


Subject(s)
COVID-19/prevention & control , Decontamination/methods , Decontamination/standards , Equipment Reuse , Hydrogen Peroxide/pharmacology , N95 Respirators/standards , Humans , Volatilization
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