Decontamination interventions for the reuse of surgical mask personal protective equipment: A systematic review

ABSTRACT

AIMS & OBJECTIVES: Surgical masks are broadly used as personal protective equipment in a pandemic setting, but little is known regarding decontamination interventions to allow for their reuse. This systematic review sought to evaluate and synthesize data from original research evaluating interventions to decontaminate surgical masks. METHODS: The protocol was registered on PROSPERO (CRD42020178290). We searched MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, and preprint servers from inception to April 8, 2020. Citation screening was conducted independently in duplicate. Outcomes of interest included mask performance (i.e. filtration efficiency, airflow resistance) and germicidal effects following decontamination. RESULTS: Of 1874 unique citations, 33 full-texts were assessed of which 7 studies were included. One study evaluated mask performance with interventions applied after mask use dry heat (via rice cooker), autoclave, and three chemical agents (70% ethanol, 100% isopropanol, and 0.5% sodium hypochlorite). Six studies evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance nanoparticle emulsions, quaternary ammonium agent, N-halamine, salt film, and a fluorochemical repellent. Heterogeneity of interventions evaluated and outcomes assessed precluded quantitative analysis. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks. Safety outcomes were infrequently evaluated. CONCLUSIONS: Limited evidence exists on the safety or efficacy of surgical mask decontamination interventions. Studies to date have evaluated interventions and outcomes using heterogenous and non-standardized test conditions, limiting our ability to compare between interventions or draw conclusions on the most efficacious intervention.