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Synonyms for reuse in Free Thesaurus. Antonyms for reuse. 2 synonyms for reuse: reprocess, recycle. What are synonyms for reuse? The goal of the grant is to support New York City in reusing, repairing, and refurbishing 100% of all discarded products that can be reused in some capacity, with.
Disposable filtering facepiece respirators (FFRs) are not approved for routine decontamination and reuse as standard of care. However, FFR decontamination and reuse may need to be considered as a crisis capacity strategy to ensure continued availability. Based on the limited research available, ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat showed the most promise as potential methods to decontaminate FFRs. This document summarizes research about decontamination of FFRs before reuse.
IntroductionReusing disposable filtering facepiece respirators (FFRs) has been suggested as a crisis capacity strategy to conserve available supplies for healthcare environments during a pandemic. Strategies for FFR extended use and reuse (without decontamination of the respirator) are currently available from. The surfaces of an FFR may become contaminated while filtering the inhalation air of the wearer during exposures to pathogen-laden aerosols. The pathogens on the filter materials of the FFR may be transferred to the wearer upon contact with the FFR during activities such as adjusting the FFR, improper doffing of the FFR, or when performing a user-seal check when redoffing a previously worn FFR. A study evaluating the persistence of SARS-CoV-2 (the virus that causes COVID-19) on plastic, stainless steel, and carboard surfaces showed that the virus is able to survive for up to 72-hours 1. One strategy to mitigate the contact transfer of pathogens from the FFR to the wearer during reuse is to issue five respirators to each healthcare worker who may care for patients with suspected or confirmed COVID-19. The healthcare worker will wear one respirator each day and store it in a breathable paper bag at the end of each shift.
The order of FFR use should be repeated with a minimum of five days between each FFR use. This will result in each worker requiring a minimum of five FFRs, providing that they put on, take off, care for them, and store them properly each day. Healthcare workers should treat the FFRs as though they are still contaminated and follow the precautions outlined in our reuse recommendations.
If supplies are even more constrained and five respirators are not available for each worker who needs them, FFR decontamination may be necessary. Decontamination and subsequent reuse of FFRs should only be practiced as a crisis capacity strategy. At present, FFRs are considered one time use and there are no manufacturer authorized methods for FFR decontamination prior to reuse. On March 28, 2020, FDA issued an at Battelle Memorial Institute to be authorized for use in decontaminating “compatible N95 respirators.” The should be checked to determine if other EUAs have been issued since the posting of this crisis capacity strategy guidance. Only respirator manufacturers can reliably provide guidance on how to decontaminate their specific models of FFRs. In absence of manufacturer’s recommendations, third parties may also provide guidance or procedures on how to decontaminate respirators without impacting respirator performance.
Decontamination might cause poorer fit, filtration efficiency, and breathability of disposable FFRs as a result of changes to the filtering material, straps, nose bridge material, or strap attachments of the FFR. CDC and NIOSH do not recommend that FFRs be decontaminated and then reused as standard care. This practice would be inconsistent with their approved use, but we understand in times of crisis, this option may need to be considered when FFR shortages exist.An effective FFR decontamination method should reduce the pathogen burden, maintain the function of the FFR, and present no residual chemical hazard. The filter media in NIOSH-approved respirators varies by manufacturer.
The ability of the respirator filter media to withstand cleaning and disinfection are not NIOSH performance requirements. The NIOSH’s National Personal Protective Technology Laboratory (NPPTL) and other researchers have investigated the impact of various decontamination methods on filtration efficiency, facepiece fit of FFRs, and the ability to reduce viable virus or bacteria on the FFRs. This research is summarized below.
Crisis Standards of Care Decontamination RecommendationsBecause ultraviolet germicidal irradiation (UVGI), vaporous hydrogen peroxide (VHP), and moist heat showed the most promise as potential methods to decontaminate FFRs, researchers, decontamination companies, healthcare systems, or individual hospitals should focus current efforts on these technologies. Specifically, the effectiveness of using these methods should be explored further with specific FFR models based on the manufacturers’ support to better understand the impact on the respirator performance, including filtration and fit.
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Table 2 provides a summary of the decontamination methods evaluated in the referenced literature and the reported effect of each method on FFR performance.Table 2. Summary of the decontamination method and effect on FFR performance Table 2 provides a summary of the decontamination methods evaluated in the referenced literature and the reported effect of each method on FFR performance. MethodTreatment levelFFR filtration performanceFFR fit performanceOther observationsReferencesVaporous hydrogen peroxide (VHP).
Al.: Room Bio-Decontamination Service (RBDS™, BIOQUELL UK Ltd, Andover, UK), which utilizes four portable modules: the Clarus® R HPV generator (utilizing 30% H 2O 2), the Clarus R20 aeration unit, an instrumentation module and a control computer. Table 3 provides a summary of the decontamination methods used, the treatment levels assessed, the microbes tested, and the antimicrobial efficacy as reported in the literature.Table 3. Summary of decontamination method antimicrobial efficacy Table 3. Provides a summary of the decontamination methods used, the treatment levels assessed, the microbes tested and the antimicrobial efficacy as reported in the literature. MethodTreatment levelMicrobe testedAntimicrobial efficacyReferencesVaporous hydrogen peroxide (VHP).
Vaporous hydrogen peroxide, ultraviolet germicidal irradiation, and moist heat are the most promising FFR decontamination methodsVaporous hydrogen peroxide, ultraviolet germicidal irradiation, and moist heat are the most promising decontamination methods. If FFR decontamination is considered, these methods do not appear to break down filtration or compromise the FFR; however, many of these methods can only be used for limited times. Vaporous hydrogen peroxideInvestigations into VHP decontamination of FFRs provides evidence of minimal effect to filtration and fit while demonstrating 99.9999% efficiency in killing bacterial spores. VHP did not reduce the filtration performance of the ten N95 FFR models tested while showing a 6-log reduction in Geobacillus stearothermophilus spores 2-4.
In a report prepared by Battelle Memorial Institute, the 3M 1860 FFR was shown to maintain filtration performance for 50 treatment cycles of VHP, also referred to as HPV by some decontamination system manufacturers, using the Clarus ® R HPV generator form Bioquell (utilizing 30% H 2O 2). Additionally, FFR fit was shown to be unaffected for up to 20 VHP treatments cycles using NPPTL’s Static Advanced Headform 4, 5. Strap degradation occurred after 20 treatment cycles.
Kenney et al., co-contaminated 3M 1870 FFRs with three bacteriophages, T1, T7, and Phi 6, and decontaminated the FFRs using VHP generated from the Bioquell’s BQ-50 system. The VHP treatment was shown inactivate 99.999% of all phages which was below the limit of detection 6. Viscusi et al. Found that 9 FFR models (three particulate N95, three surgical N95 FFRs and three P100) exposed to one cycle of VHP treatment using the STERRAD 100S H 2O 2 Gas Plasma Sterilizer (Advanced Sterilization Products, Irvine, CA) had filter aerosol penetration and filter airflow resistance levels similar to untreated models; however, Bergman et al. Found that three cycles of VHP treatment using the STERRAD 100S H 2O 2 Gas Plasma Sterilizer negatively affected filtration performance 2, 3.
Bergman et al. Measured acceptable filtration performance for six FFR models (three particulate and three surgical FFRs) that received three cycles of VHP treatment using the Clarus ® R HPV generator (utilizing 30% H 2O 2) 3.
VHP is a promising method with a potential for high capacity throughput, but certain VHP systems, such as the Clarus ® R HPV generator, may be more compatible with FFR decontamination. Ultraviolet germicidal irradiationUVGI is a promising method but the disinfection efficacy is dependent on dose. Not all UV lamps provide the same intensity thus treatment times would have to be adjusted accordingly.
Moreover, UVGI is unlikely to kill all the viruses and bacteria on an FFR due to shadow effects produced by the multiple layers of the FFR’s construction. Acceptable filtration performance was recorded for eleven FFR models exposed to various UV doses ranging from roughly 0.5–950 J/cm 2 and UVGI was shown to have minimal effect on fit 2, 3, 7, 8, 9, 10. Heimbuch et al. Tested filtration and fit of 15 FFRs and found no adverse effects to FFR performance 11. Lindsley et al.
Reported a reduction of the durability of materials of the FFRs for doses ranging from 120–950 J/cm 2; however, an approximate inactivation of 99.9% of bacteriophage MS2, a non-enveloped virus, and H1N1 influenza A/PR/8/34 were achieved with much lower doses of approximately 1 J/cm 2 12–14. Heimbuch et al. Tested the performance of 1 J/cm 2 of UVGI against Influenza A (H1N1), Avian influenza A virus (H5N1), Influenza A (H7N9) A/Anhui/1/2013, Influenza A (H7N9) A/Shanghai/1/2013, MERS-CoV, and SARS-CoV and reported virus inactivation from 99.9% to greater than 99.999% 11. UVGI is harmful. Proper precautions are required to avoid UVGI exposure to skin or the eyes.
Moist heatMoist heat, consisting of 60°C and 80% RH caused minimal degradation in the filtration and fit performance of the tested FFRs 3, 9, 10. Heimbuch et al.
Disinfected FFRs contaminated with H1N1 using moist heat, of 65°C and 85% RH, and achieved a minimal of 99.99% reduction in virus 14. One limitation of the moist heat method is the uncertainty of the disinfection efficacy for various pathogens.
Steam treatment and liquid hydrogen peroxide are promising methods with some limitations Steam treatmentSteam treatment may be a suitable approach for decontaminating FFRs. The limited number of studies for steam report minimal effect on FFR filtration and fit performance and a minimum 99.9% reduction in H1N1 and bacteriophage MS2 14, 15. Fisher et al. Used microwave steam bags, designed for disinfecting infant feeding equipment, to decontaminate six FFR models and achieved 99.9% inactivation of MS2 bacteriophage. Filtration performance of all tested FFRs scored above NIOSH certification requirements.
Three FFRs were further evaluated for three cycles of steam exposure and demonstrated no change in filtration performance 15. Bergman et al.
Also demonstrated acceptable filtration performance after three cycles of exposure to microwave generated steam 3. Microwave generated steam had little effect on FFR fit after exposure to up to three cycles of steam 9, 10. Using microwaves to produce steam to decontaminate FFRs is not without limitations. Not all microwaves are constructed the same and some are more powerful than others. The effect of higher power microwaves on FFRs is unknown. Furthermore, the metal nosebands of FFRs may cause arcing, sparks inside the microwave oven, during exposure to microwaves. Liquid hydrogen peroxideLiquid hydrogen peroxide showed no effect of FFR filtration performance 3, 7.
Bergman et al. Evaluated six FFRs for filtration performance after a 30-minute submersion in 6% hydrogen peroxide. All six FFR models tested demonstrated no changes in filter performance after three cycles of decontamination. FFR fit and disinfection efficacy were not assessed for this method.
Table 4 provides a summary of the decontamination methods evaluated for each FFR model. This table does not serve to confirm that the decontamination method was effective for each FFR model. This table serves to alert the reader about the availability of more information about the decontamination methods for specific FFR models in the literature.Table 4. Decontamination methods evaluated for each FFR model Table 4 provides a summary of the decontamination methods evaluated for each FFR model. FFR ModelTypeVHPUVGIEtOSteamMoist heatHydrogen peroxide3M 1860N95xxxxxx3M 1870N95xxxxxx3M 8000N95xxxxxx3M 8210N95xxxxxx3M 9210N95x3M Vflex 1805N95xAlpha protechN95xCardinal HealthN95xGerson 1730N95xKimberly Clark PFR-95N95xxxxxxMoldex 1512N95xMoldex 1712N95xMoldex 2200N95xxxxxMoldex 2201N95xxxxxxPrecept 65-3395N95xPrestige Ameritech RP88020N95xSperian HC-NB095N95xSperian HC-NB295N95xU.S.
Safety AD2N95AN95xU.S. Safety AD4N95AN95x3M 8293P100xxxMoldex 2360P100xxNorth 8150P100xx.
Decontamination methods that changed FFR performance or functionAutoclaving and the use of disinfectant wipes are not recommended as crisis strategies as they may alter FFR performance. Autoclave, dry heat, isopropyl alcohol, soap, dry microwave irradiation and bleachDecontamination using an autoclave, 160°C dry heat, 70% isopropyl alcohol, microwave irradiation and soap and water caused significant filter degradation to both FFRs and particle penetration levels did not meet the levels that NIOSH would allow for approval. Decontamination with bleach caused slight degradation in filtration performance and created an odor that would not be suitable for use 2, 7. Disinfectant wipesHeimbuch et al. Evaluated biological decontamination efficacy and filtration penetration following aerosol exposure of mucin or viable Staphylococcus aureus 18. Following aerosol exposure, respirators were cleaned with three types of wipes: hypochlorite, benzalkonium chloride (BAC), or nonantimicrobial. Particle penetration following cleaning yielded mean values.
References. van Doremalen, N., et al., Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. J New England Journal of Medicine, 2020. Viscusi, D.J., et al., Evaluation of five decontamination methods for filtering facepiece respirators.
Annals of occupational hygiene, 2009. 815-827. Bergman, M., et al., Evaluation of Multiple (3-Cycle) Decontamination Processing for Filtering Facepiece Respirators. Journal of Engineered Fibers and Fabrics, 2010. 33-41. Battelle.
Final Report for the Bioquell Hydrogen Peroxide Vapor (HPV) Decontamination for Reuse of N95 Respirators. 2016; Available from:. Bergman, M.S., et al., Development of an advanced respirator fit-test headform. Journal of Occupational and Environmental Hygiene, 2014. 117-125.
Kenney, Patrick, et al. Hydrogen Peroxide Vapor sterilization of N95 respirators for reuse. MedRxiv (2020). Viscusi, D.J., King, W.P., Shaffer, R.E., Effect of decontamination on the filtration efficiency of two filtering facepiece respirator models. Journal of the International Society for Respiratory Protection, 2007.
93-107. Lindsley, W.G., et al., Effects of ultraviolet germicidal irradiation (UVGI) on N95 respirator filtration performance and structural integrity. Journal of Occupational and Environmental Hygiene 2015. 509-517. Bergman, M., et al., Impact of Three Cycles of Decontamination Treatments on Filtering Facepiece Respirator Fit. Journal of the International Society for Respiratory Protection, 2011.
48-59. Viscusi, D.J., et al., Impact of three biological decontamination methods on filtering facepiece respirator fit, odor, comfort, and donning ease. Journal of Occupational and Environmental Hygiene, 2011.
426-36. Heimbuch, B.K. Research to Mitigate a Shortage of Respiratory Protection Devices During Public Health Emergencies. 2019; Available from:. Fisher, E.M. Shaffer, A method to determine the available UV‐C dose for the decontamination of filtering facepiece respirators.
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Journal of Applied Microbiology, 2011. 287-295. Mills, D., et al., Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators. American Journal of Infection Control, 2018. E49-e55. Heimbuch, B.K., et al., A pandemic influenza preparedness study: use of energetic methods to decontaminate filtering facepiece respirators contaminated with H1N1 aerosols and droplets. American Journal of Infection Control, 2011.
E1-e9. Fisher, E.M., J.L.
Williams, and R.E. Shaffer, Evaluation of microwave steam bags for the decontamination of filtering facepiece respirators. PLoS One, 2011. 6(4). Rutala, W.A.
Guideline for disinfection and sterilization in healthcare facilities, 2008. 2008; Available from:. Occupational Safety and Health Administration.
Ethylene oxide: 29 CFR 1910.1047. Heimbuch, B.K., et al., Cleaning of filtering facepiece respirators contaminated with mucin and Staphylococcus aureus. American Journal of Infection Control, 2014. 265-270. Eickmann, M., et al., Inactivation of Ebola virus and Middle East respiratory syndrome coronavirus in platelet concentrates and plasma by ultraviolet C light and methylene blue plus visible light, respectively. Transfusion, 2018.
2202-2207. 3M. Disinfection of Filtering Facepiece Respirators. Technical Bulletin 2020; Available from:Other resources.
Lowe, J.J. N95 Filtering Facemask Respirator Ultraviolet Germicidal Irradiation (UVGI) Process for Decontamination and Reuse. 2020; Available from:. N95DECON 2020. A scientific consortium for data-driven study of N95 filtering facepiece respirator decontamination. Available from.
Caption N95 face mask respirators. These respirators protect people who wear them by removing contaminants from the air. (CDC/ Debora Cartagena) Performer:Project leader: William RichterContract value: $435,285Project dates: August 2014 - July 2016 BackgroundWhile everyone else exits, they rush in.
Protecting the health and safety of first responders and health care workers is an essential part of planning for public health emergencies. Personal protective equipment (PPE) items such as respirators, protective clothing, and eye protection are standard supplies.One of many preparedness and response challenges is ensuring adequate supplies of this protective equipment during an emergency, when responders may need to don additional protective gear or replace used equipment more rapidly as they treat an increased number of patients.One type of respirator routinely used to protect workers from biological hazards is known as an N95 filtering facepiece respirator (FFR, pictured). These respirators protect the wearer by filtering contaminants from the air. Currently, these respirators must be discarded after one use, but in emergency response circumstances such as an emerging infectious disease (pandemic influenza, for example) or intentional release of a biological threat agent, reuse of these respirators may be necessary to maintain adequate supplies. Project DescriptionTo investigate the potential for reusing respirators in emergency situations, FDA awarded an 18-month contract to Battelle Memorial Institute. Battelle conducted tests to evaluate the feasibility of using a commercially available hydrogen peroxide vapor technology to decontaminate N95 respirators.Based on recommendations from an interagency respirator equipment working group known as Project BREATHE, this pilot-scale testing evaluated respirators during and after as many as 50 decontamination cycles.
The testing examined the ability of hydrogen peroxide vapor to decontaminate respirators, and it determined whether the respirators maintained their structure and function after multiple decontamination cycles.
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