Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-26T05:45:05.406Z Has data issue: false hasContentIssue false
  • English
  • Français

A simulation study to evaluate contamination during reuse of N95 respirators and effectiveness of interventions to reduce contamination

Part of: SARS-CoV-2/COVID-19

Published online by Cambridge University Press:  10 May 2021

Daniel F. Li ,
Heba Alhmidi ,
Jacob G. Scott ,
Ian C. Charnas ,
Basya Pearlmutter ,
Sandra Y. Silva ,
Brigid M. Wilson  and
Curtis J. Donskey
Daniel F. Li
Affiliation:
Research Service, Louis Stokes Cleveland Veterans’ Affairs (VA) Medical Center, Cleveland, Ohio
Heba Alhmidi
Affiliation:
Research Service, Louis Stokes Cleveland Veterans’ Affairs (VA) Medical Center, Cleveland, Ohio
Jacob G. Scott
Affiliation:
Cleveland Clinic Lerner Research Institute, Cleveland, Ohio Case Western Reserve University School of Medicine, Cleveland, Ohio
Ian C. Charnas
Affiliation:
Case Western Reserve University School of Engineering and Sears think[box], Cleveland, Ohio
Basya Pearlmutter
Affiliation:
Research Service, Louis Stokes Cleveland Veterans’ Affairs (VA) Medical Center, Cleveland, Ohio
Sandra Y. Silva
Affiliation:
Clinical and Translational Science Program, Case Western Reserve University School of Medicine, Cleveland, Ohio
Brigid M. Wilson
Affiliation:
Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
Curtis J. Donskey*
Affiliation:
Case Western Reserve University School of Medicine, Cleveland, Ohio Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
*
Author for correspondence: Curtis J. Donskey, E-mail: Curtis.Donskey@va.gov
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess the potential for contamination of personnel, patients, and the environment during use of contaminated N95 respirators and to compare the effectiveness of interventions to reduce contamination.

Design:

Simulation study of patient care interactions using N95 respirators contaminated with a higher and lower inocula of the benign virus bacteriophage MS2.

Methods:

In total, 12 healthcare personnel performed 3 standardized examinations of mannequins including (1) control with suboptimal respirator handling technique, (2) improved technique with glove change after each N95 contact, and (3) control with 1-minute ultraviolet-C light (UV-C) treatment prior to donning. The order of the examinations was randomized within each subject. The frequencies of contamination were compared among groups. Observations and simulations with fluorescent lotion were used to assess routes of transfer leading to contamination.

Results:

With suboptimal respirator handling technique, bacteriophage MS2 was frequently transferred to the participants, mannequin, and environmental surfaces and fomites. Improved technique resulted in significantly reduced transfer of MS2 in the higher inoculum simulations (P < .01), whereas UV-C treatment reduced transfer in both the higher- and lower-inoculum simulations (P < .01). Observations and simulations with fluorescent lotion demonstrated multiple potential routes of transfer to participants, mannequin, and surfaces, including both direct contact with the contaminated respirator and indirect contact via contaminated gloves.

Conclusion:

Reuse of contaminated N95 respirators can result in contamination of personnel and the environment even when correct technique is used. Decontamination technologies, such as UV-C, could reduce the risk for transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 6 , June 2022 , pp. 764 - 769
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ranney, ML, Griffeth, V, Jha, AK. Critical supply shortages—the need for ventilators and personal protective equipment during the Covid-19 pandemic. N Engl J Med 2020;382:e41.CrossRefGoogle Scholar
Brady, TM, Strauch, AL, Almaguer, CM, et al. Transfer of bacteriophage MS2 and fluorescein from N95 filtering facepiece respirators to hands: measuring fomite potential. J Occup Environ Hyg 2017;14: 898–906.CrossRefGoogle ScholarPubMed
Decontamination and reuse of filtering facepiece respirators. Centers for Disease Control and Prevention website. https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html. Accessed November 17, 2020.Google Scholar
Enforcement policy for face masks and respirators during the coronavirus disease (COVID-19) public health emergency (Revised). US Food & Drug Administration website. https://www.fda.gov/regulatory-information/search-fda-guidance-documents. Revised April 2020. Accessed November 17, 2020.Google Scholar
3M Personal Safety Division. Disinfection of filtering facepiece respirators technical bulletin. 2020. 3M website. https://multimedia.3m.com/mws/media/1824869O/decontamination-methods-for-3m-n95-respirators-technical-bulletin.pdf. Accessed November 17, 2020.Google Scholar
Cadnum, JL, Li, D, Redmond, SN, John, AR, Pearlmutter, B, Donskey, CJ. Effectiveness of ultraviolet-C light and a high-level disinfection cabinet for decontamination of N95 respirators. Pathog Immun 2020;5:52–67.CrossRefGoogle Scholar
Ozog, DM, Sexton, JZ, Narla, S, et al. The effect of ultraviolet C radiation against different N95 respirators inoculated with SARS-CoV-2. Int J Infect Dis 2020;100:224–229.CrossRefGoogle Scholar
Golladay, GJ, Leslie, KA, Zuelzer, WA, et al. Rationale and process for N95 respirator sanitation and re-use in the COVID-19 pandemic. Infect Control Hosp Epidemiol 2021. doi: 10.1017/ice.2021.37.CrossRefGoogle Scholar
Kenney, PA, Chan, BK, Kortright, KE, et al. Hydrogen peroxide vapor decontamination of N95 respirators for reuse. Infect Control Hospital Epidemiol 2021. doi: 10.1017/ice.2021.48.CrossRefGoogle Scholar
Kayani, BJ, Weaver, DT, Gopalakrishnan, V, et al. UV-C tower for point-of-care decontamination of filtering facepiece respirators. Am J Infect Control 2020. doi: 10.1016/j.ajic.2020.11.010.CrossRefGoogle Scholar
Bianco, A, Biasin, M, Pareschi, G, et al. UV-C irradiation is highly effective in inactivating SARS-CoV-2 replication. Sci Rep 2021;11:6260.Google Scholar
Tomas, ME, Kundrapu, S, Thota, P et al. Contamination of the skin and clothing of healthcare personnel during removal of personal protective equipment. JAMA Intern Med 2015;175:1904–1910.CrossRefGoogle Scholar
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:e49–e55.CrossRefGoogle ScholarPubMed
Lindsley, WG, Martin, SB Jr, Thewlis, RE, et al. Effects of ultraviolet germicidal irradiation (UVGI) on N95 respirator filtration performance and structural integrity. J Occup Environ Hyg 2015;12:509–517.CrossRefGoogle ScholarPubMed
O’Hearn, K, Gertsman, S, Sampson, M, et al. Decontaminating N95 and SN95 masks with ultraviolet germicidal irradiation does not impair mask efficacy and safety. J Hosp Infect 2020;106:163–175.CrossRefGoogle Scholar
NPPTL respirator assessments to support the COVID-19 response. Centers for Disease Control and Prevention website. https://www.cdc.gov/niosh/npptl/respirators/testing/DeconResults.html. Accessed December 19, 2020.Google Scholar
Boone, SA, Gerba, CP. Significance of fomites in the spread of respiratory and enteric viral disease. Appl Environ Microbiol 2007;73:1687–1696.CrossRefGoogle ScholarPubMed
Otter, JA, Donskey, C, Yezli, S, Douthwaite, S, Goldenberg, SD, Weber, DJ. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: possible role of dry surface contamination. J Hosp Infect 2016;92:235–250.CrossRefGoogle Scholar
Zhou, J, Otter, JA, Price, JR, et al. Investigating SARS-CoV-2 surface and air contamination in an acute healthcare setting during the peak of the COVID-19 pandemic in London. Clin Infect Dis 2020:ciaa905.CrossRefGoogle Scholar
Goldman, E. Exaggerated risk of transmission of COVID-19 by fomites. Lancet Infect Dis 2020 Jul 3:S1473-3099(20)30561-2.CrossRefGoogle Scholar
Colaneri, M, Seminari, E, Novati, S, et al. Severe acute respiratory syndrome coronavirus 2 RNA contamination of inanimate surfaces and virus viability in a health care emergency unit. Clin Microbiol Infect 2020;26:1094.e1–1094.e5.CrossRefGoogle Scholar
Ong, SWX, Tan, YK, Sutjipto, S, et al. Absence of contamination of personal protective equipment (PPE) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infect Control Hosp Epidemiol 2020;41:614–616.CrossRefGoogle Scholar