Skip to main content Accessibility help
×
Home
Hostname: page-component-59b7f5684b-frvt8 Total loading time: 0.633 Render date: 2022-09-27T23:46:06.367Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "useRatesEcommerce": false, "displayNetworkTab": true, "displayNetworkMapGraph": false, "useSa": true } hasContentIssue false

Effect of vaporized hydrogen peroxide reprocessing on N95 respirators

Published online by Cambridge University Press:  24 July 2020

Elena Beam*
Affiliation:
Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Jeffrey C. Nesbitt
Affiliation:
Occupational Safety, Rochester, Minnesota
Matthew D. Austin
Affiliation:
Occupational Safety, Rochester, Minnesota
Kannan Ramar
Affiliation:
Division of Pulmonary and Critical Care Medicine, Center for Sleep Medicine, Mayo Clinic, Rochester, Minnesota
*
Author for correspondence: Elena Beam, E-mail: beam.elena@mayo.edu
Rights & Permissions[Opens in a new window]

Abstract

Type
Letter to the Editor
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

To the Editor—The high demand for personal protective equipment (PPE) during the coronavirus disease 2019 (COVID-19) pandemic has required reprocessing and reuse of N95 respirators to mitigate shortages. Data on the impacts of reprocessing and reuse on the physical integrity and continued performance of these PPE are sparse.

Our facility uses vaporized hydrogen peroxide (VHP) according to the Duke method as a strategy to reprocess respirators for reuse.Reference Schwartz, Steigle and Greeson1 We conducted repeated quantitative fit testing of N95 respirators (model 3M 1870+, 3M, Maplewood, MN) by measuring the amount of leakage into the facepiece. We sought to better understand the impact of VHP reprocessing on reuse and extended reuse of respirators as well as the effect on the tight fit of the respirator in 2 experiments.

In our first experiment, 5 masks that were reprocessed with VHP were compared to 5 masks that were not treated with VHP. Quantitative fit testing was conducted using TSI PortaCount according to the Occupational Safety and Health Administration (OSHA) quantitative fit testing protocol. Safety staff conducted repeat use and fit tests in 10 cycles as follows: (1) Inspect the respirator. (2) Adjust and don the respirator. (3) Perform a quantitative respirator fit test. (4) Doff the respirator. And (5) flatten the respirator. Any observable failures and fit-test failures were documented after each cycle (Table 1). We found no fit-testing failure among the respirators treated with VHP, while the 5 control respirators had 4 total fit-test failures. Notably, 3 failures occurred after the ninth cycle of donning and doffing the respirators.

Table 1. Respirator Fit Test Cycle Results

a Control: 1870 respirator used without reprocessing.

b VHP: 1870 respiratory used with vaporized hydrogen reprocessing.

In our second experiment, to better understand the impact of VHP reprocessing on reuse and extended use (defined as repeat half-day use, or 4-hour shifts), we tested the same type of respirators (3M 1870) according to the following procedure: (1) The respirator was used for 4 hours. (2) The respirator was reprocessed with VHP. (3) The respirator was used for an additional 4 hours. (4) The respirator was reprocessed with VHP. And (5) a quantitative fit test was performed on the respirator. Respirators used in this experiment had already been used in hospital service by a single user for a clinical purpose. The duration of use was unknown.

All 5 respirators successfully passed the quantitative fit testing. The results from both experiments suggested that reprocessing with VHP allows for reuse and extended use of respirators. Our study has several limitations. These results might not be generalizable to other contexts. The quality and integrity of respirator used may differ by brand and style. Variability in the results may have resulted from the use of quantitative versus qualitative fit-testing techniques, which may be more prone to error due to the subjective nature of the test. Our evaluations were based on conclusions from quantitative testing.Reference Hon, Danyluk and Bryce2.3 Finally, fit-testing expertise among the staff who volunteered to run the experiment varied; however, we expect our data to be reliable because the same staff performed multiple tests. Finally, we were not able to capture the duration of clinical use of the respirators in the hospital prior to the start of our second experiment, and we were unable to define the overall “use” in the project given this limitation.

Limited evidence is available regarding the use of VHP with extended reuse of N95 respirators.Reference Fischer, Morris and van Doremalen4,Reference Degesys, Wang and Kwon5 Similar to other studies, we found no detrimental effect of VHP processing on the ability of N95 respirators to pass fit testing. Our results suggest that VHP does not affect limited reuse and extended use of 3M-1870 respirators in the context of maintenance fit testing with repeated donning and doffing.

Acknowledgments

Financial support

No financial support was provided relevant to this article.

Conflicts of interest

All authors report no conflicts of interest relevant to this article.

References

Schwartz, A, Steigle, M, Greeson, N, et al. Decontamination and reuse of N95 respirators with hydrogen peroxide vapor 2 to address worldwide personal protective equipment shortages during the 3 SARS-CoV-2 (COVID-19) pandemic. Appl Biosafety 2020 [Epub ahead of print]. doi: 10.1177/1535676020919932.CrossRefGoogle Scholar
Hon, CY, Danyluk, Q, Bryce, E, et al. Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector. J Occup Environ Hyg 2017;14:175179.CrossRefGoogle ScholarPubMed
Occupational safety and health standards: occupational health and environmental control (standard no. 1910.134). Occupational Safety and Health Administration website. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134AppA. Published 1970. Accessed July 23, 2020.Google Scholar
Fischer, RJ, Morris, DH, van Doremalen, N, et al. Assessment of N95 respirator decontamination and re-use for SARS-CoV-2. medRxiv 2020 Apr 24. doi: 10.1101/2020.04.11.20062018.Google ScholarPubMed
Degesys, NF, Wang, RC, Kwon, E, et al. Correlation between N95 extended use and reuse and fit failure in an emergency department. JAMA 2020;324:9496.CrossRefGoogle Scholar
Figure 0

Table 1. Respirator Fit Test Cycle Results

You have Access Open access
2
Cited by

Save article to Kindle

To save this article to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Effect of vaporized hydrogen peroxide reprocessing on N95 respirators
Available formats
×

Save article to Dropbox

To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about saving content to Dropbox.

Effect of vaporized hydrogen peroxide reprocessing on N95 respirators
Available formats
×

Save article to Google Drive

To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about saving content to Google Drive.

Effect of vaporized hydrogen peroxide reprocessing on N95 respirators
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *