This FREE Master Class is brought to you by TIPS: The Infection Prevention Strategy

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Immediate Challenges

Healthcare workers responding to the COVID-19 pandemic are facing many challenges.  One challenge has been the shortage of N95 respirators. Best practices may help conserve respirators during this pandemic and ensure the safety of the healthcare workers. Also, faced with the shortage of N95 masks, healthcare workers are having to wear masks for extended periods or re-use masks.  Community groups are making hand-made masks from cloth/other material.  We will discuss the guidelines for emergency contingency, resources and what the literature says.

Disinfection

Over the past decade there have been a few insightful studies published in the peer-reviewed literature indicating that germicidal UV and microwaves can be effective at disinfecting N95 full facepiece respirators to reduce the risks of re-using them in a crisis.  This presentation will give a brief introduction to UV disinfection and its key considerations, followed by a review of what this published literature suggests can be done.  An alternative disinfection method, microwave generated steam, will be reviewed also, although the literature is less extensive for this approach.

Learning Objectives

1. List current recommendations for N95 use, extended use, and reuse
2. Emergency contingencies when supplies are depleted in a pandemic
3. When to discard N95 masks
4. Understand how germicidal UV operates and its key parameters
5. Considerations and efficacy for N95 mask UV disinfection
6. UV effects on N95 mask performance
7. Potential use of microwaves for disinfection

This Master Class does not provide educational credits.

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Full video of our April 1, 2020 Webinar:

Additional Resources

The following document represents some of the Questions and Answers from the TIPS Master Class Webinar held on April 1, 2020.

VIEW Q&A DOCUMENT: APRIL 1 Webinar: N95 USE, DISINFECTION & REUSE Q & A

ARTICLE: Overview of Chemical Disinfection of N95 FFRs

Disinfection and re-use of N95 full facepiece respirators is of critical interest during supply shortages. The following overview summarizes what has been published in peer-reviewed scientific literature, especially with respect to disinfection performance and the effects on the usability of the N95 FFR.

LINK: https://infectioncontrol.tips/2020/04/02/overview-of-disinfection-n95/

ARTICLE: Five Ways to Cope When Masks Run Low

New CDC guidance offers options on reuse, decontamination — and no, don’t use home ovens or tanning beds

LINK: https://www.medpagetoday.com/infectiousdisease/covid19/85799

PRE-PRINT: Rapid evidence summary on SARS-CoV-2 survivorship and disinfection, and a reusable PPE protocol using a double-hit process

In the COVID-19 pandemic caused by SARS-CoV-2, hospitals are stretched beyond capacity. There are widespread reports of dwindling supplies of personal protective equipment (PPE), which are paramount to protect frontline medical/nursing staff and to minimize further spread of the virus. We carried out a rapid review to summarize the existing evidence on SARS-CoV-2 survivorship and methods to disinfect PPE gear, particularly N95 filtering facepiece respirators (FFR). In the absence of data on SARS-CoV-2, we focused on the sister virus SARS-CoV-1. We propose a two-step disinfection process, which is conservative in the absence of robust evidence on SARS-CoV-2. This disinfection protocol is based on an initial storage of PPE for ≥4 days, followed by ultraviolet light (UVC), dry heat treatment, or chemical disinfection. Importantly, each of the two steps is based on independent disinfection mechanisms, so that our proposed protocol is a multiplicative system, maximising the efficacy of our disinfection process. This method could be rapidly implemented in other healthcare settings, while testing of each method is undertaken, increasing the frontline supply of PPE, and avoiding many of the upstream issues of supply chain disruption currently being faced.

LINK: https://www.medrxiv.org/content/10.1101/2020.04.02.20051409v1

STUDY: Effect of decontamination on the filtration efficiency of two filtering facepiece respirator models

Respiratory protective devices such as National Institute for Occupational Safety and Health (NIOSH) certified disposable filtering facepiece respirators (FFRs) are often recommended for use by healthcare workers and the general public for infection control. However, during a wide-scale breakout of a disease spread by human-to-human transmission via infectious aerosol, shortages of FFRs are likely. One possible solution to the potential shortage is to reuse the FFR after decontamination to remove any infectious material. However, little data exists on the effects of various decontamination methods. In this study, two models of FFRs (one N95 and one P100) were treated with ten decontamination processes at two conditions each. Filtration performance of the treated respirators plus two controls was assessed using a poly-dispersed sodium chloride aerosol test method similar to that used by the NIOSH for respirator certification. Decontamination using an autoclave, 160º C dry heat, 70% isopropyl alcohol, and soap and water (20 minute soak) caused significant filter degradation to both N95 and P100 FFRs. The particle penetration levels were greater than allowed for NIOSH certification. Filtration performance after decontamination using bleach, ethylene oxide, and a microwave oven was degraded for both respirator models, although particle penetration levels were still less than the NIOSH certification criteria. The decontamination methods that had the least effect on particle penetration involved hydrogen peroxide (vaporized and liquid forms) and UV radiation. Future research should consider low-temperature decontamination methods such as vaporized and liquid hydrogen peroxide, ethylene oxide, microwave radiation for 2 minutes or less, UV radiation, and 10% diluted household bleach for further study.

LINK: https://www.cdc.gov/niosh/nioshtic-2/20033292.html

PRE-PRINT: Microwave- and Heat-Based Decontamination of N95 FFR: A Systematic Review

Microwave irradiation & heat provides safe and effective decontamination options for N95 reuse during critical shortages. Autoclaving does not

LINK: https://osf.io/4whsx/

PRE-PRINT: Decontaminating N95 masks with Ultraviolet Germicidal Irradiation (UVGI) does not impair mask efficacy and safety: A Systematic Review

Twelve studies were identified, comprising of 53 different UVGI intervention arms and 43 N95 FFR models. In all cases, FFRs maintained National Institute for Occupational Safety and Health (NIOSH) certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms respectively. Airflow resistance for the control arms averaged 9.79 mm H2O (7.97-11.70 mm H2O) vs 9.85 mm H2O (8.33-11.44 mm H2O) for UVGI treatment arms. All UVGI protocols employing a cumulative dose >20,000 J/m2 resulted in a 2 log reduction in viral load. A >3 log reduction was observed in 7 UVIG arms using a dose >40,000 J/m2. Impact of UVIG on fit was evaluated in two studies (16,200; 32,400 J/m2) and did not find evidence of compromise. Altogether, our findings suggest that further work in this area should use a cumulative UV-C dose of 40,000 J/m2 or greater, and confirm appropriate mask fit following decontamination.

LINK: https://osf.io/29z6u/

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SPEAKERS:

Prof. William A. Anderson, P.Eng.

Department of Chemical Engineering, University of Waterloo, Waterloo ON Canada

William A. (Bill) Anderson, is a Professor of Chemical Engineering at the University of Waterloo, and has been active in research on UV-driven photochemical processes for almost 30 years, including air, water, and surface disinfection.  Other industry-sponsored research topics include antimicrobial materials, rapid detection of microbes in water, and capture of anesthetic gases from hospital air emissions.

Kathleen Aumann Morales, PhD, RN, CNE

Dr. Morales received her PhD from Georgia Baptist College of Nursing of Mercer University. Her dissertation research was a mixed methods, feasibility study which tested the effect of a resident-focused hand hygiene intervention in a long-term care facility. Dr. Morales has over 30 years experience as a Registered Nurse. Her practice areas include adult medical/surgical, orthopedics, emergency department, and intensive care. Dr. Morales is a contributor to five books: Legal Nurse Consulting: Principles & Practice; The Emergency Nursing Bible; NCLEX-RN Review. Keeping it Real! Simplified; Nursing Made Easy; and Pharmacology Made Easy. She is an assistant professor of nursing at Berry College. She is on Twitter @KMorales and on LinkedIn Katie Aumann Morales, PhD, RN, CNE

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