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Exploring options for reprocessing of N95 Filtering Facepiece Respirators (N95-FFRs) amidst COVID-19 pandemic: A systematic review.
PLoS One. 2020; 15(11):e0242474.Plos

Abstract

BACKGROUND

There is global shortage of Personal Protective Equipment due to COVID-19 pandemic. N95 Filtering Facepiece Respirators (N95-FFRs) provide respiratory protection against respiratory pathogens including SARS-CoV-2. There is scant literature on reprocessing methods which can enable reuse of N95-FFRs.

AIM

We conducted this study to evaluate research done, prior to COVID-19 pandemic, on various decontamination methods for reprocessing of N95-FFRs.

METHODS

We searched 5 electronic databases (Pubmed, Google Scholar, Crossref, Ovid, ScienceDirect) and 1 Grey literature database (OpenGrey). We included original studies, published prior to year 2020, which had evaluated any decontamination method on FFRs. Studies had evaluated a reprocessing method against parameters namely physical changes, user acceptability, respirator fit, filter efficiency, microbicidal efficacy and presence of chemical residues post-reprocessing.

FINDINGS AND CONCLUSIONS

Overall, we found 7887 records amongst which 17 original research articles were finally included for qualitative analysis. Overall, 21 different types of decontamination or reprocessing methods for N95-FFRs were evaluated. Most commonly evaluated method for reprocessing of FFRs was Ultraviolet (Type-C) irradiation (UVGI) which was evaluated in 13/17 (76%) studies. We found published literature was scant on this topic despite warning signs of pandemic of a respiratory illness over the years. Promising technologies requiring expeditious evaluation are UVGI, Microwave generated steam (MGS) and based on Hydrogen peroxide vapor. Global presence of technologies, which have been given Emergency use authorisation for N95-FFR reprocessing, is extremely limited. Reprocessing of N95-FFRs by MGS should be considered for emergency implementation in resource limited settings to tackle shortage of N95-FFRs.

SYSTEMATIC REVIEW IDENTIFIER

PROSPERO, PROSPERO ID: CRD42020189684, (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020189684).

Authors+Show Affiliations

Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

33216795

Citation

Paul, Diptanu, et al. "Exploring Options for Reprocessing of N95 Filtering Facepiece Respirators (N95-FFRs) Amidst COVID-19 Pandemic: a Systematic Review." PloS One, vol. 15, no. 11, 2020, pp. e0242474.
Paul D, Gupta A, Maurya AK. Exploring options for reprocessing of N95 Filtering Facepiece Respirators (N95-FFRs) amidst COVID-19 pandemic: A systematic review. PLoS One. 2020;15(11):e0242474.
Paul, D., Gupta, A., & Maurya, A. K. (2020). Exploring options for reprocessing of N95 Filtering Facepiece Respirators (N95-FFRs) amidst COVID-19 pandemic: A systematic review. PloS One, 15(11), e0242474. https://doi.org/10.1371/journal.pone.0242474
Paul D, Gupta A, Maurya AK. Exploring Options for Reprocessing of N95 Filtering Facepiece Respirators (N95-FFRs) Amidst COVID-19 Pandemic: a Systematic Review. PLoS One. 2020;15(11):e0242474. PubMed PMID: 33216795.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exploring options for reprocessing of N95 Filtering Facepiece Respirators (N95-FFRs) amidst COVID-19 pandemic: A systematic review. AU - Paul,Diptanu, AU - Gupta,Ayush, AU - Maurya,Anand Kumar, Y1 - 2020/11/20/ PY - 2020/07/31/received PY - 2020/11/03/accepted PY - 2020/11/20/entrez PY - 2020/11/21/pubmed PY - 2020/12/2/medline SP - e0242474 EP - e0242474 JF - PloS one JO - PLoS One VL - 15 IS - 11 N2 - BACKGROUND: There is global shortage of Personal Protective Equipment due to COVID-19 pandemic. N95 Filtering Facepiece Respirators (N95-FFRs) provide respiratory protection against respiratory pathogens including SARS-CoV-2. There is scant literature on reprocessing methods which can enable reuse of N95-FFRs. AIM: We conducted this study to evaluate research done, prior to COVID-19 pandemic, on various decontamination methods for reprocessing of N95-FFRs. METHODS: We searched 5 electronic databases (Pubmed, Google Scholar, Crossref, Ovid, ScienceDirect) and 1 Grey literature database (OpenGrey). We included original studies, published prior to year 2020, which had evaluated any decontamination method on FFRs. Studies had evaluated a reprocessing method against parameters namely physical changes, user acceptability, respirator fit, filter efficiency, microbicidal efficacy and presence of chemical residues post-reprocessing. FINDINGS AND CONCLUSIONS: Overall, we found 7887 records amongst which 17 original research articles were finally included for qualitative analysis. Overall, 21 different types of decontamination or reprocessing methods for N95-FFRs were evaluated. Most commonly evaluated method for reprocessing of FFRs was Ultraviolet (Type-C) irradiation (UVGI) which was evaluated in 13/17 (76%) studies. We found published literature was scant on this topic despite warning signs of pandemic of a respiratory illness over the years. Promising technologies requiring expeditious evaluation are UVGI, Microwave generated steam (MGS) and based on Hydrogen peroxide vapor. Global presence of technologies, which have been given Emergency use authorisation for N95-FFR reprocessing, is extremely limited. Reprocessing of N95-FFRs by MGS should be considered for emergency implementation in resource limited settings to tackle shortage of N95-FFRs. SYSTEMATIC REVIEW IDENTIFIER: PROSPERO, PROSPERO ID: CRD42020189684, (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020189684). SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/33216795/Exploring_options_for_reprocessing_of_N95_Filtering_Facepiece_Respirators__N95_FFRs__amidst_COVID_19_pandemic:_A_systematic_review_ DB - PRIME DP - Unbound Medicine ER -