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The CDC states that an effective FFR decontamination
method should reduce the pathogen burden, maintain
the function of the FFR, and present no residual chemical
hazard. What is important to remember is that 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.
As the CDC notes, “Because 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. The respirator manufacturer
should be consulted about the impact of the method on
their respirators prior to considering the use of any method.
When information from the manufacturer or a third-party
is available showing that respirators can be successfully
decontaminated without impacting respirator performance,
then FFRs decontaminated following those recommendations
can be worn for any patient-care activities.”
The CDC notes that in the absence of guidance or when
information is available that a respirator cannot be decon-
taminated without negatively impacting the performance,
respirators may still be decontaminated; however, the CDC
emphasizes, “given the uncertainties on the impact of
decontamination on respirator performance, these FFRs should
not be worn by healthcare personnel when performing or
present for an aerosol-generating procedure. No current data
exists supporting the effectiveness of these decontamination
methods specifically against SARS-CoV-2 on an FFR. Other
pathogens may also be present on FFRs and there is only limited
data available for other pathogens. Further work is needed
to assure SARS-CoV-2 and other pathogens are inactivated.
Therefore, even after decontamination, these FFRs should be
handled carefully.”
The following precautionary measures should be taken
prior to using a decontaminated FFR, according to the CDC:
●Clean
hands with soap and water or an alcohol-based
hand sanitizer before and after touching or adjusting the FFR.
●Avoid
touching the inside of the FFR.
●Use
a pair of clean (non-sterile) gloves when donning
and performing a user seal check.
●Visually
inspect the FFR to determine if its integrity has
been compromised.
●Check
that components such as the straps, nose bridge,
and nose foam material did not degrade, which can affect
the quality of the fit, and seal.
●If
the integrity of any part of the FFR is compromised, or
if a successful user seal check cannot be performed, discard
the FFR and try another FFR.
18
●Users
should perform a user seal check immediately
after they don each FFR and should not use an FFR on which
they cannot perform a successful user seal check.
There have been reports of healthcare personnel using
disinfectant wipes to decontaminate and reuse respiratory
attire. Addressing this issue were Heimbuch and Harnish
(2019), who evaluated respirators that were cleaned with
three types of wipes: hypochlorite, benzalkonium chloride
(BAC), or nonantimicrobial. Particle penetration following
cleaning yielded mean values <5 percent. The highest
penetrations were observed in FFRs cleaned with BAC
wipes. The BAC wipe caused one sample of FFRs to exceed
5 percent penetration. Filter penetration following various
decontamination methods was shown in this study to vary
based on the decontamination method and the model of
FFR. It’s an issue that requires more research, experts say.
Fit-testing of respiratory protection has also been
impacted by the COVID-19 pandemic. In a memorandum
issued mid-March, the Occupational Safety and Health
Administration (OSHA) issued temporary enforcement
guidance to compliance safety and health officers for
enforcing the Respiratory Protection standard, 29 CFR §
1910.134, within the context of the COVID-19 pandemic
and the shortages of N95 filtering facepiece respirators.
The memorandum provides temporary regarding required
annual fit-testing which will be enforced until further notice.
It comes following President Trump’s March 11 directive to
the Department of Health and Human Services to “take all
appropriate and necessary steps with respect to general use
respirators to facilitate their emergency use by healthcare
personnel in healthcare facilities and elsewhere.”
According to the memorandum, “OSHA recommends
healthcare personnel (HCP) employers follow existing CDC
guidelines, including taking measures to conserve supplies
of these respirators while safeguarding HCP. One such
measure is that healthcare employers may provide HCP
with another respirator of equal or higher protection, such
as N99 or N100 filtering facepieces, reusable elastomeric
respirators with appropriate filters or cartridges, or powered
air purifying respirators (PAPR). Another measure is that
healthcare employers may change the method of fit testing
from a destructive method (i.e., quantitative) to a non-de-
structive method (i.e., qualitative). For filtering facepiece
respirators, qualitative and quantitative fit-testing methods
are both effective at determining whether the respirator fits
properly. The fitted respirator can then be safely used for
work tasks that require respiratory protection. (For additional
guidance, see Strategies for Optimizing the Supply of N95
Respirators, https://www.cdc.gov/coronavirus/2019-ncov/
hcp/respirator-supply-strategies.html)"
OSHA says that its field offices may exercise enforcement
discretion concerning the annual fit-testing requirement as
long as employers:
● Make a good-faith effort to comply with 29 CFR §
1910.134
● Use only NIOSH-certified respirators
● Implement CDC and OSHA strategies for optimizing the
may 2020 • www.healthcarehygienemagazine.com