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. 2021 Oct 11;10(1):144.
doi: 10.1186/s13756-021-00993-w.

Decontaminating N95/FFP2 masks for reuse during the COVID-19 epidemic: a systematic review

Alexandra Peters  1   2 , Nasim Lotfinejad  2 , Rafael Palomo  2 , Walter Zingg  3 , Pierre Parneix  4 , Hervé Ney  1 , Didier Pittet  5
Affiliations

Decontaminating N95/FFP2 masks for reuse during the COVID-19 epidemic: a systematic review

Alexandra Peters et al. Antimicrob Resist Infect Control. .

Abstract

Background: With the current COVID-19 pandemic, many healthcare facilities have been lacking a steady supply of filtering facepiece respirators. To better address this challenge, the decontamination and reuse of these respirators is a strategy that has been studied by an increasing number of institutions during the COVID-19 pandemic.

Methods: We conducted a systematic literature review in PubMed, PubMed Central, Embase, and Google Scholar. Studies were eligible when (electronically or in print) up to 17 June 2020, and published in English, French, German, or Spanish. The primary outcome was reduction of test viruses or test bacteria by log3 for disinfection and log6 for sterilization. Secondary outcome was physical integrity (fit/filtration/degradation) of the respirators after reprocessing. Materials from the grey literature, including an unpublished study were added to the findings.

Findings: Of 938 retrieved studies, 35 studies were included in the analysis with 70 individual tests conducted. 17 methods of decontamination were found, included the use of liquids (detergent, benzalkonium chloride, hypochlorite, or ethanol), gases (hydrogen peroxide, ozone, peracetic acid or ethylene oxide), heat (either moist with or without pressure or dry heat), or ultra violet radiation (UVA and UVGI); either alone or in combination. Ethylene oxide, gaseous hydrogen peroxide (with or without peracetic acid), peracetic acid dry fogging system, microwave-generated moist heat, and steam seem to be the most promising methods on decontamination efficacy, physical integrity and filtration capacity.

Interpretation: A number of methods can be used for N95/FFP2 mask reprocessing in case of shortage, helping to keep healthcare workers and patients safe. However, the selection of disinfection or sterilization methods must take into account local availability and turnover capacity as well as the manufacturer; meaning that some methods work better on specific models from specific manufacturers.

Systematic registration number: CRD42020193309.

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Conflict of interest statement

No member of the team has competing interests.

Figures

Fig. 1
Fig. 1
Decontaminating N95/FFP2 masks for reuse during the COVID-19 epidemic; study Prisma flow chart
See this image and copyright information in PMC

References

    1. PRISMA. http://prisma-statement.org/PRISMAStatement/Checklist.
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    1. Lin T-H, Tang F-C, Hung P-C, Hua Z-C, Lai C-Y. Relative survival of Bacillus subtilis spores loaded on filtering facepiece respirators after five decontamination methods. Indoor Air. 2018;28:754–762. doi: 10.1111/ina.12475. - DOI - PMC - PubMed
    1. Smith JS et al. Effect of various decontamination procedures on disposable N95 mask integrity and SARS-CoV-2 infectivity. medRxiv 2020.04.11.20062331 (2020). 10.1101/2020.04.11.20062331. - PMC - PubMed
    1. Fischer RJ, et al. Early release—effectiveness of N95 respirator decontamination and reuse against SARS-CoV-2 virus. Emerg Infect Dis J CDC. 2020 doi: 10.3201/eid2609.201524. - DOI - PMC - PubMed

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