Jared Kaltwasser

Necessity might be the mother of invention, but the inventions themselves—at least at first go-around—often wind up being abandoned. That was not an option for infection preventionists and other health care professionals forced to use various methods to decontaminate and reuse N95 masks early in the COVID-19 pandemic. Luckily, though, most methods used for this purpose were adequate.

 Corresponding author Max A. Schumm, MD, of the UCLA David Geffen School of Medicine, and colleagues noted that filtering facepiece respirators such as N95 masks have been in limited supply since the pandemic’s start last year. Unable to purchase adequate supplies of the theoretically single-use masks, health systems had to begin reprocessing them, something the Centers for Disease Control and Prevention (CDC) says is acceptable in emergency conditions.

“However, that [CDC] guidance is associated with few recommendations for how to reprocess these devices,” Schumm et al wrote. “Filtering facepiece respirators can fail if the reprocessing system cannot kill all the pathogens that accumulate on the mask material itself, if the filters are compromised and lose filtering efficiency, or if the mask elasticity is altered such that it no longer provides a tight fit and air leaks around the mask.”

Hoping to provide better guidance on how best to reprocess the masks, Schumm and colleagues set about examining existing studies. They found 42 studies evaluating 5 decontamination processes: UV germicidal irradiation, moist heat, microwave-generated steam, vaporized hydrogen peroxide, and ethylene oxide. The authors extracted data from the studies on a variety of parameters: process method, pathogen removal, mask filtration efficiency, facial fit, user safety, and processing capability.

The results were mostly positive. Most methods proved reliable and relatively easy to implement. The investigators found that UV germicidal irradiation, vaporized hydrogen peroxide, moist heat, and microwave-generated steam all were effective in sterilizing the respirators, and the respirators sterilized in these methods retained their filtration performance. The first 2 methods—UV germicidal irradiation, vaporized hydrogen peroxide—caused the least damage to the respirators, Schumm and colleagues found. Irradiation, moist heat, and microwave-generated steam were found to have short treatment times and could be done with readily available equipment. Vaporized hydrogen peroxide was a suitable option, although it takes longer and is more expensive, they said. The fifth method, ethylene oxide, could potentially leave toxic residue and is harder to implement, they concluded.

“Overall, the results of the review should be reassuring to health care workers because we can effectively decontaminate this essential [personal protective equipment] without damaging its filtering capability or the polymers that make up the mask,” Schumm said. However, he added 2 important caveats. First, some methods are more likely to damage the devices. Second, the shape and material composition of the respirators varied widely from manufacturer to manufacturer, which can result in variations in the efficacy of a particular method from one product to the next. “For these reasons, we recommend clinicians and leaders of health care systems confirm that the reprocessing system in use at their facility has been tested for the specific brand and model of the N95 respirator in their stockpile,” he said.

Schumm said that because N95 respirators have irregular surfaces and porous material, it is possible the SARS-CoV-2 virus or other pathogens could be protected or shielded from sterilization or become absorbed into the material. He said masks with a fluid-resistant coating may perform better for this reason. He also said decontamination performance in the studies is different from real-world exposure scenarios, which could have an impact on real-world decontamination efficacy. “Taken together, more research should be directed toward reprocessing effectiveness for SARS-CoV-2 to better characterize optimal decontamination protocols for this pathogen,” he said.

Schumm MA, Hadaya JE, Mody N, Myers BA, Maggard-Gibbons M. Filtering facepiece respirator (N95 respirator) reprocessing: a systematic review. 

 Published online March 3, 2021. doi:10.1001/jama.2021.2531

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The shape and material composition of the N95 respirators varied widely from manufacturer to manufacturer, which can result in variations in the efficacy of a particular method from one product to the next.

Jared Kaltwasser

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