“Reusing disposable filtering facepiece respirators (FFRs) has been suggested as a crisis capacity strategy to conserve available supplies for healthcare environments during a pandemic. Strategies for FFR extended use and reuse (without decontamination of the respirator) are currently available from CDC’s National Institute for Occupational Safety and Health (NIOSH).
The surfaces of an FFR may become contaminated while filtering the inhalation air of the wearer during exposures to pathogen-laden aerosols. The pathogens on the filter materials of the FFR may be transferred to the wearer upon contact with the FFR during activities such as:
- Adjusting the FFR
- Doffing the FFR improperly
- Performing a user-seal check when redoffing a previously worn FFR
A study evaluating the persistence of SARS-CoV-2 (the virus that causes COVID-19) on plastic, stainless steel, and carboard surfaces showed that the virus is able to survive for up to 72 hours . One strategy to mitigate the contact transfer of pathogens from the FFR to the wearer during reuse is to issue five respirators to each healthcare worker who may care for patients with suspected or confirmed COVID-19. The healthcare worker will wear one respirator each day and store it in a breathable paper bag at the end of each shift. The order of FFR use should be repeated with a minimum of five days between each FFR use. This will result in each worker requiring a minimum of five FFRs, providing that they put on, take off, care for them, and store them properly each day. Healthcare workers should treat the FFRs as though they are still contaminated and follow the precautions outlined in our reuse recommendations. If supplies are even more constrained and five respirators are not available for each worker who needs them, FFR decontamination may be necessary.
Decontamination and subsequent reuse of FFRs should only be practiced where FFR shortages exist. At present, FFRs are considered one time use products and there are no manufacturer authorized methods for FFR decontamination before reuse. On March 29, 2020, the U.S. Food and Drug Administration (FDA) issued the first Emergency Use Authorization (EUA) for a decontamination process, and additional subsequent EUAs have been issued. The FDA Emergency Use Authorizations websiteexternal icon should be checked for the most up-to-date information. Only respirator manufacturers can reliably provide guidance on how to decontaminate their specific models of FFRs. In the absence of manufacturer’s recommendations, third parties may also provide guidance or procedures on how to decontaminate respirators without impacting respirator performance. Decontamination might cause poorer fit, filtration efficiency, and breathability of disposable FFRs as a result of changes to the filtering material, straps, nose bridge material, or strap attachments of the FFR. While decontamination and reuse of FFRs are not consistent with approved usage, this option may need to be considered when FFR shortages exist.
An effective FFR decontamination method should reduce the pathogen burden, maintain the function of the FFR, and present no residual chemical hazard. The filter media in NIOSH-approved respirators varies by manufacturer. 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. This research is summarized below.”