Date of this Version

12-9-2021

Document Type

DNP Project

Abstract

Title

An Evidence-Based Comparison of Decontamination Strategies for the Safe Utilization of Post-Decontaminated N95 Filtering Facepiece Respirators by Anesthesia Providers

Background/Purpose/Question

Because the current pandemic threatens a limited supply of N95 filtering facepiece respirators (FFRs), many anesthesia providers have resorted to the decontamination and reuse of single-use FFR. There is little evidence of the relative safety and efficacy of the different decontamination methods. The lack of concrete evidence and guidance regarding the reuse of FFR is a cause for concern for anesthesia providers, who are at constant risk of exposure to airborne diseases. This evidence-based review seeks to answer the proposed question, “In anesthesia providers, does the reuse of post-decontaminated N95-type FFRs increase the risk of airborne diseases compared to anesthesia providers who use one-time disposable use N95-type FFRs?”

Methods/Evidence Search

An electronic search was conducted in the Cumulative Nursing and Allied Health Literature (CINAHL), Embase, and MEDLINE/PubMed. The search parameters included articles written in English and published in 2014–2021. The following search terms were used: “anesthesia providers,” “reuse,” “post decontaminates,” “N95 FFR,” and “risk of airborne disease.” The search initially resulted in 140 articles. Duplicate articles and titles with abstracts deemed irrelevant were then eliminated from the review. The inclusion criteria for research articles were based on the article’s applicability to the comfort level of N95 FFR wearers after decontamination, the concerns of N95 FFR wearers after decontamination, and determining which decontamination methods would be most practical and safe considering the available resources. An educational module containing both a pre and post assessment was created based on findings from literature review.

Synthesis of Literature/Results/Discussion

Thirteen sources met the inclusion criteria for the evidence-based review. The literature revealed that solution-based decontamination methods such as hydrogen peroxide and bleach should be avoided because they degrade the masks’ integrity and efficiency. Heat minimally alters the integrity of the mask; however, after 20–50 cycles, there was evidence of decreased efficiency and mask degradation. Other factors, such as multiple donning, also affected the integrity of the FFR. Statistical analysis showed that the fit gradually decreased after donning the FFR 5 times. The most effective methods noted within this evidence-based review were ultraviolet germicidal irradiation (UVGI), moist heat, dry heat, and hydrogen peroxide vapor (VHP). Data analysis of the pre and post-assessment from the educational module indicate an increase in provider knowledge on reuse of decontaminated N95-type FFRs. Because the pandemic continues due to the spread of different strains, mask integrity should continue to be researched to assist anesthesia providers and their employers in making informed decisions regarding personal protective equipment for anesthesia providers.

Conclusion/Recommendations for Practice

Anesthesia providers are at increased risk of acquiring airborne pathogens. If the reuse of post-decontaminated N95 FFRs remains a practice used to conserve mask supply during a pandemic, then appropriate information regarding the potential risks of reuse and decontamination should be available. Studies seem to indicate that the reuse of N95 FFRs can conserve the supply of N95 FFR in times of short supply. However, this conservation method must be studied further to determine the risk to anesthesia providers. Much remains unknown, which can pose an increased risk to providers who have no choice but to adopt these practices. It is also essential to consider the feasibility of the selected decontamination method and its cost-effectiveness. Organizations should consider the N95 FFR models they provide when instructing providers to conserve supplies by decontaminating and reusing FFRs.

Conflict of Interest

The authors have declared they have no financial relationships with any of the commercial interests related to the content of this review. There is no conflict of interest.

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