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Occupational Health

Effects of Sterilization With Hydrogen Peroxide and Chlorine Dioxide Solution on the Filtration Efficiency of N95, KN95, and Surgical Face Masks

Educational Objective
To understand how effective it is to sterilize N95, KN95, and Surgical Face Masks with hydrogen peroxide and chlorine dioxide

1 Credit CME

JAMA Network Open

Published Online: June 15, 2020

Research Letter

Article Information and Disclosures

Changjie Cai, PhD¹;

Evan L. Floyd, PhD¹

Author Affiliations

¹Department of Occupational and Environmental Health, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City

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Owing to the coronavirus disease 2019 pandemic, there is a global shortage of masks needed to protect health care personnel.¹^,2 The US Centers for Disease Control and Prevention has suggested the potential reuse of disposable respirators to conserve available supplies.³ A study by Viscusi et al⁴ evaluated various sterilization methods for reuse of N95 masks. Although surgical masks should not be used as a substitute for N95s owing to lower fit quality,⁵ a randomized clinical trail by Radonovich et al⁶ found that there was no significant difference in the incidence of laboratory-confirmed influenza among health care personnel who used N95s vs surgical face masks. The Centers for Disease Control and Prevention listed KN95 masks (the Chinese version of the N95) as suitable alternatives to N95s when N95s are not available. However, to our knowledge, there are no studies regarding the effects of sterilization on the filtration efficiencies of KN95s or surgical face masks. The goal of this quality improvement study was to test the feasibility of reusing KN95s and surgical masks.

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Article Information

Accepted for Publication: May 19, 2020.

Published: June 15, 2020. doi:10.1001/jamanetworkopen.2020.12099

Correction: This article was corrected on August 14, 2020, to clarify that the chlorine dioxide solution used was Vital Oxide.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Cai C et al. JAMA Network Open.

Corresponding Author: Changjie Cai, PhD, Department of Occupational and Environmental Health, University of Oklahoma Health Sciences Center, University of Oklahoma, 801 NE 13th St, Room 431, Oklahoma City, OK 73104 (changjie-cai@ouhsc.edu).

Author Contributions: Drs Cai and Floyd had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Both authors.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Cai.

Critical revision of the manuscript for important intellectual content: Both authors.

Statistical analysis: Cai.

Obtained funding: Both authors.

Administrative, technical, or material support: Both authors.

Supervision: Both authors.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by the Oklahoma State Department of Health to establish this testing program; the supply chain logistics group at the University of Oklahoma Medicine, which provided the respirators and sterilization treatments; and the University of Oklahoma Health Sciences Center VPR’s office through a COVID-19 Rapid Response pilot grant.

Role of the Funder/Sponsor: The funders were involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication.

References

Wu HL , Huang J , Zhang CJP , He Z , Ming WK . Facemask shortage and the novel coronavirus disease (COVID-19) outbreak: reflections on public health measures. EClinicalMedicine. April 3, 2020;100329. doi:10.1016/j.eclinm.2020.100329 PubMed Google Scholar

Feng S , Shen C , Xia N , Song W , Fan M , Cowling BJ . Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med. 2020;8(5):434-436. doi:10.1016/S2213-2600(20)30134-X PubMed Google Scholar Crossref

Centers for Disease Control and Prevention. Recommended guidance for extended use and limited reuse of N95 filtering facepiece respirators in healthcare settings. Accessed May 21, 2020. https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

Viscusi DJ , Bergman MS , Eimer BC , Shaffer RE . Evaluation of five decontamination methods for filtering facepiece respirators. Ann Occup Hyg. 2009;53(8):815-827.PubMed Google Scholar

Derrick JL , Gomersall CD . Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks. J Hosp Infect. 2005;59(4):365-368. doi:10.1016/j.jhin.2004.10.013 PubMed Google Scholar Crossref

Radonovich LJ Jr , Simberkoff MS , Bessesen MT , et al; ResPECT investigators. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA. 2019;322(9):824-833. doi:10.1001/jama.2019.11645 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.