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Effects of Sterilization With Hydrogen Peroxide and Chlorine Dioxide 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

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

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
1.
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.2020.100329PubMedGoogle Scholar
2.
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-XPubMedGoogle ScholarCrossref
3.
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
4.
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.PubMedGoogle Scholar
5.
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.2004.10.013PubMedGoogle ScholarCrossref
6.
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.2019.11645PubMedGoogle ScholarCrossref
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