scholarly journals Decontamination and reuse of surgical masks and N95 filtering facepiece respirators during the COVID-19 pandemic: A systematic review

2020 ◽  
Vol 42 (1) ◽  
pp. 25-30 ◽  
Author(s):  
Kachorn Seresirikachorn ◽  
Vorakamol Phoophiboon ◽  
Thitiporn Chobarporn ◽  
Kasenee Tiankanon ◽  
Songklot Aeumjaturapat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hydrogen Peroxide ◽  
Medical Personnel ◽  
Physical Structure ◽  
Filtration Efficiency ◽  
Level Of Evidence ◽  
Low Level ◽  
Moist Heat ◽  
Surgical Masks ◽  
Hydrogen Peroxide Vapor

AbstractObjectives:Surgical masks and N95 filtering facepiece respirators (FFRs) prevent the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and protect medical personnel. Increased demands for surgical masks and N95 FFRs during the coronavirus disease 2019 (COVID-19) pandemic has resulted in the shortage crisis. However, there is no standard protocol for safe reuse of the N95 FFRs. In this systematic review, we aimed to evaluate the effectiveness of existing decontamination methods of surgical masks and N95 FFRs and provide evidence-based recommendations for selecting an appropriate decontamination method.Methods:We performed systematic searches of Ovid MEDLINE and Ovid EMBASE electronic databases. The last search was performed April 11, 2020. Any trials studying surgical masks and/or N95 FFRs decontamination were included. Outcomes were disinfections of virus and bacteria, restoration of the filtration efficiency, and maintenance of the physical structure of the mask.Results:Overall, 15 studies and 14 decontamination methods were identified. A low level of evidence supported 4 decontamination methods: ultraviolet (UV) germicidal irradiation (9 studies), moist heat (5 studies), microwave-generated steam (4 studies), and hydrogen peroxide vapor (4 studies). Therefore, we recommended these 4 methods, and we recommended against use were given for the other 10 methods.Conclusions:A low level of evidence supported the use of UV germicidal irradiation, moist heat, microwave-generated steam, and hydrogen peroxide vapor for decontamination and reuse of N95 FFRs. These decontamination methods were effective for viral and bacterial disinfection as well as restoration of the filtration efficiency, and the physical structure of the FFRs.

Additional appointments and discomfort associated with compliance-free fixed Class II corrector treatment: a systematic review

2018 ◽  
Vol 41 (4) ◽  
pp. 404-414 ◽  
Author(s):  
Ashley Phuong ◽  
Nathalia Carolina Fernandes Fagundes ◽  
Sahar Abtahi ◽  
Mary Roduta Roberts ◽  
Paul W Major ◽  
...  
Keyword(s):  
Systematic Review ◽  
Selection Process ◽  
Grey Literature ◽  
Class Ii ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Low Level ◽  
Weak Recommendation ◽  
Number Of Patients ◽  
Cross Sectional Studies

Summary Objective A critical analysis of the literature to determine the prevalence and type of emergency/additional appointments, and discomfort levels associated with fixed Class II correctors. Methods Studies examining patient’s sources of discomfort or emergency appointments associated with compliance-free Class II correctors were included. Comprehensive searches up to July 2018 were conducted using the following databases: MEDLINE (OvidSP), PubMed, Web of Science, and Embase. A partial grey literature search was taken using Google Scholar and OpenGrey. Two reviewers independently performed the selection process and risk of bias assessment. The Newcastle-Ottawa Scale for cross-sectional studies were used. A summary of the overall strength of evidence was presented using ‘Grading of Recommendations, Assessment, Development and Evaluation’ (GRADE) tool. Included studies were evaluated according to their design, study quality, consistency, and directness. Results The selected studies were published between 2001 and 2018, and the number of patients per studied group ranged from 8 to 182. One thousand five hundred forty-two patients were evaluated in total. The patients’ mean age at start of treatment ranged from 10 to 16.9 years and the fixed Class II corrector treatment duration ranged from 4 to 12 months. The included studies in this systematic review were too clinically heterogeneous (different appliances, different data recollection processes) to justify a meta-analysis. Limitations This review was not previously registered. A low level of evidence was observed among the two randomized trials, the 10 cohorts and three cross-sectional studies identified. Conclusions The main source of discomfort from Forsus-type appliances appears to be soreness in the cheeks (low level of evidence with a weak recommendation strength). Most evaluated patients treated with a Herbst appliance, regardless of design, will experience complications (fractures and/or dislodging) requiring emergency appointments (low level of evidence with a weak recommendation strength). Registration The review protocol was not registered.

scholarly journals The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction

2017 ◽  
Vol 52 (6) ◽  
pp. 387-407 ◽  
Author(s):  
Vasileios Korakakis ◽  
Rodney Whiteley ◽  
Alexander Tzavara ◽  
Nikolaos Malliaropoulos
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Lower Limb ◽  
Risk Of Bias ◽  
Eccentric Training ◽  
Level Of Evidence ◽  
Extracorporeal Shockwave Therapy ◽  
Low Level ◽  
Shockwave Therapy

ObjectiveTo evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT).DesignSystematic review.Eligibility criteriaRandomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated.ResultsModerate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting.ConclusionLow level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

scholarly journals Mask decontamination methods (model N95) for respiratory protection: a rapid review

2021 ◽  
Author(s):  
Livia Fernandes Probst ◽  
Ana Tereza Gomes Guerrero ◽  
Andréia Insabralde de Queiroz Cardoso ◽  
Antônio José Grande ◽  
Mariana Garcia Croda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hydrogen Peroxide ◽  
Rapid Review ◽  
Respiratory Protection ◽  
Dry Heat ◽  
Wet Heat ◽  
Isopropanol Solution ◽  
Heat Pasteurization ◽  
High Level ◽  
Hydrogen Peroxide Vapor

Abstract Background: N95 respiratory protection masks are used by healthcare professionals to prevent contamination from infectious microorganisms transmitted by droplets or aerosols.Methods: We conducted a rapid review of the literature analyzing the effectiveness of decontamination methods for mask reuse. The database searches were carried out up to September 2020. The systematic review was conducted in a way which simplified the stages of a complete systematic review, due to the worldwide necessity on reliable fast evidences on this matter.Results: A total of 563 articles were retrieved of which 48 laboratory-based studies were selected. Fifteen decontamination methods were included in the studies. A total of 19 laboratory studies used Hydrogen peroxide, 21 studies used ultraviolet germicidal irradiation,4 studies used ethylene oxide, 11 studies used dry heat, 9 studies used moist heat, 5 studies used ethanol, two studies used isopropanol solution, 11 studies used microwave oven, 10 studies used sodium hypochlorite, seven studies used autoclave, three studies used electric rice cooker, one study used cleaning wipes, one study used bar soap, one study used water, one study used multi-purpose high-level disinfection cabinet and another one used chlorine dioxide. Five methods promising: hydrogen peroxide vapor, ultraviolet irradiation, dry heat, wet heat/pasteurization, and microwave ovens.Conclusions: We have presented the best available evidence on masks decontamination, nevertheless, its applicability are limited due to few studies on the topic and lack of studies on real environments.

scholarly journals Surgical masks decontamination for reuse by members of the public: feasibility study and development of home-based methods

2020 ◽  
Author(s):  
Mun Cheok Hong ◽  
Tan Sook Lan ◽  
Phua Soo Zeng Fiona ◽  
Lim Wei Qi ◽  
Pang Shyue Wei ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Staphylococcus Aureus ◽  
Ultraviolet Irradiation ◽  
Influenza A ◽  
H1n1 Influenza ◽  
Filtration Efficiency ◽  
The Public ◽  
Enveloped Virus ◽  
Log Reduction ◽  
Surgical Masks

Abstract This study aims to propose decontamination methods that are suitable for use by members of the public to cope with the shortage of surgical masks during the current COVID-19 pandemic. 3-ply surgical masks were subjected to different decontamination protocols (heat, chemical, ultraviolet irradiation) to assess their abilities to achieve at least 4-log reduction of two common respiratory pathogens, H1N1 Influenza A virus, a single-stranded RNA enveloped virus similar to SARS-CoV-2 and Staphylococcus aureus, a Gram-positive bacterium that is more resistant to decontamination than single stranded RNA enveloped virus. Decontaminated surgical masks were assessed for differences in breathability, particle filtration efficiency and bacteria filtration efficiency as compared with non-decontaminated masks. The number of decontamination cycles that the 3-ply surgical masks could undergo without significant changes in breathability and filtration efficiencies were also determined. It was found that surgical masks decontaminated by either soaking for 60 min in 0.5% (v/v) aqueous hydrogen peroxide solution, or 30 min of soaking in 0.05% - 0.5% (v/v) aqueous sodium hypochlorite diluted from household bleach or ultraviolet irradiation by a surface dose of 13.5 kJ/m2 were able to achieve at least a 4-log reduction of both Staphylococcus aureus and H1N1 Influenza A virus spiked on surgical mask test swatches. No significant changes in breathability and filtration efficiencies of the surgical masks were observed after ten decontamination cycles of hydrogen peroxide or diluted bleach treatment or 30 cycles of ultraviolet irradiation.

scholarly journals Mask decontamination methods (model N95) for respiratory protection: a rapid review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Livia Fernandes Probst ◽  
Ana Tereza Gomes Guerrero ◽  
Andréia Insabralde de Queiroz Cardoso ◽  
Antonio Jose Grande ◽  
Mariana Garcia Croda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hydrogen Peroxide ◽  
Rapid Review ◽  
Respiratory Protection ◽  
Dry Heat ◽  
Wet Heat ◽  
Isopropanol Solution ◽  
Heat Pasteurization ◽  
High Level ◽  
Hydrogen Peroxide Vapor

Abstract Background N95 respiratory protection masks are used by healthcare professionals to prevent contamination from infectious microorganisms transmitted by droplets or aerosols. Methods We conducted a rapid review of the literature analyzing the effectiveness of decontamination methods for mask reuse. The database searches were carried out up to September 2020. The systematic review was conducted in a way which simplified the stages of a complete systematic review, due to the worldwide necessity for reliable fast evidences on this matter. Results A total of 563 articles were retrieved of which 48 laboratory-based studies were selected. Fifteen decontamination methods were included in the studies. A total of 19 laboratory studies used hydrogen peroxide, 21 studies used ultraviolet germicidal irradiation, 4 studies used ethylene oxide, 11 studies used dry heat, 9 studies used moist heat, 5 studies used ethanol, two studies used isopropanol solution, 11 studies used microwave oven, 10 studies used sodium hypochlorite, 7 studies used autoclave, 3 studies used an electric rice cooker, 1 study used cleaning wipes, 1 study used bar soap, 1 study used water, 1 study used multi-purpose high-level disinfection cabinet, and another 1 study used chlorine dioxide. Five methods that are promising are as follows: hydrogen peroxide vapor, ultraviolet irradiation, dry heat, wet heat/pasteurization, and microwave ovens. Conclusions We have presented the best available evidence on mask decontamination; nevertheless, its applicability is limited due to few studies on the topic and the lack of studies on real environments.

scholarly journals How to Intervene in the Caries Process: Early Childhood Caries – A Systematic Review

2020 ◽  
Vol 54 (2) ◽  
pp. 102-112 ◽  
Author(s):  
Julian Schmoeckel ◽  
Kristina Gorseta ◽  
Christian H. Splieth ◽  
Hrvoje Juric
Keyword(s):  
Systematic Review ◽  
Early Childhood ◽  
General Anaesthesia ◽  
Systematic Reviews ◽  
Early Childhood Caries ◽  
Randomized Clinical Trials ◽  
Level Of Evidence ◽  
Low Level ◽  
Anterior Teeth ◽  
Childhood Caries

For an Organisation for Caries Research/European Federation of Conservative Dentistry consensus, this systematic review is aimed to assess the question of how to manage the caries process in the case of early childhood caries (ECC). Medline via PubMed was searched systematically regarding management of ECC. First priority was existing systematic reviews or randomized clinical trials otherwise cohort studies dealing with management of ECC, primarily with carious anterior teeth. After data extraction, the potential risk of bias was estimated depending on the study types, and the level of evidence was evaluated. Regarding management of ECC, results are presented for silver diamine fluoride (SDF, n = 5), nonoperative caries management (NOCM, n = 10), and restorative approaches (RA, n = 8) separately, as different kinds of studies with different levels of evidence were found for the different aspects in the management of ECC. The 5 systematic reviews on SDF showed a high potential for arrest of ECC on a high level of evidence. In NOCM, a low level of evidence for a moderate effect of fluoride varnish in arresting or remineralizing, especially non-cavitated lesions, was assessed. For RA in carious anterior upper primary teeth, a low level of evidence was found for higher failure rates of glass ionomer cement and composite fillings than composite strip crowns even if placed under general anaesthesia and especially compared to other crowns (stainless steel and zirconia). In conclusions, ECC may be managed successfully with nonoperative (SDF, regular fluoride application) and moderately well with operative approaches, but the decision is affected by many other variables such as pulpal involvement, the child’s cooperation, or a general anaesthesia setting.

scholarly journals Effects of the scope of practice on family physicians: a systematic review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hervé Tchala Vignon Zomahoun ◽  
Isabelle Samson ◽  
Jasmine Sawadogo ◽  
José Massougbodji ◽  
Amédé Gogovor ◽  
...  
Keyword(s):  
Systematic Review ◽  
Job Satisfaction ◽  
Family Physician ◽  
Family Physicians ◽  
Scope Of Practice ◽  
Bibliographic Databases ◽  
Future Research ◽  
Clinical Practices ◽  
Level Of Evidence ◽  
Low Level

Abstract Background Family medicine is a branch of medicine that manages common and long-term illnesses in children and adults. Family physicians in particular play a major role and their scope of practice is expected to impact patient and population. However, little is known about its impact on physicians. We aimed to assess the effects of scope of practice on family physician outcomes. Methods We performed a systematic review that we reported using PRISMA guidelines. For the inclusion criteria, any study exploring an association between the scope of practice and physician outcomes was considered. Three bibliographic databases Medline, Embase, and ERIC were consulted through OVID interface from their respective inceptions to November, 2020. Two reviewers independently selected studies, extracted data and assessed the risk of bias of studies using appropriate tools. We conducted data synthesis using a narrative form. GRADE was used for evaluating quality of cumulative evidence. Results In total, we included 12 studies with 38,732 participants from 6927 citations identified. Eleven of them were cross-sectional, and one was a cohort study with acceptable methodological quality. We found that: 1) family physicians with diverse clinical and nonclinical activities significantly improve their job satisfaction (p<0.05); 2) family physicians with a variety of clinical practices significantly improve their competences and health status (p<0.05); 3) family physicians who perform clinical procedures (mainly extended to gynecological procedures) significantly improve their psychosocial outcomes (e.g., job satisfaction) (p<0.05); and 4) some associations are not statistically significant (e.g., relation between variety of practice settings and outcomes). We observed that the evidence available has a very low level. Conclusions Our findings suggest that the scope of practice may be favorably associated with some family physician outcomes but with a very low level of evidence available. Based on these findings, healthcare system managers could monitor the scope of practice among family physicians and encourage future research in this field. Systematic review registration Our protocol was registered under the number CRD42019121990 in PROSPERO.

scholarly journals Efficacy and Safety of Disinfectants for Decontamination of N95 and SN95 Filtering Facepiece Respirators: Protocol for a Systematic Review

2020 ◽  
Author(s):  
Katie O'Hearn ◽  
Richard J Webster ◽  
Anne Tsampalieros ◽  
Margaret Sampson ◽  
Lindsey Sikora ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hydrogen Peroxide ◽  
Disease Control ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Structural Integrity ◽  
Protective Equipment ◽  
Efficacy And Safety ◽  
Surgical Masks ◽  
Eastern Ontario

During the COVID-19 pandemic, a shortage of personal protective equipment (PPE), namely surgical masks, N95 masks, and gowns, has been experienced by some hospitals and could be expected in others due to a rapidly increased need. One method of addressing the shortage is to decontaminate and re-use PPE. The Centres for Disease Control (CDC) specifically recommends N95 filtering facepiece respirators (FFRs) for healthcare workers who are interacting with patients with COVID-19. There are anecdotal reports and published literature evaluating the potential of using disinfectants, such as hydrogen peroxide and bleach to decontaminate FFRs, with mixed reports of impact on structural integrity. To date this literature has not been comprehensively synthesized and the purpose of this review is to systematically review the existing literature on the use of disinfectants for the decontamination of facemask PPE.This information will be used to contribute to FFR decontamination protocols at the Children’s Hospital of Eastern Ontario and shared with other hospitals in Ontario, Canada, and internationally.

scholarly journals DECONTAMINATION INTERVENTIONS FOR THE REUSE OF SURGICAL MASK PERSONAL PROTECTIVE EQUIPMENT (PPE): A PROTOCOL FOR A SYSTEMATIC REVIEW

2020 ◽  
Author(s):  
David Zorko ◽  
Karen Choong ◽  
Dayre McNally ◽  
Katie O'Hearn ◽  
Margaret Sampson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hydrogen Peroxide ◽  
Personal Protective Equipment ◽  
Protective Equipment ◽  
High Demand ◽  
Ultraviolet Germicidal Irradiation ◽  
Surgical Masks ◽  
Global Spread ◽  
Single Use ◽  
Novel Coronavirus

As the global spread of novel coronavirus (SARS-CoV-2) escalates, the high demand for personal protective equipment (PPE) has created shortages of this equipment globally and prompted the need to ensure appropriate stewardship and develop strategies to conserve supply. Surgical masks have broad and commonplace applications as PPE, including in the care of suspected or confirmed COVID-19 patients, and for the care of the general patient population in areas where community spread of COVID-19 is of concern. Surgical mask rationing and conservation is therefore a priority to ensure adequate supply during a pandemic. Several methods have been considered to decontaminate and allow the reuse of single-use PPE, such as hydrogen peroxide vapour and ultraviolet germicidal irradiation, but to date this literature has not been comprehensively synthesized. The objective of this systematic review is to identify and synthesize data from published studies evaluating interventions used to decontaminate or treat surgical mask PPE for the purposes of reuse.

scholarly journals Validation of N95 filtering facepiece respirator decontamination methods available at a large university hospital

2020 ◽  
Author(s):  
Krista R. Wigginton ◽  
Peter J. Arts ◽  
Herek Clack ◽  
William J Fitzsimmons ◽  
Mirko Gamba ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Relative Humidity ◽  
Hepatitis Virus ◽  
Biological Indicators ◽  
Biological Indicator ◽  
Filtration Efficiency ◽  
Full Scale ◽  
Moist Heat ◽  
N95 Respirators ◽  
The Impact

AbstractImportanceFiltering facepiece respirators, including N95 masks, are a critical component of infection prevention in hospitals. Due to unprecedented shortages in N95 respirators, many healthcare systems have explored reprocessing of N95 respirators. Data supporting these approaches are lacking in real hospital settings. In particular, published studies have not yet reported an evaluation of multiple viruses, bacteria, and fungi along with respirator filtration and fit in a single, full-scale study.ObjectiveWe initiated a full-scale study to evaluate different N95 FFR decontamination strategies and their impact on respirator integrity and inactivating multiple microorganisms, with experimental conditions informed by the needs and constraints of the hospital.MethodsWe explored several reprocessing methods using new 3M™ 1860 N95 respirators, including dry (<10% relative humidity) and moist (62-66% relative humidity) heat (80-82 °C) in the drying cycle of industrial instrument washers, ethylene oxide (EtO), pulsed xenon UV (UV-PX), hydrogen peroxide gas plasma (HPGP), and vaporous hydrogen peroxide (VHP). Respirator samples were treated and analyzed for biological indicator inactivation using four viruses (MS2, phi6, influenza A virus, murine hepatitis virus), three bacteria (Escherichia coli, Staphylococcus aureus, Geobacillus stearothermophilus), and the fungus Aspergillus niger. The impact of different application media was also evaluated. In parallel, decontaminated respirators were evaluated for filtration integrity and fit.ResultsVHP resulted in >2 log10 inactivation of all tested biological indicators. The combination of UV-PX + moist heat resulted in >2 log10 inactivation of all biological indicators except G. stearothermohphilus. Greater than 95% filtration efficiency was maintained following 2 (UV-PX + <10% relative humidity heat) or 10 (VHP) cycles of treatment, and proper fit was also preserved. UV-PX + dry heat was insufficient to inactivate all biological indicators. Although very effective at virus decontamination, HPGP resulted in decreased filtration efficiency after 3 cycles, and EtO treatment raised potential toxicity concerns. The observed inactivation of viruses with UV-PX, heat, and hydrogen peroxide treatments varied as a function of which culture media (PBS buffer or DMEM) they were deposited in.Conclusions and RelevanceHigh levels of biological indicator inactivation were achieved following treatment with either moist heat or VHP. These same treatments did not significantly impact mask filtration or fit. Hospitals have a variety of scalable options to safely reprocess N95 masks. Beyond value in the current Covid-19 pandemic, the broad group of microorganisms and conditions tested make these results relevant in potential future pandemic scenarios.

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