Decontamination of filtering facepiece respirators in primary care using medical autoclave

ObjectiveThere are widespread shortages of personal protective equipment as a result of the coronavirus disease 2019 (COVID-19) pandemic. Reprocessing filtering facepiece respirators may provide an alternative solution in keeping health care professionals safe. Designprospective, bench-to-bedside SettingA primary care-based study using filtering facepiece particles (FFP) type 2 respirators without exhalation valve (3M Aura 1862+, Maco Pharma ZZM002), FFP2 respirators with valve (3M Aura 9322+ and San Huei 2920V), and valved FFP type 3 respirators (Safe Worker 1016). InterventionsAll masks were reprocessed using a medical autoclave (34-minute total cycle time of steam sterilization, with 17 minutes at 121{degrees}C) and subsequently tested up to 3 times whether these decontaminated respirators retained their integrity (seal check, pressure drop) and ability to filter small particles (0.3-5.0m) in the laboratory using a particle penetration test. ResultsWe tested 32 respirators, and 63 samples for filter capacity. All 27 FFP-2 respirators retained their shape, whereas half of the sterilized FFP-3 respirators (Safe Worker 1116) showed deformities and failed the seal check. The filtering capacity of the 3M Aura 1862 was best retained after 1, 2, and 3 sterilization cycles (0.3m: 99.3{+/-}0.3% (new) versus 97.0{+/-}1.3, 94.2{+/-}1.3% or 94.4{+/-}1.6, p<0.001). Of the other FFP-2 respirators, the San Huei 2920V had 95.5{+/-}0.7% at baseline versus 92.3{+/-}1.7% versus 90.0{+/-}0.7 after one- and two-time sterilization, respectively (p<0.001). The tested FFP-3 respirator (Safe Worker 1016) had a filter capacity of 96.5{+/-}0.7% at baseline and 60.3{+/-}5.7% after one-time sterilization (p<0.001). Breathing and pressure resistance tests indicated no relevant pressure changes between respirators that were used once, twice or thrice. ConclusionThis study shows that selected FFP2-type respirators may be reprocessed for use in primary care, as the tested masks retain their shape, ability to retain particles and breathing comfort after decontamination using a medical autoclave. Strengths and limitations of this study- Pragmatic use of autoclave to sterilize and reuse filter facepiece respirators - Combining clinical and laboratory findings to evaluate the safety in terms of shape, ability to retain particles and breathing comfort - The study is limited in sample size and restricted to selected FFP-2 and FFP-3 respirators - The study is a first of its kind in primary care settings and thus unvalidated - The study does not provide "hard" clinical evidence in terms of a randomized trial (i.e. reprocessed mask versus usual care)