Published by N95Decon
Version 1.0, 04/17/2020

N95 Respirator Emergency Decontamination​ Example Guide to Beginning N95 Decontamination and Reuse
Intended Audience:​ Hospital administrators, Decision makers

Introduction
This document outlines approaches and issues to be considered by hospitals if they plan todecontaminate and reuse N95 filtering facepiece respirators (FFRs). N95 decontamination is acomponent of an overall strategy for optimizing N95 respirator supply. Decontamination is tobe used only under crisis conditions. See ​CDC guidance for optimizing respirator supply​. The
CDC recommends implementing ​extended use and limited reuse​ before implementing
decontamination and reuse​.
Decontamination procedures are under development at many organizations. The guidance
may change. See ​n95decon.org​ for updates. Please send comments and feedback athttps://www.n95decon.org/contact​.
Reviewed by​: MDs (2), COVID ICU RNs (2), and Hospital Health and Safety Staff (2)Important Points for Decontamination and Reuse
Decontamination is a risk-mitigation practice for crisis conditions, and decontamination
approaches vary considerably in (1) pathogen inactivation, (2) effects on N95 fit and filtration,and (3) accessibility to a range of healthcare environments.
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Some protocols achieve sterilization (destruction of all microorganisms) while others
only achieve low-level decontamination (pathogens and spores may survive) (​Guidelinefor Disinfection and Sterilization​, 2008).
The number of decontamination cycles an N95 can withstand depends on the method
used (N95DECON Fact Sheets). User seal checks are crucial to ensure proper fit(Filtering out Confusion, 2018).
Different models of N95 have different performance after decontamination by various
protocols. Ensure an appropriate decontamination method is used for the N95 model inuse (N95DECON Fact Sheets).
Each don/doff reduces the likelihood that an N95 will fit well. In one study the fit factor
was observed to drop with each don/doff, and after five dons was consistently below
the OSHA standard of 100 (Bergman et al., 2010).
Improper doffing has been shown to expose the wearer to contamination risk. Proper
doffing must accompany decontamination (Brady et al., 2017).

DISCLAIMER: The Content provided by N95DECON is for INFORMATIONAL PURPOSES ONLY andDOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE and IS NOT INTENDED TO BE A
SUBSTITUTE FOR INDEPENDENT PROFESSIONAL MEDICAL JUDGMENT, ADVICE, DIAGNOSIS, OR
TREATMENT. Use or reliance on any Content provided by N95DECON is SOLELY AT YOUR OWN
RISK. A link to the full N95DECON disclaimer can be found at​ https://www.n95decon.org/disclaimer​.
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The decision to implement N95 decontamination and reuse should be made on a per-hospitalbasis after reviewing regulatory guidance and after exhausting conventional and contingency
capacity strategies. Any decontamination approach needs to be accompanied by an industrial
hygiene workflow that meets FDA and OSHA standards.

Adoption
1. Review CDC, FDA, and OSHA regulatory guidance. See ​ECRI guide​ for additional
information.
2. Review documents on ​N95DECON’s Example Processes Page​,
3. Communicate to staff who use N95 FFRs to stop wearing makeup, sunscreen, Vaseline,or facial oils. Explain that N95 FFRs cannot be processed for decontamination if theyare soiled.
4. Decide whether to implement ​pooled​ or ​return-to-user ​processing​ ​and which method(H​2​O​2​, humid heat, UV-C) is best suited to your organization’s needs and resources.
Pooled return is appropriate for sterilization methods only.
5. Begin collecting used N95 FFRs as soon as personnel are fully trained.

Implementation
1. Use the Hospital Incident Command Structure (HICS) to:a. Identify personnel, in-house equipment, and supply needs to implement themethod-specific protocol and reuse plan. Implementation will require
coordination of Materials Management, Infection Control, Decontamination,
Healthcare Workers, Sterile Processing Units, Hygiene Experts, and others.
b. Set up collection and return stations well before (e.g. ~10 days if possible)
reaching crisis shortage. Prepare the rollout of the chosen N95 FFR return
protocol:i.
Pooled. ​Widely distribute clearly-labelled N95 collection bins—one bin at
the nursing station of every patient care unit. Repurpose ​recycling andtrash bins from closed areas (labs, clinics). Label side and top of bin.
Make a smaller collection hole in the top of the bin. Clearly mark “ForN95 FFRs to be decontaminated ONLY.”
ii.
Return-to-index-user. ​Read ​Example Return-to-Index User Setup andLogistics​ document.
iii.
If an ​external decontamination service​ is used (with either pooled orreturn-to-indexed user), they may provide more specific or additionalguidelines to follow.
c. Train healthcare workers (HCWs). An ​example​ of training material for healthcare
workers can be found on n95decon.org. Provide information about thedecontamination process chosen and ​emphasize any important changes toproper doffing technique​ that may be necessary to facilitate N95
decontamination and reuse (e.g. ​Nebraska video on donning and doffing​)

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d. Train decontamination personnel with the method-specific SOP, safety, andchain of custody. Begin collecting N95 FFRs.
e. Develop and pilot-test a protocol using on-site equipment and personnel. (e.g.
Nebraska UVGI Decontamination and Reuse​).
When the decontamination and reuse program is approved by the hospital quality
control team and meets regulatory standards, begin implementing the program on arolling basis.
Perform regular verification/quality control to check for compliance with themethod-specific critical processing parameters.
Obtain and incorporate continual feedback to improve the program.
Monitor new N95 supply levels. When able, end the reuse program or makemodifications as necessary or in response to updated federal guidance.

Regulatory Guidance●

CDC guidance for optimizing respirator supply
https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html●CDC extended use and limited reuse
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html●CDC Decontamination and Reuse of Filtering Facepiece Respirators
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuserespirators.html

Information and Resources●ECRI CLINICAL EVIDENCE ASSESSMENT: Safety of Extended Use and Reuse ofN95 Respirators
https://www.elsevier.com/__data/assets/pdf_file/0006/997863/COVID-ECRI-N95-Respir
ators_2020-03.pdf●Processes published by N95DECON and other sources
https://www.n95decon.org/example-processes●

Literature reviews of different decontamination methods published by N95DECON
https://www.n95decon.org/publications●A bibliography of sources for this and other N95DECON publications
https://www.n95decon.org/bibliography●

Training material on donning and doffing N95 FFRs for reuse
N95 Respirator Limited Resue - Healthcare Professionals Providing Clinical Care
https://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=132&src=yt

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References
Bergman, M., Viscusi, D., Heimbuch, B., Wander, J., Sambol, A., & Shaffer, R. (2010). Evaluation ofMultiple (3-Cycle) Decontamination Processing for Filtering Facepiece Respirators. ​Journal ofEngineered Fibers and Fabrics​, ​5​, 33–41. ​https://doi.org/10.1177/155892501000500405
Brady, T. M., Strauch, A. L., Almaguer, C. M., Niezgoda, G., Shaffer, R. E., Yorio, P. L., & Fisher, E. M.
(2017). Transfer of bacteriophage MS2 and fluorescein from N95 filtering facepiece respirators tohands: Measuring fomite potential. ​Journal of Occupational and Environmental Hygiene​, ​14​(11),898–906. ​https://doi.org/10.1080/15459624.2017.1346799
Guideline for Disinfection and Sterilization in Healthcare Facilities. (​ 2008).
https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/index.html
Filtering out Confusion: Frequently Asked Questions about Respiratory Protection (DHHS (NIOSH) No.
2018–130). (2018). Centers for Disease Control and Prevention, National Institute for Occupational
Safety and Health. ​https://doi.org/10.26616/NIOSHPUB2018130

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