Mark Ridder, M.D. 
Outbreaks due to respiratory viruses pose a unique threat to health care as they require often significant amounts of personal protective equipment. Based upon previous modeling of severe influenza pandemics, the need for N95 filtering face piece respirators (FFRs) would range between 1.7 and 7.3 billion FFR’s, however there were only an estimated 60 million FFRs available at the time of the onset of the COVID-19 pandemic [1].
Given this known threat and likely shortfall of FFRs, work has been done to evaluate the efficacy and safety of maximizing the use of FFRs in the context of pandemic situations. Strategies have included prolonged use, as well as decontamination and reuse which may be employed in the context of FDA issued emergency use authorization. This paper is an overview of decontamination strategies as well as the particular data supporting the evidence for decontamination and reuse at the Nebraska Medical Center with the use of ultraviolet light germicidal irradiation (UVGI).
Findings of this review include that multiple strategies may be employed dependent upon resources and requirement for facilities, and that UVGI is a feasible and effective strategy for large-scale decontamination and reuse of FFRs with recognition of certain limitations. Advantages of UVGI include a generally low resource requirement with high output for reuse of FFRs with evidence for efficacious decontamination for many target pathogens (including many respiratory viruses), and evidence for efficacy in particular for 3M 1860, 1870, and 1870+ N95 respirators. However, limitations include strap integrity reduction over multiple irradiation cycles and the use, thus limiting the total number of cycles for FFR decontamination and reuse and the inability to apply UVGI to all N95 respirators.
UVGI decontamination can safely be used in times of emergency to extend the supply of N95 respirators. However, each N95 respirator model is different and the efficacy of UVGI decontamination should be confirmed for each model before broad application. In addition, manufacturer’s recommendations for single use should be reinstituted when adequate supplies of FFRs are available. A more sustainable approach to respiratory protection with the use of elastomeric respirators or powered air purifying respirators (PAPRs) should also be considered. Finally, it is important to recognize that PPE is but one intervention in a fully functional respiratory protection plan that includes engineering and administrative controls.
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1) MillsD,Harnish DA, Lawrence C, Sandoval-PowersM, Heimbuch BK. Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators. Am J Infect Control. 2018;46(7):e49–55. https://doi.org/10.1016/j.ajic.2018.02.018.
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