Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review

  1. Elaine C. Toomey
  2. Yvonne Conway
  3. Chris Burton
  4. Simon Smith
  5. Michael Smalle
  6. Xin-Hui S. Chan
  7. Anil Adisesh
  8. Sarah Tanveer
  9. Lawrence Ross
  10. Iain Thomson
  11. Declan Devane
  12. Trish Greenhalgh

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Abstract

Background:

Shortages of personal protective equipment during the coronavirus disease 2019 (COVID-19) pandemic have led to the extended use or reuse of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination.

Objectives:

To synthesize current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering face-piece respirators.

Data sources:

We used the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. We used Medline, PubMed, Epistemonikos, Cochrane Database, and preprint servers for systematic reviews.

Methods:

Two reviewers conducted screening and data extraction. The quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesized.

Results:

In total, 6 guidance documents were identified. Levels of detail and consistency across documents varied. They included 4 high-quality systematic reviews: 3 focused on reprocessing (decontamination) of N95 respirators and 1 focused on reprocessing of surgical masks. Vaporized hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale.

Conclusions:

Evidence on the impact of extended use and reuse of surgical masks and respirators is limited, and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organizations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.

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  1. Version published to 10.1017/ice.2020.1243
  2. ScreenIT

    SciScore for 10.1101/2020.06.04.20121947: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We conducted a rapid review in line with the Cochrane Interim Guidance for Rapid Reviews7.
    Cochrane Interim
    suggested: None
    Searches and identifying literature: Data extraction and synthesis: Data were extracted by ET and verified by YC using separate pre-developed data extraction templates in Excel and NVIVO for the two sections of this review.
    Excel
    suggested: None

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: This review was conducted in adherence with current Cochrane rapid review guidance and used more than one author for searching, screening, data extraction and quality appraisal of included studies. The interdisciplinary nature of the research team was a particular strength and included frontline healthcare workers (XHC, LR) and individuals with expertise in occupational medicine (AA), infection control (XHC, LR), respiratory protective equipment design and performance (SS, IT), emergency nursing (YC), evidence synthesis (ET, YC, DD, TG, CB, ST) and an information specialist (MS). Owing to the need for timely review production, we limited our search for guidance to four major international health organisations and we did not search exhaustively for primary studies. At the time of writing, the included systematic reviews are non-peer reviewed pre-prints, but this reflects the rapid emergence of new evidence in this field. Recent research has compared international regulations regarding re-use and extended use of filtering facepiece respirators6, and guidance on respiratory protective equipment more broadly22. However, the former did not address surgical masks, and neither study compared recommendations with current evidence. Our study synthesises and integrates recommendations and evidence for single-use surgical masks and respirators to enable a clearer understanding of current evidence, gaps and facilitate evidence-informed decision-making in this a...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • No funding statement was detected.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.06.04.20121947v1 on medRxiv