Ultraviolet germicidal irradiation: Possible method for respirator disinfection to facilitate reuse during the COVID-19 pandemic

Abstract

To the Editor: The ability to disinfect and reuse disposable N95 filtering facepiece respirators is urgently needed during the current COVID-19 pandemic because supplies are running low in hospitals throughout the United States and abroad. Ultraviolet (UV) germicidal irradiation (UVGI) is one possible method for respirator disinfection to facilitate the reuse of dwindling supplies. Dermatology offices often use narrow-band UVB to treat skin diseases. If necessary, we propose a possible repurposing of phototherapy devices, including these UVB units, to serve as a platform for UVC germicidal disinfection. UVGI is a disinfection method that uses UVC radiation to inactivate microorganisms by causing DNA damage and preventing replication. Previous studies have shown that UVC can inactivate coronaviruses, including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV).1Bedell K. Buchaklian A.H. Perlman S. Efficacy of an automated multiple emitter whole-room ultraviolet-C disinfection system against coronaviruses MHV and MERS-CoV.Infect Control Hosp Epidemiol. 2016; 37: 598-599Crossref PubMed Scopus (84) Google Scholar One study of respirators contaminated with H1N1 influenza A found significant reductions (≥3-log reduction) in viable influenza virus under substantial artificial soiling conditions after being treated for 60 to 70 seconds at an irradiance of 17 mW/cm2, resulting in a UVGI dose of ∼1 J/cm2 measured at 254 nm.2Mills D. Harnish D.A. Lawrence C. Sandoval-Powers M. Heimbuch B.K. Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators.Am J Infect Control. 2018; 46: e49-e55Abstract Full Text Full Text PDF Scopus (164) Google Scholar The efficacy of this dose has been verified in additional studies, and higher doses (up to 2 J/cm2) have been shown to provide diminished benefit after 1 J/cm2.3Fisher E.M. Shaffer R.E. A method to determine the available UV-C dose for the decontamination of filtering facepiece respirators.J Appl Microbiol. 2011; 110: 287-295Crossref Scopus (93) Google Scholar,4Mills D.S. Lawrence C. Heimbuch B. Harnish D.A. Ultraviolet Germicidal Irradiation of Influenza-Contaminated N95 Filtering Facepiece Respirators. Poster presentation at: American Society for Microbiology. Poster Presentation.https://www.fda.gov/downloads/EmergencyPreparedness/Counterterrorism/MedicalCountermeasures/MCMRegulatoryScience/UCM505730.pdfDate: 2016Date accessed: March 23, 2020Google Scholar It is recommended to treat used masks, but not visibly soiled, to allow the 3-log reduction reported in the literature to be sufficient to achieve safe reuse levels.5Eickmann M. Gravemann U. Handke W. et al.Inactivation of three emerging viruses - severe acute respiratory syndrome coronavirus, Crimean-Congo haemorrhagic fever virus and Nipah virus - in platelet concentrates by ultraviolet C light and in plasma by methylene blue plus visible light.Vox Sang. 2020; https://doi.org/10.1111/vox.12888Crossref PubMed Scopus (87) Google Scholar It is important to note that the time to deliver 1 J/cm2 depends on the irradiance; hence, it can be longer or shorter depending on the delivery device's capabilities. In a prototype model that has been developed (Fig 1), this dose can be delivered in 1 minute and 40 seconds at an irradiance of 10 mW/cm2. The distance from the lamp to the top of the table in Fig 1 is approximately 14 cm. However, UV radiation does degrade polymers, which presents the possibility that UVGI exposure, while decontaminating, may also reduce the efficacy of the respirator and decrease protection to workers. Lindsley et al6Lindsley W.G. Martin Jr., S.B. Thewlis R.E. et al.Effects of ultraviolet germicidal irradiation (UVGI) on N95 respirator filtration performance and structural integrity.J Occup Environ Hyg. 2015; 12: 509-517Crossref PubMed Scopus (164) Google Scholar exposed 4 different models of N95 filtering facepiece respirators to UVGI doses of 120 to 950 J/cm2. Results of the study showed that UVGI exposure led to a small increase in particle penetration (up to 1.25%) and had little effect on the flow resistance. However, at higher UVGI doses, the strength of the layers of the respirator material was substantially reduced (in some cases, >90%), but this significantly varied among the different models. UVGI had less of an effect on the respirator straps: a dose of 2360 J/cm2 reduced the breaking strength of the straps by 20% to 51%.6Lindsley W.G. Martin Jr., S.B. Thewlis R.E. et al.Effects of ultraviolet germicidal irradiation (UVGI) on N95 respirator filtration performance and structural integrity.J Occup Environ Hyg. 2015; 12: 509-517Crossref PubMed Scopus (164) Google Scholar It should be noted that the dosages used in the study above are 100- to 1000-times higher than those shown to disinfect H1N1 influenza A–contaminated respirators. Therefore, considering that many of our health care providers are using substitutes for N95 filtering facepiece respirators that offer very limited degree of protection, using UVGI and repurposing phototherapy devices could be the best practical solution at this time. We would like to thank Bob Golding and his team at Daavlin (Byron, OH) for leading the reengineering of a phototherapy device that can be used to disinfect N95 masks.