Post written by Camilla Gallo, MD, from the Center for Endoscopi Research Therapeutics and Training, Università Cattolica del Sacro Cuore di Roma, Rome, Italy.

The abrupt outbreak of COVID-19 led many healthcare systems almost to the collapse and to the shortage of personal protective equipment (PPE). Rational use and successful reuse of respirators can help in facing PPE shortage during a pandemic.

As a first big step while facing PPE shortage and rational use, it is essential to underline possible differences in terms of efficacy in preventing the viral transmission among the currently most-used PPE. The PPE shortage scenario has already occurred in previous pandemics, and the time has come to learn from history. A systematic review of previous scientific evidence regarding the protective efficacy of masks and respirators is needed in order to practically suggest which type of PPE best suits each sanitary scenario depending on its risks. PPE scarcity could be furthermore mitigated through the identification of an effective reuse technique Since many advances in technology were lately reported, our research aims to propose a proper biological mask decontamination process.

Most studies on prior respiratory virus epidemics suggest similar efficacy of surgical masks to N95 respirators. A strong protective effect of both masks has been demonstrated, especially when used in combination with other protective measures such as hand washing, eye protection, gowns, and gloves. International organizations, first and foremost the World Health Organization, recommend health care workers use N95 respirators in high-risk situations such as aerosol generating procedures. In specific emergency situations such as the COVID-19 pandemic, the use of N95 respirators should be restricted among the general population and non-high-risk medical staff, in favor of high-risk healthcare workers.

As far as it concerns respirator reuse, UVGI is widely known as an effective and useful decontaminative technique. Its virucidal mechanism was proficiently applied to determine N95 respirators decontamination from viral respiratory agents. The highly energetic short-wave UVGI at 254 nm was demonstrated to be especially effective in reducing the viral load over surgical masks. The refinement of the application of this technique and the propensity to limit its critical issues can represent a turning point while facing a worldwide sanitary emergency.

To sum up, if surgical masks are worn by every member of a population facing any sanitary emergency, they protect as much as N95 respirators. N95 respirators must be saved for high-risk exposed healthcare workers. Further studies testing the UVGI decontamination technique on different models are an unmet need.

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