Cleaning and disinfecting 3M versaflow Powered air purifying respirators

3M versaflow for health care- 3M 

If available, the proper use of a HEPA filtered powered air purifying respirator (PAPR) can be used to reduce the use of N-95s by health care workers as the HEPA filter on the device may be used for an extended period of time without changing.  The face shield and covers can also be disinfected.  These series of videos show proper assembly, donning and doffing of one style of 3M PAPR.

These supplemental notes to the videos on PAPR use and decontamination were developed by Nancy Rolstad from the BioSafety group at University Health and Safety.

Before Starting:

Eyeglass users: 

Consider a strap retainer to hold the eyeglasses in place. This may take a little adjusting as the hood is donned and more care when doffing to not be tempted to reach for glasses before hand hygiene is performed.  People may also use medical tape over the frame to their temples too but not without some discomfort.

There are also silicone retainers to slide on frames to help eyeglasses stay in place. https://www.amazon.com/Benvo-Eyeglasses-Retainers-Anti-slip-Protectors/dp/B07TTW1LD7/ref=sr_1_3?dchild=1&keywords=eyeglass+retainers&qid=1585941102&sr=8-3

Precheck:

Test airflow with the ball tube  (set out of the way so it doesn't become contaminated during doffing)

Hand over the output to test alarm  (shown in the video posted below)

Verify that there is enough battery power

The battery may need a good thump to get it locked in on the respirator, try pulling it off to verify it's tight.

To facilitate decontamination, install a plastic sleeve over the tube and secure with twist ties, tucking ends of twist ties in a way to prevent snagging.  (Consider taping, with a tab for easy removal as another option)

Check the hood for leaks before donning by gathering up the shoulder shroud (as if choking it) to verify it fills with air and you don't hear or feel any air pushing out any little holes. 

Donning:

Shroud Layering- Leave the longer shroud inside the disposable gown to help protect in from contamination

Use the gown to cover the unit to help protect it from contamination as shown in the video.

Doffing:

Follow the demonstration in the video with respect to doffing the disposable gown and gloves to prep for decontamination between patients or end of the shift.

Assure that there is a large enough space for two people.

Decontamination post doffing:

All items to be disinfected must remain visibly wet for the contact time listed on the (EPA approved) disinfectant's container and left to air dry. Do not attempt to wipe it dry. 

Wipe down the plastic sleeve being careful not to poke gloves with the twist tie ends which may be pointy.  Wipe down and carefully remove and properly dispose of the plastic sleeve at the end of the shift or if it becomes damaged.

Gently hang shroud to dry for next use. 

Wipe down table. 

Battery:

Battery connection points can become corroded if they get wet during decontamination. Avoid contact with disinfectant and battery connection points, if they do get wet be sure the battery contact points are dry before starting to charge.

Verify the battery is charging.

If there seems to be a connectivity issue a soft pencil eraser on the copper contact points can help to gently remove residue.     

Locate the battery charger in a place where it will not come into contact with items being doffed/ decontaminated.

Versaflow TR300 Mask 3 min. 27 seconds.

S- series head cover information.  View the first 2 minutes and 15 seconds

Donning, Doffing and disinfecting 3M PAPR breathing apparatus - 10 min. Please note this head cover is different from the s-series head cover in the previous video.  

There is a Cleaning Reusable Respirators-and-PAPR-assemblies document available from 3M

Home made face masks and COVID-19-

This is an early prototype of a two layer cloth mask made by my sister. The final mask will reposition the straps and have a twist tie sewn in above the nose bridge to get a better fit. I will be offering support for her to make masks to prolong the life of N-95 respirators, and to help protect others from people who do not know they have symptoms. The newer mask is an updated version of the Olson Mask

The fabrics used in a mask as well as the mask air leakage affect the ability of the cloth mask to filter out large and small particles. Combining multiple layers of different fabrics improves the mask filter efficiency. ACS Nano April, 2020.

MDH (Minnesota Department of Health (interim guidelines on alternative face masks) Wash dirty masks between each use. Wash in hot water with regular detergent. Dry completely on hot setting.  It contains guidance for when the respirators are appropriate to use and several websites with suggested designs. 

The University of Minnesota has a MN COVID Mask Sewist Group. You participate by making masks or requesting a cloth mask.  It also has a Face covering FAQ on the requirement that all people on campus are required to wear face coverings.  Please also see the UHS guide for fabric face coverings. 

Research paper (NIH) that does a comparison of cloth mask materials - Testing the efficacy of home made masks. It is interesting that the results of this study is slightly different from my current limited tests of recent home made mask designs. 

Lisa Brosseau offers a commentary that masks for all is not based on sound science. Filter efficiency and fit are key to the effectiveness of respirators. The filtering efficiency and face fit of the cloth mask is variable and deficient when compared to a properly fitted N-95 respirator. 

A recent summary at Fast.ai suggests that combining social distancing with cloth mask usage appears to be helpful in flattening the curve in some countries notably the Czech Republic. The video below explains how the Czech republic successfully established their Masks4All program  using the phrase, "I protect you. You protect me."

Home Made Face Mask Use - Czech Republic

The calls for general public mask use are increasing. In Australia grocery shoppers must wear masks - Reuters. The CDC has issued guidelines on the voluntary use of cloth face coverings. They emphasize the use of these cloth face coverings is an addition the maintenance of social distances and proper hand hygiene.

Amy L. Baxter, MD in a Medscape article asks Is it Time that We All Start Wearing Face Masks?
She offers strong arguments that it will reduce the efficiency of transmission from an infected individual to another person.

My comments:

The cotton masks do not work as well as a properly fitted and worn N-95 respirator.  However a multi-ply cloth respirator covering the mouth and nose will limit the amount of droplet aerosols produced during coughing, speaking, sneezing, or singing. Wearing a cloth mask will reduce a person's ability to infect another person. It will also make it more difficult for a person to directly touch their nose or mouth.

Breathing through a mask can cause more resistance from breathing. If you have questions about the use of one of these masks consult with your super busy health care provider.

Hand hygiene after mask removal is important. These masks will need to be washed and dried daily in a dryer on high temperature setting. Others have recommended washing, drying, and steam ironing for additional disinfection.

Maybe this will be another way we can all do our part to flatten the curve.

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COVID-19 Michael Osterholm March 2020 interviews

Joe Rogan Experience with Michael Osterholm (1 hour 34 min.) - 3/16/2020

I've been fortunate to hear Michael Osterholm speak many times. He is an intelligent, articulate expert on the the progress of infectious disease outbreaks. This video has been viewed over 13 Million times on YouTube since the middle of March.  

Radio Show Host Dan Barreiro and Michael Osterholm talk coronavirus - 15 min. 3/23/2020

The above discussion is from a radio broadcast toward the end of March with local Twin Cities radio host Dan Barreiro.

Michael Osterholm Bloomberg Australia interview talks about balancing health and economics - 8:24 minutes.


CIDRAP Global Coronavirus Response - podcast 38:48 minutes

On March 31, 2020 COVID-19 response Michael Osterholm discusses the current condition with the virus. He does not find a model that would support seasonality.  He gives counsel on how to best ride out the storm. We need to base our decisions on science and telling the truth. We need to care for each other. 

COVID - 19 Resources at the University of Minnesota

U of Minnesota Clinical trials

The University of Minnesota has extensive resources for the COVID-19 response. The main link for all responses is the Safe Campus

COVID-19 Page U of Minnesota

University COVID-19 Action Network

CIDRAP (Center for Infectious Disease Research and Policy

COVID-19 Clinical Trials at the U

COVID-19 Guidance for the research community

Health Emergency Response Office (HERO)

Safe Campus COVID-19 updates

U of Minnesota Transforming ideas into trials - Dr. Tolar 3/30/2020 - 2 min. 

COVID-19 U of M Ventilator update 3/26/2020 - 2 min. 

CDC guidance on room air changes COVID-19 and surface cleaning

Wyoming Department of Health

The CDC has provided guidance about the number of minutes a room needs to remain unoccupied between patients based on the number of air changes per hour in the room. More in depth information is provided with the CDC link below.

Room air changes and airborne contaminant removal COVID-19

Surfaces in the space will also need to be cleaned in between patients. See section 6 in the CDC Infection Prevention Control Guidance.  The chemicals used would need to be included in the CDC list of approved chemicals for disinfecting COVID-19

Environmental cleaning of high touch surfaces in patient care rooms - U of Nebraska - 5 min. 

OSHA guidance for workers who remain on the job

Preparing workplaces for COVID-19 - OSHA

As some employees are required to remain working on the job while many others work from home, OSHA has developed a tiered response for the remaining workers. OSHA specifies ventilation, administrative and personal protection equipment for each risk level.

Guidance on Preparing Workplace for COVID-19

Cleaning workplace - CDC

Some locations at work may need to be cleaned after a person with COVID-19 has occupied the space. The CDC has provided guidelines for cleaning and disinfecting these non clinical environment spaces.

Environmental Cleaning and Disinfection - CDC

Disinfection workplace if someone is sick - CDC

Lists of approved cleaning products for disinfection COVID-19: Keep in mind that some chemicals require the surface to be wet approximately one minute prior to wiping (0.5% hydrogen peroxide) or four minutes with quaternary ammonia compound solutions.  Please consult the manufacturers labels for contact time. 

Center for Biocide Chemistry List for COVID-19

Center for Disease Control List for COVID-19

WCCO TV interviews Mark Hegberg from the U of MN about cleaning surfaces - 3 min. 

Hand hygiene and glove removal

Proper handwashing is an disease prevention technique  for the flu, COVID-19, or many other bacterial or viral illnesses. The Center for Disease control has a CDC Hand hygiene page with in depth information about the science of proper hand washing.

Soap and water and drying with a paper towel remain the best method of assuring proper cleaning of the hands.  Videos below illustrate proper hand washing techniques and proper glove removal.




Handwashing WHO technique 1 minute and 49 seconds

Glove removal technique - 49 seconds

COVID - 19 Disposable Respirator Guides from NIOSH

Face fitting respirator - NIOSH

The Minnesota Health Department has issued Strategies for Optimizing the Supplies of PPE as of April 2, 2020

CDC has issued Guidance for PPE Optimization and Guidelines for respirator decontamination

Update Lancet article on Stability of SARS CoV-2 in different environmental conditions.  April, 2020. Survival up to 7 days for surgical masks. 

Guides for Decontamination of N-95 respirator. from N95 decon.org

Vaporized Hydrogen peroxide sterilization of respirators from San Antonio, Texas is underway. The respirators with obvious visual contamination are discarded.  The respirators can be reused by the same person up to 5 times. The hospital can process 50 respirators a day.

Amy Herr from UC Berkley and David Rempel from UC San Francisco respond to an extended Q and A session on issues with N-95 respirator decontamination from the North Coast Journal.

NIOSH guidelines for decontaminating and reuse of filtering facepiece respirators.

I have recently been helping health care providers with disposable respirator fit testing. Part of the procedure involves teaching the providers how to put the mask on and fit it to their face. Helpful tips based in this experience include:

• Remove earrings or other body jewelry that may interfere with the seal of the respirator or cause problems with putting on or taking off the respirator. Hoop earrings were particularly problematic. 
• For long hair, consider placing it in a pony tail, braid it, or cut it. Pull back the hair from the face to prevent the hair from getting in between the seal of the respirator. 
• Make sure to put the respirator on underneath the eyeglasses. The eyeglasses can be used to check the face fit as they will often fog up during the positive pressure test.
• Keep facial hair out of contact with the respirator seal. I've included a link to the NIOSH guide for respirator facial hair.
• Use the two finger method shown above to help adjust the nose piece. Do not pinch the ridge with a thumb and index finger as it will often create an air gap at the bridge of the nose. 

The guides recommend complying with applicable laws with respect to respirator fit testing. This fit testing helps assure that the respirator will properly fit your face and provide the protection when properly put on.  On March 14, 2020, OSHA has temporarily suspended the requirement for annual fit testing of health care workers to preserve the stock of respirators.

Links:

NIOSH Respirator Face Seal Check

NIOSH How to Properly Put On and Take Off a Disposable Respirator

NIOSH/CDC guide to facial hair and respirators

Donning and Doffing Respirators UNMC - 5 minutes

Fantastic Fungi Directed by Louie Schwartzberg

Fantastic Fungi Trailer - Approx. 3 minutes

Just saw the movie Fantastic Fungi directed by Louie Schwartzberg over this past weekend. The time lapse photography in this film is visually stunning The a computer animation sequence illustrating threes use of mycorrhizal to communicate was fascinating. The film focuses on how fungi interact with other species of plants and animals often performing necessary work to decompose other creatures at the end of life.

There is also a book, Fantastic Fungi: How Mushrooms Can Heal, Shift Consciousness, and Save the Planet based on the movie. I just recently purchased it and will review it at a later date. 

Fantastic Fungi Trailer Andrew Weil - Approx. 3 minutes



Fantastic Fungi Trailer The forbidden fruit - Approx. 3 minutes

Coronavirus information COVID-19

Graphic on symptom comparison from YaleNewHavenHealth

There are many symptom comparison checklists. I chose this one because it is from a reputable source and fairly easy to understand. At my most recent stop at a health care facility they also started asking if I lost my sense of taste or smell.

This post is a departure from the usual information about fungal organisms and sustainability, but  COVID-19 is a worldwide concern for health and the economy. The information below was compiled by Robin Tobias who works in the BioSafety Group at the University of Minnesota. I've just added a single link to the coronavirus.gov website.

CDC Guidelines: 

• Coronavirus.gov
• Coronavirus COVID-19 Landing Page
• Interim Guidance for US Institutions of Higher Education   
• Information for Laboratories
• Infection Control 
• COVID-19 PPE

WHO Guidelines:

• COVID-19 Q &A
• Rolling update on COVID-19 events as they happen

EPA Guidelines: 

• Coronavirus Approved Disinfectants List

American Biological Safety Association (ABSA)

• COVID-19 Toolkit  

Johns Hopkins

• Real-time case mapping tool

Stephen Curry and Dr. Anthony Fauci - 28 minutes.  

The above interview was excellent. I was impressed with Stephen's questions and Dr Fauci's answers. I wish that more interviews could be in this long format with just two people rather than panel discussions where people talk over each other.