Fisher Edward M, Shaffer Ronald E
a National Personal Protective Technology Laboratory , National Institute for Occupational Safety and Health , Pittsburgh , Pennsylvania.
J Occup Environ Hyg. 2014;11(8):D115-28. doi: 10.1080/15459624.2014.902954.
Public health organizations, such as the Centers for Disease Control and Prevention (CDC), are increasingly recommending the use of N95 filtering facepiece respirators (FFRs) in health care settings. For infection control purposes, the usual practice is to discard FFRs after close contact with a patient ("single use"). However, in some situations, such as during contact with tuberculosis patients, limited FFR reuse (i.e., repeated donning and doffing of the same FFR by the same person) is practiced. A related practice, extended use, involves wearing the same FFR for multiple patient encounters without doffing. Extended use and limited FFR reuse have been recommended during infectious disease outbreaks and pandemics to conserve FFR supplies. This commentary examines CDC recommendations related to FFR extended use and limited reuse and analyzes available data from the literature to provide a relative estimate of the risks of these practices compared to single use. Analysis of the available data and the use of disease transmission models indicate that decisions regarding whether FFR extended use or reuse should be recommended should continue to be pathogen- and event-specific. Factors to be included in developing the recommendations are the potential for the pathogen to spread via contact transmission, the potential that the event could result in or is currently causing a FFR shortage, the protection provided by FFR use, human factors, potential for self-inoculation, the potential for secondary exposures, and government policies and regulations. While recent findings largely support the previous recommendations for extended use and limited reuse in certain situations, some new cautions and limitations should be considered before issuing recommendations in the future. In general, extended use of FFRs is preferred over limited FFR reuse. Limited FFR reuse would allow the user a brief respite from extended wear times, but increases the risk of self-inoculation and preliminary data from one study suggest that some FFR models may begin to lose effectiveness after multiple donnings.
诸如疾病控制与预防中心（CDC）等公共卫生组织越来越多地建议在医疗环境中使用N95过滤式面罩呼吸器（FFR）。出于感染控制目的，通常做法是在与患者密切接触后丢弃FFR（“一次性使用”）。然而，在某些情况下，例如在接触结核病患者期间，会实行有限的FFR重复使用（即同一个人反复佩戴和摘下同一个FFR）。一种相关做法是延长使用，即佩戴同一个FFR多次接触患者而不摘下。在传染病爆发和大流行期间，为节省FFR供应，已建议采用延长使用和有限的FFR重复使用。本评论审视了CDC关于FFR延长使用和有限重复使用的建议，并分析了文献中的现有数据，以提供与一次性使用相比这些做法风险的相对估计。对现有数据的分析以及疾病传播模型的使用表明，关于是否应建议延长使用或重复使用FFR的决定应继续针对病原体和具体事件。制定建议时应考虑的因素包括病原体通过接触传播的可能性、该事件可能导致或当前正在导致FFR短缺的可能性、FFR使用提供的防护、人为因素、自我接种的可能性、二次暴露的可能性以及政府政策和法规。虽然最近的研究结果在很大程度上支持先前在某些情况下延长使用和有限重复使用的建议，但在未来发布建议之前应考虑一些新的注意事项和限制。一般而言，FFR的延长使用优于有限的FFR重复使用。有限的FFR重复使用会让使用者从长时间佩戴中得到短暂缓解，但会增加自我接种的风险，并且一项研究的初步数据表明，一些FFR型号在多次佩戴后可能开始失去有效性。
