Instruction for use: Berodual — DR

Instructions for use of the aerosol «Moskitol special protection against ticks»

Active substance Ipratropium bromide + Fenoterol

ATX Code R03AL01 Ipratropium bromide + Fenoterol

Pharmacotherapeutic group:

Beta-adrenergic agonist in combination

The nosological classification (ICD-10)

J44 Other chronic obstructive pulmonary disease

Allergic bronchitis, Bronchitis asthma, Asthmatic bronchitis, wheeze bronchitis, Bronchitis is an obstructive, bronchi disease, Shortness of sputum in acute and chronic respiratory diseases, Cough in inflammatory diseases of the lung and bronchus, Reversible airflow obstruction, Reversible obstructive airway disease, Obstructive bronchitis disease, Obstructive lung disease, Obstructive bronchitis, Spastic bronchitis, Chronic lung disease, Chronic nonspecific lung diseases, Chronic obstructive pulmonary disease, Chronic obstructive bronchitis, Chronic obstructive airway disease, Chronic obstructive pulmonary disease, Restrictive lung pathology

J45 Asthma

Asthma physical effort, status asthmaticus, Bronchial asthma, Asthma lung flow, Bronchial asthma with obstruction of sputum discharge, Bronchial asthma heavy currents, Bronchial asthma physical effort, hypersecretory asthma, Hormone-dependent form of bronchial asthma, Relief of asthma attacks in bronchial asthma, Non-allergic asthma, nocturnal asthma, Exacerbation of asthma, Asthma attacks, Endogenous forms of asthma, Night asthma, Cough with bronchial asthma

J46 Status asthmaticus

Asthmatic attack, status asthmaticus, Bronchospasm in bronchial asthma

J98.8.0 * Bronchospasm

Bronchospasm in bronchial asthma, Bronchospasm when exposed to an allergen, bronchospastic reactions, bronchospastic status, bronhospastichesky syndrome, Diseases accompanied by bronchospastic syndrome, reversible bronchospasm, spasmodic cough

Structure and Composition

A solution for inhalation of 1 ml

ipratropium bromide, 0.261 mg

(Corresponding to 0.25 mg of ipratropium bromide anhydrous)

fenoterol hydrobromide 0.5 mg

in flakonah- 20 ml (1 ml = 20 drops); in box 1 bottle.

Aerosol inhalation dosage 1 dose

ipratropium bromide, 0.021 mg

(Corresponding to 0.02 mg of ipratropium bromide anhydrous)

fenoterol hydrobromide 0.05 mg

propellant: 1,1,1,2 — tetrafluoroethane (HFA 134a)

Excipients: anhydrous citric acid; distilled water; ethanol

in aerosol cans with a mouthpiece 10 ml (200 doses); in box 1 bottle.

pharmachologic effect

Flomax contains two components having bronchodilator activity: ipratropium bromide — m-holinoblokator and fenoterol hydrobromide — beta2-agonists. These active ingredients complement each other, resulting in enhanced antispasmodic effect on bronchial muscles.

Bronchodilation when inhaled ipratropium bromide is mainly due to local rather than systemic anticholinergic effects.

In patients with bronchospasm associated with chronic obstructive pulmonary disease (chronic bronchitis and emphysema), significant improvement in lung function (increase in forced expiratory volume in 1 second (FEV1) and the average space velocity forced expiratory 15% or more), there is 15 minutes , the maximum effect is achieved after 1-2 hours and lasts for most patients to 6 hours.

Ipratropium bromide does not adversely affect the secretion of mucus in the airways, mucociliary clearance and gas exchange.

Fenoterol hydrobromide selectively stimulating beta2-adrenergic receptors.

Fenoterol relaxes bronchial smooth muscle and blood vessels and prevents the development of bronchospastic reactions, caused by histamine, methacholine, cold air and allergen (immediate hypersensitivity reaction). Fenoterol blocking the release of mediators of inflammation and bronchial obstruction from mast cells, and enhances mucociliary clearance.

Beta-adrenergic effect of the drug on cardiac activity (increase in power and heart rate) due to the action of vascular fenoterol, stimulation of beta2-adrenergic receptors of the heart, and at doses exceeding therapeutic, — stimulation of beta1-adrenergic receptors. Tremor is the most common adverse effect of using beta-agonists.

When the joint application of the two active substances in the form of metered aerosol achieved bronchodilation effect by acting on different pharmacological targets. The complementary action is such that in order to achieve the desired effect required a lower dose of beta-adrenergic component, which allows individual selection of an effective dose of the substantial absence of side effects.

Prophylaxis and symptomatic treatment of chronic obstructive respiratory disease with reversible bronchospasm: bronchial asthma, chronic obstructive bronchitis, emphysema complicated or uncomplicated.

Hypersensitivity, hypertrophic obstructive cardiomyopathy, tachyarrhythmia, pregnancy (I term).

Pregnancy and breast-feeding

It contraindicated in I trimester of pregnancy. To use caution during breastfeeding.

It is necessary to consider the possibility of inhibiting H Berodual effect on uterine activity.

CNS: fine tremor, nervousness; rarely — headache, dizziness, disturbance of accommodation; in rare cases — a change of mentality.

Cardio-vascular system: tachycardia, palpitations (especially in patients with aggravating factors); rarely (if used in high doses) — DBP reduction, increase Sad arrhythmia.

From the respiratory system: rarely — cough, local irritation; very rarely — paradoxical bronchospasm.

From the digestive tract: nausea, vomiting.

Allergic reactions: seldom — rash, angioedema swelling of the tongue, lips and face, urticaria.

Other: hypokalemia, increased sweating, fatigue, myalgia, cramps, urinary retention.

There are adverse effects on communication by the eye (see. «Precautions»).

Beta-adrenergic and anticholinergics, xanthine derivatives (theophylline) may enhance the effect of bronchodilator. Co-administration of other beta-agonists entering the systemic circulation anticholinergics or xanthine derivatives (eg, theophylline) may lead to increased side effects.

Perhaps the significant weakening of bronchodilator action with concomitant administration of beta-blockers.

Concomitant use with MAO inhibitors and tricyclic antidepressants increases the effects Berodual N.

Inhalation of halogenated hydrocarbon anesthetics (halothane, trichlorethylene, enflurane) may increase the effects of Berodual H on the cardiovascular system.

Against the background of Berodual H may develop hypokalemia, which can be enhanced while the appointment of xanthine derivatives, steroids and diuretics. This fact should be given special attention in the treatment of patients with severe obstructive airways disease.

Hypokalemia may increase the risk of arrhythmias in patients receiving digoxin. Additionally, hypoxia may exacerbate the negative effect of hypokalemia on cardiac rhythm. In such cases it is advisable to carry out monitoring of the level of potassium in the blood serum.

Dosing and Administration

A solution for inhalation. Adults and children over 12 years of cupping — on 20-80 drops (1-4 ml). When long-term therapy — 1-2 ml (20-40 drops) to 4 times per day. In cases of moderate bronchospasm or need auxiliary ventilation — 0.5 ml (10 drops). Children 6-12 years of cupping — 0.5-1 mL (10-20 drops) once, when severe attacks — 2-3 ml (40-60 drops), with long-term treatment — 0.5-1 ml ( 10-20 drops) four times daily, at a moderately expressed bronchospasm — 0.5 ml (10 drops). For children under 6 years of age (body weight less than 22 kg) (only under medical supervision) for 25 mg of ipratropium bromide and fenoterol hydrobromide 50 mg per 1 kg of body weight, and 0.5 ml (10 drops) up to 3 times a day.

The recommended dose is diluted immediately before use with saline to a volume of 4.3 ml nebulized and inhaled for 6-7 minutes until the solution is completely consumed. Flomax solution for inhalation should not be diluted with distilled water. The solution must be diluted before use, remaining after inhalation diluted solution should be discarded.

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The dosage depends on the mode and Performance inhalation nebulizer. The duration of inhalation can be controlled by the amount of the diluted solution.

Berodual solution for inhalation may be applied using various commercially available inhalation systems. In the presence of a stationary central oxygen supply, the best solution is administered at a rate of 6-8 l / min. If necessary, repeat the inhalation carried out with an interval of at least 4 hours.

Aerosol. Adults and children over 6 years to designate 2 inhalation doses. After 5 min facilitate respiration does not occur, it is possible to assign another 2 inhalation dose. With the ineffectiveness of 4 inhalations should immediately seek medical help.

During prolonged therapy and intermittent — 3 doses 1-2 times per day (up to 8 inhalations per day).

For maximum effect, you must use the correct metered aerosol.

Before using the metered aerosol for the first time shake the bottle, and double-click the bottom of the container.

Every time you use a metered aerosol is necessary to observe the following rules:

1. Remove the protective cap.

2. Make a slow, deep breath.

3. Hold the bottle, grasp the tip of the lips. The container should be sent upside down.

4. Making the most deep breath at the same time quickly press the bottom of the bottle to release one inhalation dose. For a few seconds, hold your breath, then take a tip from the mouth and breathe out slowly. Repeat the steps for the second inhalation dose.

5. Place the protective cap.

6. If the spray can is not used for more than 3 days prior to use should be pressed once to the bottom of the container before the aerosol cloud.

The container is designed for 200 inhalations. Thereafter, the cylinder must be replaced. Despite the fact that the cylinder can be some amount of content, the amount of drug released during inhalation can be reduced.

The cylinder is opaque, so the amount of drug in the container can be determined only by the following method: removing the cap, the cylinder is immersed into a container filled with water. The amount of drug is determined depending on the position of the cylinder in water.

The tip should be kept clean, if necessary, it can be washed in warm water. After using the soap or detergent, rinse thoroughly with clean water tip.

Warning: The plastic adapter is specifically designed for oral metered aerosol H and Flomax is used for accurate dosing of the drug. The adapter should not be used with other dosage aerosols. You can not use aerosol metered tetraftoretanosoderzhaschy Flomax H with any other adapters except for the adapter supplied with the balloon.

The cylinder is under pressure. The cylinder must not be opened and exposed to heat above 50 ° C.

Symptoms: tachycardia, palpitation, arterial hyper- or hypotension, increased pulse pressure, anginal pain, arrhythmias, flushing, tremor.

Treatment: the appointment of sedatives, tranquilizers, in severe cases — intensive therapy. As antidotes are recommended cardioselective beta-blockers. However, keep in mind the possible strengthening of bronchial obstruction under the influence of beta-blockers and carefully select a dose for patients with asthma or chronic obstructive pulmonary disease.

Be wary appoint diabetes, recent myocardial infarction, severe diseases of the cardiovascular system, hyperthyroidism, pheochromocytoma (required regular monitoring of the level of potassium in the blood), prostatic hypertrophy, urinary tract obstruction in patients predisposed to narrow-angle glaucoma.

In the case of sudden appearance and rapid progression of dyspnea (difficulty breathing) should seek medical advice immediately.

— In patients with bronchial asthma or mild and moderate chronic obstructive pulmonary disease symptomatic treatment may be preferable to regular use;

— In patients with bronchial asthma or steroidzavisimymi forms of chronic obstructive pulmonary disease should be aware of the need for strengthening or anti-inflammatory therapy to control airway inflammation and the disease process.

There have been reports of individual cases of complications in the eye (mydriasis, increased intraocular pressure, angle-closure glaucoma, pain in the eyeball) encountered in Eye spray ipratropium bromide or its combination with beta2-agonists.

Patients should be instructed in detail in the rules regarding the use of metered-dose aerosol inhaler Flomax N.

Pain in the eye, blurred vision, feeling ghosting or color spots before the eyes, combined with redness of the eyes in the form of corneal or conjunctival injection may be signs of an acute attack of angle-closure glaucoma. When you see these symptoms in any combination should begin treatment with eye drops, causing constriction of the pupil and immediately seek specialized medical care.

In patients with a history of cystic fibrosis, possible violations of GI motility.

It should be borne in mind that the use of cupping large doses for a long time may cause uncontrolled deterioration of the course of the disease and determine the need for correction of the basic anti-inflammatory therapy. In connection with the depressing effect on the use of generic activities stopped shortly before birth. Avoid contact with eyes.

The first application of a new form of metered aerosol Flomax H patients may note that a new drug to taste a little different from the previous dosage form containing freon. In the transition from one form to another, patients should be warned about a possible change in taste sensation. It is also reported that these drugs interchangeably, and that taste properties are not related to the safety and efficacy of a new drug.

The temperature is not above 30 ° C (do not freeze).

Keep out of the reach of children.

Shelf-life of Berodual

solution for inhalation 0.25 mg + 0.5 mg / ml 0.25 mg 0.5 + — 5 years.

aerosol for inhalation dose of 20 mg + 0.5 mg / 20 mg dose 0.5 — 3 years.

Do not use beyond the expiration date printed on the package.

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Instructions for use of the aerosol «Moskitol special protection against ticks»

Active substance Salbutamol

ATX Code R03CC02 Salbutamol

Pharmacotherapeutic group:

Bronchodilator agent — a selective beta2-agonists [beta-adrenergic agonist]

The nosological classification (ICD-10)

J42 Chronic bronchitis, unspecified

recurrent bronchitis, Bronchitis asthma, wheeze bronchitis, chronic Bronchitis, Inflammatory airways disease, bronchi disease, Qatar smoker, Cough in inflammatory diseases of the lung and bronchus, Exacerbation of Chronic Bronchitis, Chronic bronchitis, Chronic obstructive pulmonary disease, Chronical bronchitis, Chronic bronchitis smokers, Chronic spastic bronchitis, allergic Bronchitis

J44 Other chronic obstructive pulmonary disease

Allergic bronchitis, Bronchitis asthma, Asthmatic bronchitis, wheeze bronchitis, Bronchitis is an obstructive, bronchi disease, Shortness of sputum in acute and chronic respiratory diseases, Cough in inflammatory diseases of the lung and bronchus, Reversible airflow obstruction, Reversible obstructive airway disease, Obstructive bronchitis disease, Obstructive lung disease, Obstructive bronchitis, Spastic bronchitis, Chronic lung disease, Chronic nonspecific lung diseases, Chronic obstructive pulmonary disease, Chronic obstructive bronchitis, Chronic obstructive airway disease, Chronic obstructive pulmonary disease, Restrictive lung pathology

J45 Asthma

Asthma physical effort, status asthmaticus, Bronchial asthma, Asthma lung flow, Bronchial asthma with obstruction of sputum discharge, Bronchial asthma heavy currents, Bronchial asthma physical effort, hypersecretory asthma, Hormone-dependent form of bronchial asthma, Relief of asthma attacks in bronchial asthma, Non-allergic asthma, nocturnal asthma, Exacerbation of asthma, Asthma attacks, Endogenous forms of asthma, Night asthma, Cough with bronchial asthma

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J45.0 Asthma with a predominance of allergic component

Asthma bakers, Allergic lung disease, Asthma professional, Aspirin asthma, atopic asthma, Atopic bronchial asthma, Atopic asthma, Atopic asthma, Persistent atopic asthma, Allergic respiratory diseases

J45.1 Non-allergic asthma

Asthma bronchial physical stress, Asthma physical effort

J98.8.0 * Bronchospasm

Bronchospasm in bronchial asthma, Bronchospasm when exposed to an allergen, bronchospastic reactions, bronchospastic status, bronhospastichesky syndrome, Diseases accompanied by bronchospastic syndrome, reversible bronchospasm, spasmodic cough

Structure and Composition

Aerosol for inhalation dose 1 dose

salbutamol sulphate 120.5 mg

(Equivalent to 100 mcg salbutamol)

Excipients: tetrafluoroethane — 1 dose

aerosol aluminum cylinder (complete with a dosing device); In the paper cartons 1 cylinder.

Aerosol for inhalation dose: aluminum inhaler equipped with a plastic dosing device with protective cap, containing a suspension of white or nearly white.

pharmachologic effect

Salbutamol is a selective β2-adrenoceptor agonist. At therapeutic doses it acts on the β2-adrenergic receptors of the smooth muscle of the bronchi, providing little or no effect on β1-adrenergic receptors of myocardium. Has a pronounced bronchodilator effect of preventing or arresting bronchospasm, reduces the resistance in the airways. It increases lung capacity. Increases mucociliary clearance (in chronic bronchitis to 36%), stimulates the secretion of mucus, activates the function of the ciliated epithelium.

At the recommended therapeutic doses has no adverse effect on the cardiovascular system, does not cause increase in blood pressure. To a lesser extent, compared with the group PM has a positive chronotropic and inotropic effects. It is an extension of the coronary arteries.

It has a number of metabolic effects: reduces the concentration of potassium in the plasma affects glycogenolysis and insulin release, has a hyperglycemic (especially in patients with bronchial asthma) and lipolytic effect, increases the risk of acidosis.

Once inhaled forms action develops rapidly, the start effect — in 5 min, max — after 30-90 min (75% of the maximum effect is reached within 5 min), duration — 4.6 hours.

After inhalation of 10-20% salbutamol dose reaching the lower respiratory tract. The rest of the doses remain in the inhaler or is deposited in the oropharynx and then swallowed. The fraction deposited in the airways is absorbed into the pulmonary tissues and blood, but it is not metabolized in the lungs.

The degree of salbutamol binding to plasma proteins is approximately 10%.

Once in the bloodstream, salbutamol is metabolized in the liver and excreted predominantly in the urine in unchanged form or as phenol sulfate.

Swallowed part of the inhalation dose is absorbed from the gastrointestinal tract and undergoes active metabolism in the first passage through the liver, turning into the phenolic sulphate. Unchanged salbutamol and conjugate are excreted primarily in the urine.

Entered / w salbutamol has a T1 / 2 4-6 h. Kidneys displayed partially and partly as a result of metabolism to inactive 4′-O-sulphate (phenolic sulphate), which also appears mainly in urine. With the feces excreted by only a fraction of the administered dose of salbutamol. Most of the dose of salbutamol administered into the body / in, oral or inhalation, is excreted within 72 hours.

— Relief of asthma attacks, including an exacerbation of bronchial asthma heavy currents;

— Prevention of attacks of bronchospasm associated with exposure to the allergen or exercise-induced;

— Used as a component in long-term maintenance treatment of asthma;

COPD, accompanied by reversible airway obstruction;

Hypersensitivity to any component of the drug;

management of preterm labor;

Children under 2 years old.

Precautions: tachyarrhythmia, myocarditis, heart defects, aortic stenosis, coronary artery disease, severe chronic heart failure, hypertension, hyperthyroidism, pheochromocytoma, decompensated diabetes, glaucoma, epipripadki, renal or hepatic insufficiency, concomitant use of nonselective β-blockers, pregnancy, lactation.

Pregnancy and breast-feeding

drug for pregnant women is assigned only when the expected benefit to the patient outweighs the potential risk to the fetus.

During post-marketing surveillance revealed rare cases of various congenital malformations in children, including the formation of cleft palate and limb malformations, while taking their mothers during pregnancy, salbutamol. In some of these cases, the mother taking multiple concomitant medications during pregnancy. The causal relationship to drug intake has not been established.

Salbutamol is likely to penetrate into breast milk, so it is not recommended for nursing mothers unless the expected benefit to the patient outweighs the most potential risk to the child. No data is provided if present in breast milk salbutamol harmful effect on the newborn.

Adverse reactions are listed according to the anatomical and physiological classification and frequency of occurrence, which is defined as follows: very common (≥1 / 10), commonly (≥1 / 100 and

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N95 Mask Re-Use Strategies

This document was updated and re-released April 17, 2020. This content supersedes the previous versions.

Did you find this information helpful?
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Personal protective equipment (PPE) shortages during the COVID-19 pandemic have precipitated a wave of creative solutions for repurposing of N95 masks. A growing influx of new information can make it difficult to discern best practices for mask re-use. Below we provide resources and tips on this topic. This page will be updated regularly as new information comes in.

Note that based on manufacturer recommendations, N95 masks are designed for one-time use. The CDC and NIOSH do not formally recommend decontamination and re-use of N95 masks, but acknowledge that in times of scarcity, the strategies below are options that can be considered based on individual clinical judgment and the institutional resources available. [1]

How do N95’s work?

The filtration media contained in the N95 is designed to capture at least 95% of particles measuring a median of 0.3 µm. Even though viral particles are a few orders of magnitude smaller than this, nanoparticles mainly travel by Brownian motion and are effectively captured within the N95 filter via mechanical and electrostatic forces.[2] The outer mask material is typically hydrophobic polypropylene. Importantly, extended use, re-use, or re-processing of masks all affect the filtration capacity of the mask.

What are my options for extending the life of my N95 mask?

It is important to differentiate between extended use, re-use, and mask re-processing.

Extended use

The CDC reports that prolonged N95 mask use (including between patients) can be safe for up to 8 hours, and encourages each user to review each manufacturer’s recommendations prior to following this strategy. Current guidelines encourage wearing a face shield over the N95 to decrease the chances of soiling the mask.

Re-use

Because coronaviruses lose their viability significantly after 72 hours [3],[4] , many organizations have promoted a rotation and re-use strategy. Assuming there is no soiling and minimal to no viral contamination to the mask, the CDC suggests that masks can be re-used up to 5 times with the following strategy:

Mask Rotation

Acquire a set number of N95 masks (at least 5 per the CDC), and rotate their use each day, allowing them to dry for long enough that the virus is no longer viable (> 72 hours). Proper storage for this technique requires either hanging the respirators to dry, or keeping them in a clean, breathable container like a paper bag between uses. Make sure the masks do not touch each other, and that you do not share your respirator with other people. A user seal check should be performed before each use.

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Importantly, when planning to reuse an N-95 mask, practice fastidious donning/doffing to avoid contamination of the inside or outside of the mask at all times (see below methods for donning and doffing). If the mask is damaged or significantly contaminated from aerosol-generating procedures or bodily fluids, the CDC recommends discarding it.

Reprocessing/Decontamination

Mask decontamination strategies are actively being investigated by the CDC, mask companies, and large academic/industry collaboratives. General principles of re-processing include:

  1. The method must sufficiently inactivate the viral load on the mask.
  2. The mask cannot be soiled (bodily fluids, makeup[a]).
  3. The filtration capacity and electrostatic charge must be preserved as much as possible.
  4. The fit of the mask cannot be compromised.

Most studies on N95 decontamination were performed with flu virus or bacterial spores and cautious extrapolation to the current pandemic is being exercised. Fortunately, recent publications have started to test SARS-CoV-2 specifically, and have found promising results.

Below is a brief summary of the decontamination methods supported by current data. Due to the rapid nature of this research, some publications are not yet peer-reviewed. Additionally, note that there are many versions of N95 masks, with different strap materials and shapes. Thus, one method may work well for one mask type, and not for another.

Hydrogen Peroxide Vaporization

Hydrogen peroxide vapor (HPV) decontamination has been shown in pilot studies to allow multiple cycles of N95 processing with acceptable preservation of function. [5] It is now approved by the FDA as an emergency method for N95 decontamination for healthcare personnel during the COVID-19 pandemic. [6] This method of decontamination can only be used on N95 models that do not contain cellulose, such as the 1860. It is being utilized in industrial facilities such as Battelle (up to 20 cycles) as well as individual hospitals via Sterrad (up to 2 cycles) or Steris equipment (up to 10 cycles).

UV treatment

Proper UV treatment of N95 masks requires specific dosing protocols and full surface area illumination to ensure proper inactivation of viral particles with minimal mask degradation. [7] Due to the precision required, home UV light use is not recommended. This method of decontamination has been implemented by some hospital systems in the United States. [8] ,[9]

Moist Heat

Moist heat (heating at 60-70°C and 80-85% relative humidity) has been shown to be effective for flu viruses, but there is limited data on the temperature, humidity, and time required to completely inactivate SARS-COV-2 viral particles. Moreover, the parameters required to kill the virus may adversely affect filtration efficacy of the mask. Due to the dearth of specific data on a protocol to achieve both aims, this method is not currently recommended. [10]

Dry Heat

Dry heating of the mask at 70°C for 30 minutes has been suggested as a method of decontamination which can adequately kill virus and preserve the filter integrity for re-use. [11], [12] Recent tests at the NIH utilizing SARS-CoV-2 specifically indicated that this method can be used for two cycles to kill the virus without compromising fit. [13] Research efforts are ongoing to determine optimal parameters (temperature and duration), and this is not yet recommended by the CDC.

My hospital only provides one N95 at a time and I cannot utilize the rotation or decontamination strategies. What are my options?

If your hospital has one-day turnaround capability for the above strategies, this is a potential option. Otherwise, unfortunately there are no at-home strategies recommended by the CDC. The best method is to follow meticulous donning and doffing to avoid touching the inside or outside of the mask, and to prevent soilage. If new methods become available, this section will be updated.

What methods are pending/promising?

The CDC lists a few methods undergoing investigation that may eventually become viable:

Which methods are NOT approved?

  • Bleach
  • Alcohol
  • Baking
  • Boiling
  • Ethylene oxide
    • May be toxic to the wearer
  • Microwave
    • At-home microwaving is not recommended because of variable power settings, and metal portions of the masks may catch fire.
  • Sanitizing wipes
  • Soapy Water

Are there alternatives to N95 Masks?

The CDC recently allowed use of particular non-NIOSH masks from other countries. The approved list is here.

Certain hospital systems have created masks from available hospital materials. These are listed here for informational purposes only, but are not endorsed by the FDA:

Home-made or fashion-industry N95-like masks made from materials such as HEPA filters or fabric are unproven and have potential hazards (HEPA filters may expose the user to fiberglass), and are not recommended at this time.

How do I spot a counterfeit?

The NIOSH has an approved list of N95 vendors that is regularly updated. Check to see if your mask is on this list. The manufacturer of the mask should have certifications readily available for you to view. In addition, there are telltale signs of counterfeits listed on the NIOSH website. Do not use a non-NIOSH mask unless you have ensured it is authentic.

My hospital is no longer doing fit testing, or no longer carries the mask I was originally fitted for. Do I have options for performing a seal check at home?

The CDC does not consider a user seal check an adequate substitute for a fit test. [14]

If you have to wear a new type of N95 mask, a formal fit test is recommended. To ensure that your mask continues to have an adequate seal with repeat uses, the CDC and OSHA recommend performing a user seal check each time the mask is re-used.

Additional Tips

The University of Nebraska has a compilation of PPE protocols available to healthcare personnel that are based on their extensive experience as a National Ebola Training and Education center.

Other problems encountered on the ground include:

  • Facial hair is an important consideration when it comes to mask fit. The CDC has recommendations for acceptable configurations. For people who still cannot achieve an adequate seal with an N95, half-face masks or powered air purifying respirators (PAPR) are the next options. [15]
  • There are various online videos with methods of donning and doffing that help to minimize contact to the front of the mask. Here is a representative example: https://www.youtube.com/watch?v=EhxpJFDHAeI

Summary

There is no definitive “best practice” for N95 re-use and re-processing. These methods are options for times of crisis and should not be used routinely if mask supply is sufficient. Based on the resources available at each institution, the optimal strategy for each person or institution will vary.

References

[a] Residue on the mask may adversely affect the integrity of the material after re-processing. It is recommended that foundation, sunscreen, or other forms of make-up not be worn underneath.

[3] van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1 [published online ahead of print, 2020 Mar 17]. N Engl J Med. 2020;10.1056/NEJMc2004973. doi:10.1056/NEJMc2004973

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