Conventional, Contingency, and Crisis Strategies
CDC is reviewing this page to align with updated guidance.
Who this guidance is for: Federal, state, and local public health officials, respiratory protection program managers, occupational health service leaders, infection prevention and control program leaders, and other leaders in healthcare settings who are responsible for developing and implementing policies and procedures for preventing pathogen transmission in healthcare settings.
Purpose: This webpage offers guidance for the use of reusable elastomeric particulate respirators to provide respiratory protection to healthcare practitioners (HCP) against pathogens as a component of a formally developed and implemented written respiratory protection program.
This guidance is based on what is currently known about the transmission and severity of coronavirus disease 2019 (COVID-19).
The US Centers for Disease Control and Prevention (CDC) will update this guidance as needed and as additional information becomes available. Please check the CDC COVID-19 website periodically for updated guidance.
Conventional guidance is not applicable during the COVID-19 response when supplies are short. HCP should follow the contingency and crisis strategies.
Elastomeric respirators, such as half facepiece or full facepiece tight-fitting respirators where the facepieces are made of synthetic or natural rubber material, can be repeatedly used, cleaned, disinfected, stored, and re-used. They are available as alternatives to disposable half mask filtering facepiece respirators (FFRs), such as N95 FFRs, for augmenting the total supply of respirators available for use by HCP. While elastomeric respirators are not cleared by FDA for fluid resistance, based on their NIOSH approval, they can provide at least equivalent protection to N95 FFRs. Some types of elastomeric respirators can offer higher assigned protection factors (APFs) than N95 FFRs. They are equipped with replaceable filter cartridges or flexible, disc or pancake-style filters, which are not housed in a cartridge body. All elastomeric respirators equipped with the proper air-purification filters, cartridges, or canisters would also have utility in this application. Elastomerics may also have sealing surfaces and adjustable straps that accommodate a better fit.
Because they can be re-used, elastomeric particulate respirators provide an alternative respiratory protection option to FFRs for protection against pathogens. While this document focuses on respiratory protection for exposure to pathogens, these respirators may also serve as protection against other airborne hazards in healthcare settings. However, they require maintenance and a supply of replaceable components including straps, inhalation and exhalation valves, valve covers, and filters, cartridges, or canisters.
This webinar provides an overview of respiratory protection and guidance surrounding supply shortages. This webinar also provides information on infection prevention measures, strategies for optimizing the supply of N95 respirators, and a broad overview of the use of elastomeric respirators in healthcare. Guidance on elastomeric respirators is currently in development.
Elastomeric respirators have the same basic requirements for an OSHA-approved respiratory protection program as filtering facepiece respirators, including medical evaluation, training, and fit testing. However, they have additional maintenance requirements which also include cleaning and disinfection of the facepiece components such as straps, valves, and valve covers. While it is often possible to decontaminate the hard outer casing of filters, the filter material itself typically cannot be cleaned or disinfected for reuse. Instead, filter components should be discarded when they become damaged, soiled, or clogged.
There are several types of elastomeric respirators, half-facepiece or half mask (APF = 10)1 and full facepiece (APF = 50). The specific cautions, limitations, and restrictions of use should be understood when determining whether to use these respirators in healthcare facilities. Respirators with full facepieces have the same filter considerations but provide greater protection because of better sealing characteristics and less face seal leakage and also provide protection to more of the face and very importantly, the eyes. Elastomeric respirators with exhalation valves should not be used in surgical settings due to concerns that unfiltered air coming out of the exhalation valve may contaminate the surgical field.
When respirators are used to protect against hazardous airborne exposures in the workplace, OSHA requires employers to develop and implement a written respiratory protection program that conforms to OSHA 29CFR1910.134 including initial and annual fit testing.1 The use of a NIOSH-approved respirator is required by OSHA. OSHA also requires that respirators be used in conformance with the conditions of their NIOSH certification. Hence, a NIOSH-approved respirator assembly cannot be modified, and only those replacement parts specified and provided by the manufacturer must be used. The manufacturer’s instructions are specific to its respirator materials and specifications. Manufacturer instructions are generally provided with the respirator facepiece packaging.
Appendix B-2 to OSHA’s Respiratory Protection standard (29CFR1910.134 ) provides general procedures for employers to use when cleaning respirators. OSHA also permits employers to use the cleaning recommendations provided by the respirator manufacturer, if such procedures are as effective as those listed in Appendix B- 2, meaning that the respirator is properly cleaned and disinfected in a manner that prevents damage to the respirator and does not cause harm such as skin irritation to the user.
Generally, it is recommended that respirators be cleaned and disinfected immediately after doffing (i.e., removing). To avoid contact transmission, precautions should be taken during doffing and use. Training on appropriate donning and doffing procedures should be provided to all employees expected to wear respirators. Both CDC and OSHA have videos illustrating proper donning and doffing of the respirator.16 Elastomeric components vary among manufacturers and react differently to cleaning and disinfection solutions and procedures. The respirator facepiece components such as facepiece, valves, and straps require maintenance including cleaning, disinfection and inspection prior to reuse. OSHA only requires replacing filters “where necessary,” for example, when soiled, contaminated, or clogged.
Viruses and bacteria that cause acute respiratory infections can survive on respirator components for variable periods of time, from hours to weeks. Consequently, contaminated respirators must be handled, cleaned, and disinfected carefully and properly to reduce the possibility of the device carrying infection and contributing to disease transmission.2 Manufacturers recommend cleaning and disinfection procedures for their elastomeric respirator components such as facepiece, valve covers, valves, and straps. The materials that comprise the elastomeric components of NIOSH-approved respirators vary among manufacturers; consequently, cleaning and disinfection solutions and procedures recommended by manufacturers may also vary. Manufacturers typically recommend that filter cartridges be discarded after each use when cleaning an elastomeric respirator. Following manufacturer recommendations may be possible for some employers, but others may find discarding the filter component with each cleaning of an elastomeric respirator to be a cost factor when selecting between FFRs and elastomeric respirators, but especially in times of shortage, users may find it difficult to replace the filter cartridges due to supply difficulties. OSHA only requires replacing filters “where necessary,” for example, when soiled, contaminated, or clogged. Additionally, cleaning and disinfecting respirators can damage or deteriorate respirator facepiece component materials and adversely affect their performance when re-using after disinfection.
Three types or series of filters are available for use with reusable elastomeric respirators. Filters are classified by their resistance to degradation by oil-based aerosols.
Manufacturers provide use-time limitations and other limitations or restrictions depending on the respirator’s intended use. If the healthcare setting does not have any oil-based aerosols present, any filter series can be used. Filters are available in three efficiency levels – 95, 99, 100. Thus, a wide selection is potentially available for use to augment the overall supply of respirators in healthcare settings. The half mask or facepiece type respirator with N-Series 95% efficiency level filters (N-95) has been determined to provide adequate protection in combination with other healthcare practice interventions such as hand washing, isolation, and spatial distance for the risks associated with the transmission of tuberculosis, influenza, and novel coronaviruses.3 4
Generally, in industrial settings, filters are replaced when soiled or contaminated, damaged, and when breathing resistance increases. However, in healthcare settings breathing resistance will unlikely be a reason for filter replacement since filters should seldom if ever become loaded with heavy concentrations of dust. Depending on use, one manufacturer recommends the filter be discarded after each use, while another recommends the filter cartridge be disposed no later than 30 days after the first use if no oil mists are present.5 6 The respirator’s other elastomeric components should not be cleaned with solvents (e.g., acetone, ethanol) or exposed to temperatures greater than 50°C (122°F).
Cleaning and disinfection must be done using either the procedures in OSHA’s Respiratory Protection Standard or the procedures recommended by the respirator manufacturer, provided they are at least as effective as OSHA’s procedures. The employer must consult with the manufacturer for the proper disinfectants/procedures and their potential impact upon its respirator facepiece components.
If it is determined that the disinfection solution and procedures do not degrade the facepiece components, it is possible the components can be re-used, subject to inspection by a qualified individual to determine whether the components need to be repaired or replaced.
Filter cartridges should be removed from the facepiece prior to cleaning and disinfecting the elastomeric facepiece components. Generally, the facepiece components are removed from the facepiece to be cleaned and disinfected. There are several basic steps to clean and disinfect a respirator – remove, clean, disinfect, rinse and dry, inspect and repair or replace, and store. The order and details of each step are important. And it is very important that respirators are thoroughly air dried prior to storage.
Some disinfectants are powerful germicides and their use requires special precautions such as adequate ventilation, use of clean non-sterile gloves, gowns, and/or face shields. Therefore, cleaning and disinfection must be done by competent, trained individuals. Centralizing this activity might help ensure that it is being properly executed.
Maintenance must be performed only by those individuals who have been trained in the task and are knowledgeable of the models being serviced. Specially trained individuals (ideally the same people who clean and disinfect respirators) should also be employed to carefully inspect respirators after cleaning with attention to valves and straps. Inspections should follow the manufacturer’s recommendations. Only the original respirator manufacturer’s component parts should be stocked and available to replace damaged components when necessary.
Who this guidance is for: Those responsible for developing and implementing policies and procedures for preventing pathogen transmission in healthcare settings. This includes federal, state, and local public health officials, respiratory protection program managers, occupational health service leaders, and infection prevention and control program leaders.
Purpose: This webpage describes options for deploying air-purifying reusable elastomeric particulate respirators to provide respiratory protection to healthcare practitioners (HCP) when supplies of N95 filtering facepiece respirators (FFRs), including surgical N95s, are limited or not available.
Strategies for reusable elastomeric respirator use in healthcare settings in conventional, non-surge demand situations, are discussed in Conventional Strategies. Conventional use should adhere to OSHA requirements and manufacturer-specific recommended instructions.
Contingency capacity strategies are for emergency situations in which each elastomeric respirator is issued for the exclusive use of an individual employee. The respirators are cleaned and disinfected as often as necessary to remain unsoiled and sanitary. Their description and use should be part of a written OSHA respiratory protection program (RPP). If there is deviation from the standard RPP, it should be authorized and documented by the program’s administrator.
Crisis capacity strategies are for emergency use, limited respirator and/or respirator component supplies such as filters, cartridges, or canisters, and valves, and situations in which it is impossible for individual HCP to have a dedicated elastomeric respirator, for example when the same respirator must be used by multiple HCP. When used by more than one HCP, respirators must be cleaned and disinfected before being worn by different individuals. The use of elastomeric respirators should be part of a written OSHA RPP. If there is any deviation from the conventional RPP, it should be authorized and documented by the program’s administrator.
NIOSH-certified reusable elastomeric particulate respirators provide at least the same level of protection as N95 FFRs, and some types of elastomeric respirators can offer higher assigned protection factors than N95 FFRs.
The most significant difference between reusable elastomeric respirators and disposable FFRs is that reusable respirators must be maintained and inspected after each use, including cleaning and disinfection of the elastomeric components such as facepiece valves, valve covers, and straps. When used in conventional workplace conditions, the filter, cartridge, or canister of a reusable elastomeric respirator is not cleaned or disinfected; it is discarded once damaged, soiled, or clogged. Elastomeric respirators are equipped with replaceable filters. Some replaceable filters are cartridge style in which the filtration media is housed inside of a cartridge. Others consist of flexible, disc or pancake-style filters, in which the filter media are not housed within a cartridge body.
This document provides considerations for disinfecting the outside of a filter cartridge during contingency and crisis scenarios to increase the supply of respirators for protection during the Coronavirus Disease 2019 (COVID-19) pandemic. However, there is an increased risk of contact transmission or damage to the filter cartridge that must be considered.
Reusable respirators described in this document include tight-fitting half-facepiece or full-facepiece elastomeric respirators that use replaceable filters, cartridges, or canisters and have facepieces made of synthetic or natural rubber material permitting repeated cleaning, disinfection, storage, and reuse. They contain an exhalation valve and should not be used in surgical settings when there is concern that unfiltered air coming out of the exhalation valve may contaminate the surgical field. As with N95 FFRs, reusable respirators require an RPP including, but not limited to, initial and annual fit testing, and a user seal check each time the respirator is used. However, on March 14, 2020 OSHA issued Temporary Enforcement Guidance permitting OSHA field offices to exercise enforcement discretion regarding the annual fit testing requirements until further notice.7
NIOSH-approved, elastomeric respirators provide an alternative respiratory protection option capable of decreasing the total number of respirators required because they may be cleaned, disinfected, and reused numerous times, which should reduce the number of respirators needed when supplies are limited.8 However, a supply of elastomeric respirator facepiece components should be held in reserve to replace damaged or deteriorated parts, and supplies of replacement filters, cartridges, or canisters are also needed. The filters of these respirators are at least as protective as the N95 FFRs and surgical N95 FFRs typically used in healthcare settings. They are not cleared by FDA for fluid resistance and require maintenance including cleaning, disinfection, and inspection.
There are several types of filter media for use with NIOSH-approved reusable, half -facepiece elastomeric respirators. All are sufficient at removing droplet and viral size particles when worn correctly for the duration of the exposure. Filters are available in three efficiency levels – 95, 99, 100. Thus, a wide selection is potentially available for use to augment the overall supply of respirators in healthcare settings.
Half-facepiece or half mask (APF = 10)1 and full facepiece (APF = 50) elastomeric respirators have specific cautions, limitations, and restrictions of use that need to be understood when determining whether to use these respirators in a healthcare facility. Respirators with full facepieces have the same filter considerations but provide greater protection because of better sealing characteristics and less face seal leakage and also provide protection to more of the face and very importantly, the eyes.
During contingency and crisis capacity strategies, when shortages are predicted, but supplies are still available, each elastomeric respirator is issued for the exclusive use of an individual employee. Elastomeric respirators must be cleaned as often as necessary to remain unsoiled and sanitary.
Viruses and bacteria that cause acute respiratory infections can survive on respirator components for variable periods of time, from hours to weeks. Consequently, contaminated elastomeric respirators must be handled, cleaned, and disinfected properly to reduce the possibility of the device carrying infectious particles and contributing to disease transmission.2
Each respirator manufacturer identifies the appropriate cleaning procedures, which typically involves 1) using soap and warm water or chemical disinfectants authorized for use with their specific elastomeric facepiece components and 2) discarding the filter cartridge.
For conventional use: Employers must consult with the manufacturer concerning the effectiveness and uncertainties of alternative cleaning and disinfectant solutions and procedures used for reuse of the facepiece, straps, and filter components.
For contingency and crisis use: Because of necessity, elastomeric facepiece components and filter cartridges may be treated differently for their cleaning and disinfection. Whereas conventional practice is to discard the filter component, contingency practices may necessitate cleaning and disinfecting the filter housing, but care must be taken to not exposed the filter media to any cleaning solutions. The performance of filter media can be degraded by contact with the disinfectant.
There are several basic steps to clean and disinfect an elastomeric respirator – remove, clean, disinfect, rinse and dry, inspect and repair or replace, and store. Bessesen et al. provide useful guidelines for cleaning and disinfecting elastomeric respirators in healthcare environments.10 These methods have been used successfully in several healthcare settings in the United States. The order and details of each step are important.
If available and appropriate, the respirator facepiece components should be cleaned using OSHA or manufacturer protocols.7 14–15 Filter cartridge components would conventionally be discarded. However, during periods of surge capacity, a careful wipe of the filter cartridge, avoiding contact with the filter media, and using a common hospital disinfectant wipe has low risk of damaging the filter. The filter cartridge should never be dipped or submerged in disinfectant or excessively wetted with disinfectant.
Generally, it is recommended that respirators be cleaned and disinfected immediately after doffing (i.e., removing). To avoid contact transmission, precautions should be taken during doffing and use. Training on appropriate donning and doffing procedures should be provided to all employees expected to wear respirators. Both CDC and OSHA have videos illustrating proper donning and doffing of the respirator.16 Elastomeric components vary among manufacturers and react differently to cleaning and disinfection solutions and procedures. The respirator facepiece components such as facepiece, valves, and straps require maintenance including cleaning, disinfection and inspection prior to reuse. OSHA only requires replacing filters “where necessary,” for example, when soiled, contaminated, or clogged. The alternate cleaning and disinfection method, described by Bessesen et al. for use in healthcare when conventional practices are not practical, has been used successfully.10
The effectiveness of an alternate filter cartridge disinfection solution and procedure may be uncertain:
Some elastomeric respirators have filter cartridges that prevent disinfectant contact with the filter media. If available, these filter cartridges should be used in the contingency capacity strategies approach. These filter cartridges provide added assurance that the filter media will not be contacted with the cleaning and disinfectant solutions. These cartridges may be wiped down repeatedly.
NOTE: P-series filters can generally be re-used until they are soiled, damaged, or difficult to breathe through. Caution should be used when using the filter for a live virus, and thorough disinfection of the filter cartridge should be completed.
Practices not approved by the manufacturer can increase the risk and uncertainty of re-using damaged or degraded components. This must be balanced against other available HCP protection options to sustain effective HCP protection and patient care.
Modified procedures used during emergencies should be assessed and documented in the written RPP, including alternate cleaning and disinfection practices.
For disinfection, diluted household bleach solutions, alcohol solutions with at least 70% ethyl alcohol, and EPA-registered household disinfectants should be effective against coronaviruses.
For use of diluted household bleach solutions, follow disinfectant manufacturer’s instructions for proper disinfectant application, PPE, and ventilation.
CAUTION: The following may degrade or damage the respirator components.
Some EPA-approved disinfectants are also available as ready to use at 2700 ppm for 1 minute; however, these strong solutions could impact the integrity of the respirator components. Products with EPA-approved emerging viral pathogens claims are expected to be effective against SARS-CoV-2. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
Disinfectants listed on the EPA’s Registered Antimicrobial Products for Use Against Novel Coronavirus SARS-CoV-2, the virus that causes COVID-19, could be used to inactivate the virus.18 Those intended for use with soft surfaces may be preferred.
All respirators used in routine situations must be inspected by properly trained individuals before each use and during cleaning. This includes a check of respirator function, tightness of connections, and the condition of the various parts, such as the facepiece, head straps, valves, cartridges, and canisters or filters.
Inspect elastomeric parts for pliability and signs of deterioration. Respirators that fail an inspection or are otherwise found to be defective should be removed from service and discarded, repaired, or adjusted in accordance with the following procedures:
Discard filter cartridges if they become visibly soiled or wet, if they are visibly damaged, or if the respirator becomes notably harder to breathe through. Otherwise, change out the filters periodically. Provided the cartridge integrity and filter have not been compromised, current practice shows that conservatively, the filters could be used for at least one year.18
Workers must be educated and trained on how to safely use their elastomeric respirator. Employers should follow the respirator manufacturer’s instructions and OSHA guidance to the greatest extent possible; and consider training recommendations described in the Bessesen protocol. The NIOSH JETFIT study provides excellent training for contingency situations.
To ensure respirator maintenance is conducted properly, employers should establish disinfection and cleaning procedures and train staff to perform the required maintenance including storage, inspection, distribution, repair or replacement, cleaning, disinfection, and disposal. Employers may identify a central location for disinfection or train individual users to clean and disinfect their respirators. Initial surface cleaning should be done at point of use before moving to a central location for disinfection. 19, 20, 21
Respirators must be stored in a clean, non-contaminated location in a manner that does not distort the facepiece or straps. Respirators need to be thoroughly air dried prior to storage.
During periods of crisis surge capacity, several strategies in addition to the contingency strategies may be followed.
If it is impossible for individual HCP to have dedicated elastomeric respirators, the same elastomeric respirator may be used by multiple HCP. Elastomeric respirators issued to more than one employee should be cleaned, disinfected, and inspected before being worn by different individuals. One option is to label the respirator, conduct surface cleaning at the point of use, and return to a central location to be disinfected by central staff before reissuing the respirator to a different user.
Machines may be used to expedite the cleaning, sanitizing, rinsing, and drying of large numbers of elastomeric respirators. In general, the respirator’s elastomeric components should not be cleaned with solvents (e.g., acetone, ethanol) or exposed to temperatures greater than 50°C (122°F). Post-cleaning inspection by personnel trained in the necessary maintenance tasks should still be conducted to assure respirator functionality has not been degraded.
Extreme care should be taken to limit tumbling, agitation, or exposure to temperatures above those recommended by the manufacturer, as these conditions may result in damage to the respirators.
Ultrasonic cleaners, clothes washing machines, dishwashers, and clothes dryers have been specially adapted and successfully used for cleaning and drying elastomeric respirators. 22
OSHA has issued temporary enforcement guidance about switching from quantitative to qualitative fit testing, and OSHA is waiving the annual fit testing requirements as described above.7 If fit testing is not possible, leakage at the face seal could occur and the protection provided to the wearer may be significantly reduced. For any tight-fitting respirator, such as FFRs and elastomeric respirators, a successful user seal check must be performed with each donning.
Under serious outbreak conditions in which respirator supplies are severely limited, HCP may not have the opportunity to ever be fit tested on a respirator before needing to use it. While this is not ideal, in this scenario, HCP should work with their employers to choose the respirator that fits them best, as, even without fit testing, a respirator will provide better protection than using no respirator at all or using a surgical mask.
If possible, the HCP should start with the size used previously for fit testing, but as size can vary by manufacturer and model, a different size may be needed to achieve a good fit.
If fit testing has never been done, the following recommendations are still useful.
Fit testing is necessary to confirm if a respirator does or does not fit. During a crisis, however, when conventional requirements cannot be implemented, healthcare professionals should be able to determine if they have obtained a reasonable fit if they have had training and they perform a successful user seal check prior to each use of the respirator.
1 An Assigned Protection Factor (APF) is the workplace level of respiratory protection that a respirator is expected to provide to employees when used in conjunction with an effective RPP.
1 OSHA (Standards – 29 CFR). Occupational Safety and Health Standards. Available from: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=12716&p_table=standards
2 WHO [2014]. Infection prevention and control of epidemic-and pandemic prone acute respiratory infections in health care. Available from: https://www.who.int/csr/bioriskreduction/infection_control/publication/en/
3 CDC [2020]. Coronavirus Disease 2019 (COVID-19): FAQ about PPE. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html
4 CDC [2020]. Coronavirus Disease 2019 (COVID-19): Optimize PPE Supply. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
5 3M [2020]. Respiratory Protection for Airborne Exposures to Biohazards. Available from: https://multimedia.3m.com/mws/media/409903O/respiratory-protection-against-biohazards.pdf
6 Moldex. 7000 Series Reusable Half Mask Respirator. Available from: https://www.moldex.com/product/7000-series-half-mask-respirator/
7 OSHA [2020]. Temporary Enforcement Guidance – Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak. Available at: https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit
8 NIOSH [1996]. NIOSH Guide to the Selection and Use of Particulate Respirators (Certified Under 42 CFR 84). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, DHHS (NIOSH) Publication 96-101, https://www.cdc.gov/niosh/docs/96-101/default.html
9 Pompei LA, Kraft CS, Brownsword EA [2020]. Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared with Disposable N95 Respirators. JAMA. doi:10.1001/jama.2020.4806
10 Bessesen M, Adams JC, Radonovich L, Anderson J [2015]. Disinfection of Reusable Elastomeric Respirators by Health Care Workers: A Feasibility Study and Development of Standard Operating Procedures. American Journal of Infection Control 43(6):629-634.
11 CDC [2020]. Coronoavirus Disease 2019 (COVID-19): Decontamination and Reuse of Filtering Facepiece Respirators. Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
12 Rutala WA, Weber DJ [2019]. Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008.
13 Lawrence C, Harnish DA, Sandoval-Powers M, Mills D, Bergman M, Heimbuch BK [2017]. Assessment of half-mask elastomeric respirator and powered air-purifying respirator reprocessing for an influenza pandemic. Am J Infect Control, 45(12):1324-1330.
14 OSHA 29CFR1910.134. Available from: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134
15 OSHA 1910.134 App B-2 Respirator Cleaning Procedures (Mandatory). Available from: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134AppB2
16 CDC. Sequence for Putting On Personal Protective Equipment (PPE). Available at: https://www.cdc.gov/niosh/npptl/pdfs/PPE-Sequence-508.pdf
17 EPA [2020]. List N: disinfectants for use against SARS-CoV-2. Available from: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
18 Personal communications with University of Maryland School of Medicine, March 18, 2020.
19 University of Nebraska Medical Center [2012]. Half Mask Respirator II: Gross Decon, Reassembly, and Storage. Available at: https://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=73&src=yt
20 University of Nebraska Medical Center [2011] Half Mask Respirator III: Light Decon and Storage. Available at: https://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=72&src=yt
21 CDC [2020]. Elastomeric Respirators for U.S. Healthcare Delivery. Available from: https://www.youtube.com/watch?v=8wd5Bx2fVDI
22 ATSM International F3387-19, Standard for Respiratory Protection.
23 OSHA [2009]. Respiratory Safety (video). Available at: https://www.youtube.com/watch?v=Tzpz5fko-fg
24 OSHA [2009]. Seguridad de Máscaras de Respiración. Available at: https://www.youtube.com/watch?v=jgRKuRcTGeE
25 University of Nebraska Medical Center [2011]. Half Mask Respirator I: Donning, Doffing and Fit Check. Available at: https://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=71&src=ytexternal icon
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