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      Skin and eye protection against ultraviolet C from ultraviolet germicidal irradiation devices during the COVID‐19 pandemic

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          Abstract

          With the COVID‐19 pandemic depleting personal protective equipment worldwide, various methods including ultraviolet C (UVC) germicidal irradiation (UVGI) have been implemented to decontaminate N95 filtering facepiece respirators. These devices pose a risk for UVC exposure to the operator with reported adverse effects generally limited to the eyes and skin. Our hospitals are currently using UVC devices for N95 decontamination with a few reported cases of face and neck erythema from exposure. Because sunscreens are designed and tested for UVA and UVB protection only, their effects on blocking UVC are largely unknown. Therefore, our objective was to determine if various sunscreens, UV goggles, and surgical mask face shields minimize UVC exposure from UVGI devices. Our study clearly demonstrated that healthcare workers responsible for the disinfection of PPE using UVGI devices should always at least utilize clear face shields or UV goggles and sunscreen to protect against side effects of UVC exposure.

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          Transmission of human epidermis and stratum corneum as a function of thickness in the ultraviolet and visible wavelengths.

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            Ultraviolet germicidal irradiation: Possible method for respirator disinfection to facilitate reuse during the COVID-19 pandemic

            To the Editor: The ability to disinfect and reuse disposable N95 filtering facepiece respirators is urgently needed during the current COVID-19 pandemic because supplies are running low in hospitals throughout the United States and abroad. Ultraviolet (UV) germicidal irradiation (UVGI) is one possible method for respirator disinfection to facilitate the reuse of dwindling supplies. Dermatology offices often use narrow-band UVB to treat skin diseases. If necessary, we propose a possible repurposing of phototherapy devices, including these UVB units, to serve as a platform for UVC germicidal disinfection. UVGI is a disinfection method that uses UVC radiation to inactivate microorganisms by causing DNA damage and preventing replication. Previous studies have shown that UVC can inactivate coronaviruses, including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). 1 One study of respirators contaminated with H1N1 influenza A found significant reductions (≥3-log reduction) in viable influenza virus under substantial artificial soiling conditions after being treated for 60 to 70 seconds at an irradiance of 17 mW/cm2, resulting in a UVGI dose of ∼1 J/cm2 measured at 254 nm. 2 The efficacy of this dose has been verified in additional studies, and higher doses (up to 2 J/cm2) have been shown to provide diminished benefit after 1 J/cm2. 3 , 4 It is recommended to treat used masks, but not visibly soiled, to allow the 3-log reduction reported in the literature to be sufficient to achieve safe reuse levels. 5 It is important to note that the time to deliver 1 J/cm2 depends on the irradiance; hence, it can be longer or shorter depending on the delivery device's capabilities. In a prototype model that has been developed (Fig 1 ), this dose can be delivered in 1 minute and 40 seconds at an irradiance of 10 mW/cm2. The distance from the lamp to the top of the table in Fig 1 is approximately 14 cm. Fig 1 Image of prototype being developed by Daavlin. The field of irradiation is approximately 15 inches × 45 inches, and depending on the manufacturer of the mask, this would allow for the treatment of ∼18 to 27 masks (2 minutes per side). (A) With ultraviolet light on and (B) ultraviolet light off. (Photographs used with permission of Bob Golding, Daavlin, Byron, Ohio.) However, UV radiation does degrade polymers, which presents the possibility that UVGI exposure, while decontaminating, may also reduce the efficacy of the respirator and decrease protection to workers. Lindsley et al 6 exposed 4 different models of N95 filtering facepiece respirators to UVGI doses of 120 to 950 J/cm2. Results of the study showed that UVGI exposure led to a small increase in particle penetration (up to 1.25%) and had little effect on the flow resistance. However, at higher UVGI doses, the strength of the layers of the respirator material was substantially reduced (in some cases, >90%), but this significantly varied among the different models. UVGI had less of an effect on the respirator straps: a dose of 2360 J/cm2 reduced the breaking strength of the straps by 20% to 51%. 6 It should be noted that the dosages used in the study above are 100- to 1000-times higher than those shown to disinfect H1N1 influenza A–contaminated respirators. Therefore, considering that many of our health care providers are using substitutes for N95 filtering facepiece respirators that offer very limited degree of protection, using UVGI and repurposing phototherapy devices could be the best practical solution at this time.
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              Applications of ultraviolet germicidal irradiation disinfection in health care facilities: Effective adjunct, but not stand-alone technology

              This review evaluates the applicability and relative contribution of ultraviolet germicidal irradiation (UVGI) to disinfection of air in health care facilities. A section addressing the use of UVGI for environmental surfaces is also included. The germicidal susceptibility of biologic agents is addressed, but with emphasis on application in health care facilities. The balance of scientific evidence indicates that UVGI should be considered as a disinfection application in a health care setting only in conjunction with other well-established elements, such as appropriate heating, ventilating, and air-conditioning (HVAC) systems; dynamic removal of contaminants from the air; and preventive maintenance in combination with through cleaning of the care environment. We conclude that although UVGI is microbiocidal, it is not “ready for prime time” as a primary intervention to kill or inactivate infectious microorganisms; rather, it should be considered an adjunct. Other factors, such as careful design of the built environment, installation and effective operation of the HVAC system, and a high level of attention to traditional cleaning and disinfection, must be assessed before a health care facility can decide to rely solely on UVGI to meet indoor air quality requirements for health care facilities. More targeted and multiparameter studies are needed to evaluate the efficacy, safety, and incremental benefit of UVGI for mitigating reservoirs of microorganisms and ultimately preventing cross-transmission of pathogens that lead to health care-associated infections.
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                Author and article information

                Contributors
                Ihamzav1@hfhs.org
                Journal
                Int J Dermatol
                Int J Dermatol
                10.1111/(ISSN)1365-4632
                IJD
                International Journal of Dermatology
                John Wiley and Sons Inc. (Hoboken )
                0011-9059
                1365-4632
                01 December 2020
                : 10.1111/ijd.15255
                Affiliations
                [ 1 ] Department of Dermatology Henry Ford Health System Detroit MI USA
                [ 2 ] Department of Physics and Astronomy Wayne State University Detroit MI USA
                Author notes
                [*] [* ] Correspondence

                Iltefat H. Hamzavi, md

                Photomedicine and Photobiology Unit

                Department of Dermatology

                Henry Ford Health System

                3031 W. Grand Blvd, Suite 800

                Detroit, MI 48202

                USA

                E‐mail: Ihamzav1@ 123456hfhs.org

                Author information
                https://orcid.org/0000-0003-0799-5680
                Article
                IJD15255
                10.1111/ijd.15255
                7753667
                33259055
                5faaba6b-798d-4c11-9a92-446bf728e2b7
                © 2020 the International Society of Dermatology

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 04 August 2020
                : 23 September 2020
                Page count
                Figures: 1, Tables: 1, Pages: 3, Words: 3089
                Categories
                Updates from Medicine
                Updates from Medicine
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.6 mode:remove_FC converted:22.12.2020

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