LAUSR

To the Editor-in-Chief, The COVID-19 pandemic has infected more than a 3 million patients, caused > 230,000 deaths, and have greatly impacted the lives of millions [1]. Singapore was one of the first countries outside China to be affected by the virus. Aggressive contact tracing and isolation with national legislations have helped limit the spread of the virus to just over 1400 people over the last 10 weeks of the pandemic. Nonetheless, there has been increasing community spread with a high number of unlinked cases detected. This has necessitated a partial lockdown to enforce distancing measures. Healthcare workers (HCW) meanwhile are rapidly ramping up capabilities and preparing for a worsening of the crisis. COVID-19 has been well established to spread through droplets and potentially, aerosol-generating procedures (AGP) [2]. The protection of the health of HCW is of paramount importance. One of the few protective measures is the strict compliance to personal protective equipment (PPE). On top of the utility of surgical face masks and N95 respirators, powered air-purifying respirators (PAPR) is another tool in our armamentarium. Of significant importance is the worldwide shortage of disposable N95 respirators due to production and supply chain cuts. Protectionist policies and stockpiling have also greatly reduced availability [3]. Sengkang General Hospital was a newly opened 1400 bed hospital in August 2018. To date, we have managed 748 COVID-19 positive cases in a “mixed COVID” hospital. Currently, 0% of the hospital’s HCW have been infected by COVID-19. As routine stocks for disaster and emergency preparedness, we had purchased 686 CleanSpace® HALOTM (CleanSpace Technology Pte Ltd, Artarmon, NSW, Australia) PAPR. In the pandemic outbreak, these PAPRs were provisioned to clinical areas with COVID patient contact or had a risk of exposure to AGP—Operating Theatre (OT), Endoscopy Centre, Emergency Department (ED), Intensive Care Unit (ICU) and isolation wards. Each CleanSpace® HALOTM consists of a detachable reusable mask (half/full), HEPA filter, the power system, reusable harness and neck support. When compared to the HAZMAT suits and 3 MTM JupiterTM PAPR Helmet, which were used commonly during the SARS-CoV-2003 outbreak, the CleanSpace® HALOTM is marketed as the lightest PAPR, potentially offering doctors better manoeuvrability and comfort. This PAPR with face-pieces also has a higher Assigned Protection Factor (workplace level respiratory protection) of 50 compared to hooded PAPR with loose-fitted PAPR which has an APR of 25 [4]. The utility, disinfection and turnover of these PAPR are critical in ensuring the availability of the device during high risks procedures. To date, there has been limited knowledge of the processes and recommendations for such PAPR. This is especially pertinent as COVID-19 pandemic is likely to be protracted and traditional N95 respirators will continue to be restricted supply. Our hospital’s Central Sterile Supply Unit (CSSU) has advised for the surface disinfection of individual parts of the PAPR upon its removal, using Isopropyl Alcohol 70% wipes in keeping with UK guidelines.[5] While bleach may reduce contaminants more, handling of bleach in the clinical area is not as common as compared to the alcohol wipes [6]. The masks and harnesses of the CleanSpace® HALOTM are then collected in biohazard-waste-bags-lined containers before being dispatched to the CSSU 3 times a day (8 a.m., 2 p.m., 8 p.m.), to ensure a full-load disinfection is performed each time. When masks and harnesses are dropped off with a dispatch form (Fig. 1), they would be exchanged with the same Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s1330 4-020-00809 -3) contains supplementary material, which is available to authorized users.