Received: 7 November 2022 | Revised: 20 December 2022 | Accepted: 22 December 2022
DOI: 10.1002/hsr2.1042
NARRA T I V E R E V I EW
Evaluating the effects of air disinfectants in decontamination
of COVID‐19 aerosols
Soheil Dehghani1,2 | SeyedAhmad SeyedAlinaghi2 | Amirali Karimi1 |
Fatemeh Afroughi3,4 | Shayan Abshenas5 | Kimia Azad4 |
Marcarious M. Tantuoyir1,6 | Parsa Mohammadi1 | Seyed Mohammad Ghavam2 |
Hengameh Mojdeganlou7 | Omid Dadras2,8 | Newsha Nazarian4 |
Farzin Vahedi1 | Alireza Barzegary4 | Esmaeil Mehraeen9
1School of medicine, Tehran University of
Medical Sciences, Tehran, Iran Abstract
2Iranian Research Center for HIV/AIDS, Introduction: Airborne transmission is the most crucial mode of COVID‐19
Iranian Institute for Reduction of High Risk
transmission. Therefore, disinfecting the severe acute respiratory syndrome
Behaviors, Tehran University of Medical
Sciences, Tehran, Iran coronavirus‐2 (SARS‐CoV‐2) aerosols float can have important implications in
3Pars Hospital, Iran University of Medical limiting COVID‐19 transmission. Herein, we aimed to review the studies that utilized
Sciences, Tehran, Iran
various disinfectants to decontaminate and inactivate the SARS‐CoV‐2 aerosols.
4School of medicine, Islamic Azad University,
Tehran, Iran Methods: This study was a review that studied related articles published between
5School of medicine, Kashan University of December 1, 2019 and August 23, 2022. We searched the online databases of
Medical Sciences, Kashan, Iran PubMed, Scopus, Web of Science, Cochrane, on August 23, 2021. The studies were
6Biomedical Engineering Unit, University of downloaded into the EndNote software, duplicates were removed, and then the
Ghana Medical Center (UGMC), Accra, Ghana
7 studies were screened based on the inclusion/exclusion criteria. The screeningDepartment of Pathology, The Johns
Hopkins University School of Medicine, process involved two steps; first, the studies were screened based on their title and
Baltimore, Maryland, USA
abstract and then their full texts. The included studies were used for the qualitative
8Department of Global Public Health and
Primary Care, University of Bergen, Bergen, analysis.
Norway Results: From 664 retrieved records, only 31 met the inclusion criteria and were
9Department of Health Information included in the final qualitative analysis. Various materials like Ozone, H2O2, alcohol,
Technology, Khalkhal University of Medical
Sciences, Khalkhal, Iran and TiO2 and methods like heating and using Ultraviolet were described in these
studies to disinfect places contaminated by COVID‐19. It appeared that the efficacy
Correspondence
of these disinfectants varies considerably depending on the situation, time, and
Esmaeil Mehraeen, Department of Health
Information Technology, Khalkhal University ultimately their mode of application.
of Medical Sciences, Khalkhal 5681761351, Conclusion: Following reliable protocols in combination with the proper selection of
Iran.
Email: es.mehraeen@gmail.com disinfectant agents for each purpose would serve to achieve desired elimination of
the SARS‐CoV‐2 transmission.
K E YWORD S
aerosol, COVID‐19, decontamination, disinfectants, SARS‐CoV‐2
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.
Health Sci. Rep. 2023;6:e1042. wileyonlinelibrary.com/journal/hsr2 | 1 of 12
https://doi.org/10.1002/hsr2.1042
2 of 12 | DEHGHANI ET AL.
1 | INTRODUCTION 2 | METHODS
Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) is a 2.1 | Overview
newly emerging virus that has been a critical global health concern
for the past two years.1–3 In December 2019, the first cases of This study was a review that studied related articles published
COVID‐19 were discovered in Wuhan, Hubei Province, China.4 between December 1, 2019 and August 23, 2022. This article was
Rapidly a pandemic was developed, which was announced by the conducted in accordance with PRISMA (Preferred Reporting Items
World Health Organization on March 11, 2020.5 The virus is for Systematic Reviews and Meta‐Analyses) checklist (Supporting
transmitted via airborne and direct contact with infected individuals Information Material 1). We searched and retrieved the studies using
(kissing and shaking hands) or surfaces.6 keywords on online databases of PubMed, Scopus, Web of Science,
Airborne transmission has been divided into two distinct modes and Cochrane, on August 23, 2022. The selected articles were
that do not require direct contact: (i) virus‐containing droplets and (ii) imported into EndNote (Thomson Reuters), and duplicates were
virus‐containing aerosols.7,8 Although SARS‐CoV‐2 has been spread- removed using both the “duplicate” function and manually. Four
ing through all the mentioned methods, it seems that airborne researchers screened the remaining records in a two‐phase process.
transmission may play the loading role in this rapidly spreading First, Three independent researchers read the titles and abstracts of
outbreak.9 For transmission of the virus through an airborne route, all studies to identify potentially relevant articles based on inclusion
various factors like air conditioning, temperature, humidity, and the criteria. The full texts of selected studies were thoroughly reviewed
rate of infected people are essential.10 afterward and checked against the inclusion criteria, and irrelevant
In general, aerosols are defined as liquid and solid particles, records were excluded. Three independent reviewers screened the
which are called ultrafine particles (≤5 μm), that can be produced by full texts of selected studies and extracted the necessary information.
respiration, talking, mechanical ventilation, dental procedures, and Any disagreements between these reviewers were addressed
other aerosol‐producing procedures.11,12 Some in‐vitro studies have through discussion and consensus with other researchers.
reported that SARS‐CoV‐2 could be viable for 3 h in an aerosol13 and
could be retained in the ambient air for hours14 or could be
transmitted > 2m or 6 feet before falling on the ground due to 2.2 | Search strategy
gravity.12,15 Infectious droplets produced by coughing or sneezing
contain larger particles (>5 μm) and are believed to settle within <2m We have decided to search a combination of keywords, including
or 6 feet away from the infected person who produces them.16,17 “Disinfectants,” “Aerosols,” “COVID‐19,” and their synonyms in the
Although there are some controversies about the role of aerosols abovementioned databases. All relevant studies were included
in virus transmission,13,18 there is now some strong evidence to regardless of their publication stage. Search strategies are provided
consider aerosol spread as a major route in virus transmission.7,8,19 in Supporting Information Material 2 for each database. An example
Studies have reported that asymptomatic carriers, who have no of search strategy for PubMed was as follows:
cough, sneeze, or direct contact could transmit the virus.20–22
Only a few previous studies focused on the need to curb [COVID‐19] OR [SARS‐CoV‐2] OR [SARS‐CoV2] OR [2019‐nCoV]
transmission of SARS‐CoV‐2 by disinfecting the aerosols containing OR [Novel coronavirus].
the virus.8,14,23 As far as we know, there are only two systematic [Aerosol] OR [Aerosols] OR [Virus‐containing aerosol] OR [Viral
reviews that address the inactivation of SARS‐CoV‐2 in aerosols.24,25 aerosol] OR [Airborne transmission] OR [Droplet] OR [Airborne
As has been mentioned before, the most dominant form of this super particle] OR [N95 masks] OR [Bioaerosol] OR [Ambient air].
spread of SARS‐CoV‐2 is airborne transmission. Although the [Disinfection] OR [Disinfectant] OR [Disinfectants] OR
inactivation of SARS‐CoV‐2 in aerosols to control its rapid transmis- [Decontamination] OR [Superior filtration] OR [Virusend] OR
sion is crucial everywhere, the effectiveness and toxicity of disinfec- [TX‐10] OR [TiO2] OR [Alcohol] OR [Ozone].
tants are also of concern.26,27 Therefore, it is necessary to identify safe [A] AND [B] AND [C].
disinfectants that can be applied in public areas without evacuating
people. Given the significance of SARS‐CoV‐2 spreading via aero-
sols,8,10,28 particularly in setting connected to healthcare, hospitals, 2.3 | Study selection
dental units and aerosol‐creating conditions,11 it is critical to
understand how to prevent it from spreading by disinfecting aerosols. We included all original studies concerning the effects of various
Given the significance of SARS‐CoV‐2 spreading via aerosols,8,10,28 disinfecting methods on the SARS‐CoV‐2 aerosols that have been
especially in crowded areas, hospitals, and aerosol‐creating condi- published in English. To improve the validity of our findings, the
tions,11 it is critical to understand how to prevent it from spreading by review included all the observational (prospective cohort, cross‐
disinfecting aerosols. Thus, we aimed to review the existing studies to sectional, and case studies) and experimental (randomized controlled
find the best disinfectant method for eliminating the SARS‐CoV‐2 in trials, pre−post design, quasi‐experimental) studies.
aerosols to prevent COVID‐19 spread. Exclusion criteria were as follows:
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DEHGHANI ET AL. | 3 of 12
1. Nonoriginal studies, including reviews, systematic reviews, and 3 | RESULTS
meta‐analyses.
2. Case reports. A total of 664 articles were retrieved, of which 244 duplicates were
3. Abstract, conference abstracts, and studies with unavailable full‐ removed, and 420 records remained for screening. Furthermore, 236
texts. and 153 studies were excluded in the title/abstract and full‐text
4. Opinions, editorials, commentaries. screening, respectively; and 31 articles were included in the final
qualitative analysis (Figure 1).
These studies reported various materials as well as methods
2.4 | Data extraction that are used in viral as well as bacterial disinfection (Table 1).
Disinfectants are used primarily to reduce the risk of viral
Three researchers thoroughly read and extract the data from transmission on contact surfaces and areas prone to aerosol
included studies and organized them into a word table containing contamination. Prominent disinfectants include Ultraviolet C
the author name, type of study, year of publication, disinfection (UVC), heat, ozone, electrostatic disinfector, H2O2, alcohol, and
agent, time of the viral reduction, amount of viral reduction, size of TiO2. These particular disinfectants are being used to reduce
the particles, and summary of findings. Another independent SARS‐CoV‐2 virus transmission. The efficacy of these disinfec-
researcher reviewed the extracted data and addressed any discrep- tants varies considerably depending on the situation, time, and
ancies and issues raised between other researchers. ultimately their mode of application.
F IGURE 1 PRISMA 2020 flow diagram for this review. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses.
 23988835, 2023, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/hsr2.1042 by University of Ghana - Accra, Wiley Online Library on [18/04/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
4 of 12 | DEHGHANI ET AL.
TABLE 1 Summary of the findings for all the included studies
Year of Reduction of viral Summary of findings (e.g., efficacy of
ID First Author Country publication Disinfection agent Time of reduction infectivity Size of particles disinfectants, etc.)
1 Corrêa et al.29 Brazil 2021 UV–C 84%–97% in the This study was effective and safe by observing air
hospital disinfection standards using UV‐C technologies
environments and can be repeated.
2 Feng et al.30 China 2021 UV + Filter in built Close to 100% two size ranges, one in Size‐dependent filtration efficiency was close to
environment the sub‐micron 100%. The UV + filter is the most reliable and
region (dp between safe; while, consuming the highest energy. The
0.25 and 1.0 µm) proposed new design method for air purification
and the other in systems could be an essential tool for controlling
super‐micron region airborne diseases.
(dp> 2.5 µm)
3 Feng et al.31 China 2021 Electrostatic 100% The well‐designed ESD disinfection efficiency (with a
disinfector (ESD) spatial charge density of 3.6 × 10−06 C/m3) can
be up to 100%. Compared to HEPA, ESD can save
99% of energy which is consumed by HEPA
without reducing disinfection efficiency.
4 Fiore et al.32 Italy 2021 H2O2 2 h This method can be used not only for office paper‐
based sensors but also for filtering paper‐based
sensors, which increases the application of this
easy method of mass correction.
5 Garcia de Spain 2021 Low‐temperature‐ As a result, certain models of FFP2, FFP3, or N95 masks
Abejo steam–2%‐formaldehyde do not compromise their structure, fit, or filtering
et al.33 sterilization process capacity in one or two disinfection cycles with
2% LTSF.
6 Hill et al.34 USA 2021 UV 1‐, 5‐, and 9‐mm As the particle scale and UV absorption of the
(0.1 mm for the particle's material increase, Sp increases, and
individual virion) decreases.
7 John et al.35 USA 2021 N95 filtering face‐piece 1 h and 16min ~99% ~106 colony‐forming PAA room HLDS are effective for the
respirator with a units (CFU) of G. decontamination of N95 respirators in a
peracetic acid room stearothermophilus short time
disinfection system spores and ~106
plaque‐forming
units (PFU) of
bacteriophage MS2
8 Kumar et al.36 India 2021 face masks following with 30 and 60min 100% 0.3–10 µm When some measures, especially social distancing,
different sterilization are challenging to maintain the mask, it can
methods provide more protection.
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DEHGHANI ET AL. | 5 of 12
TABLE 1 (Continued)
Year of Reduction of viral Summary of findings (e.g., efficacy of
ID First Author Country publication Disinfection agent Time of reduction infectivity Size of particles disinfectants, etc.)
9 Lammersetal.37 USA 2021 blue surgical sterilization 95% 0.3 µm The current claims, which show superior filtration
wrap for homemade results compared to medical‐grade N95 masks,
respirator masks are derived from a misinterpretation of industrial
experiments.
10 Li et al.38 China 2021 an aggregation‐induced 5−10min >99% A set of antimicrobial evaluations show that TTVB @
emission (AIE)‐active NM can effectively treat pathogenic aerosols
luminogen‐loaded containing bacteria (inhibition rate: >99%), fungi
nanofibrous membrane (~88%), and viruses (>99%) Turn off sunlight in
(TTVB@NM) sharing just 10min.
sunlight‐triggered
photodynamic/
photothermal anti‐
pathogen functions are
prepared using the
electrospinning technique
11 Mohan et al.39 India 2021 dioxide (ClO2) Inactivates upto Remove virus and Protein layer of enveloped and non‐enveloped
99% of viruses bacteriophages viruses and RNA and DNA Inactivates by
Ozone (O3) upto 0.001m in size oxidizing.
Sodium hypochlorite (NaOCl)
hydrogen peroxide
(H2O2) peracetic
acid (PAA)
Solar Nonionizing (UV)
Ionizing (gamma‐ray)
Slow sand and ceramic
Ultra‐filtration, Nano‐
filtration, Reverse
osmosis Membrane
12 Parry et al.40 India 2021 62%–75% ethanol 3−4 times after a 62%–75% ethanol reduces infectivity of SARS‐CoV‐2 by
contact period 3 to 4 times after a contact period of 1min. Sodium
(NaClO)
of 1min hypochlorite (NaClO) solution in a concentration of
glutaraldehyde and 0.1%–0.5% reduces the infectivity of the virus by 3
0.5% H2O2 times after a contact period of 1min. 2%
glutaraldehyde and 0.5% H2O2 areequally efficient
and reduce infectivity by 3 times after 1min of
contact time.
(Continues)
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6 of 12 | DEHGHANI ET AL.
TABLE 1 (Continued)
Year of Reduction of viral Summary of findings (e.g., efficacy of
ID First Author Country publication Disinfection agent Time of reduction infectivity Size of particles disinfectants, etc.)
13 Percivalle Italy 2021 zone at the three tested 40min 99% Ozone at the three tested concentrations of 0.5, 1,
et al.41 concentrations of 0.5, and 2 ppm significantly reduced the SARS‐CoV‐2
1, and 2 ppm titerafter 40min fumigation on all assessed
surfaces, including FFP2 mask and surgical gown.
14 Schinkothe Germany 2021 Dry fogging (aerosolized 48−52 h Dry fogging is highly microbicidal, efficient, rapid,
et al.42 peroxyacetic acid and robust, and neutral. A low concentration of
hydrogen peroxide) dispersed disinfectant entails high material
compatibility. It is an ideal method for hospitals,
public conveyances, and indoor areas.
15 Sharun et al.43 India 2021 Sunlight exposure (UVC) 9min Complete Direct skin exposure promotes the production of
inactivation vitamin D which can lower the risk of Respiratory
not achieved Tract infections. The intensity of sunlight is
highest near the equator; therefore they had
lower fatality rates. Antimicrobial photodynamic
therapy can be considered as an alternative
therapeutic strategy.
16 Zucker et al.44 Israel 2021 Ozone (1000 ppm) 30min. 99% Ozone gas is an effective disinfectant for SARS‐CoV‐
2 with high potential to overcome the low
accessibility of commonly applied liquid
disinfectants
17 Guo et al.45 China 2020 alcohol Alcoholic disinfection for the nozzle and the
surrounding air was effective in reducing germs in
aerosols.
18 Gupta et al.46 India 2020 Negative Pressure Aerosol This type of innovation requires an hour to reduce
Containment Box the risk for HCW without compromising patient
safety and comfort in an affordable manner.
19 Heo et al.47 Republic of 2020 TiO2−CV 99.9% 1−2mm
Korea
based VLA antimicrobial air
filters
20 Inagaki et al.48 Japan 2020 deepMN‐UV LED irradiation 10 s (for 99.9% 99.9% 150 μl Virus‐infected cells irradiated for 60 s showed a
reduction) morphology largely comparable to that of cloned
cells.
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DEHGHANI ET AL. | 7 of 12
TABLE 1 (Continued)
Year of Reduction of viral Summary of findings (e.g., efficacy of
ID First Author Country publication Disinfection agent Time of reduction infectivity Size of particles disinfectants, etc.)
21 Mijoska et al.49 Macedonia 2020 Ethyl alcohol (78%–95%), 1 min Eliminate virus Water and detergents in combination with common
2‐propanol (70%–100%), infectivity by disinfectants should be used to clean operational
a combination of 45% 4 log or more and areas at high risk for the presence of the virus
2‐propanol with 30% with 0.05% sodium hypochlorite diluted with
1‐propanol, water
glutaraldehyde(0.5% (1 g/L). For disinfection of smaller areas, 70%
−2.5%), formaldehyde Ethanol can be used, which after 1 min of
(0.7%–1%), and Povidone‐ exposure showed a significant reduction in the
iodine (0.23%–7.5%) vitality of coronaviruses.
22 Morawska Australia 2020 germicidal ultraviolet (GUV, 5min With almost a <2.5 µm Under laboratory conditions, GUV has been shown to
et al.50 or UVGI—ultraviolet 6 log reduction be effective against a suite of microorganisms
germicidal irradiation in 5min including coronaviruses.
23 Raventos Spain 2020 Hydroalcoholic aerosol (70% 641 s Removes all traces R2 = 0.9698 Air curtains equipped with sprayers thatdistribute HA
et al.51 ethanol) droplets to surfaces, reduce the viral load. It
represents an additional and manageable measure
to rapidly and economically reduce the spread of
the virus.
24 Ren et al.52 China 2020 Circulating wind ultraviolet Circulating wind air disinfectors with high ultraviolet
air disinfectors rays, kill the microorganisms and promote the
flow of indoor air.
25 Rohit et al.53 India 2020 Ultraviolet radiation 52‐min cycle Over 95% 0.3−0.5 microns Three N95 face masks of different make subjected to
exposure, isopropyl 6 decontamination methods. All sterilization
alcohol dip, ethylene retained over 95% efficiency, with autoclave
oxide, autoclave, plasma showed a drop, and UV showed variations in the
sterilization, dry heat size of the particle after decontamination.
sterilization
26 Tu et al.54 China 2020 in‐situ formed nickel oxide 30 s 95% Electrochemical disinfection approach to treat with
hydroxide(NiOOH) as the COVID‐19 via inactivating the SARS‐CoV‐2
5min 99.99%
anode catalyst and virus in a water electrolysis process
sodium carbonate
(Na2CO3) as electrolyte
27 Vernez et al.55 Nether- 2020 ultraviolet germicidal 600mJ/cm2 (10 Particle Decontamination procedure for FFR masks is an
lands irradiation (UVGI) Cycles) penetration attractive method for respirators in case of
for FFR masks ratio < 5%−6% shortages during a SARS pandemic
28 Campos et al.56 USA 2020 Heat 75°C 30min. 100% Heating with temperatures of 75 − 85°C can
efficiently inactivate the virus on melt‐blown
85°C 20min.
polypropylene Fabriqueof N95 masks after
20−30min without lowering filtration efficiency
(Continues)
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8 of 12 | DEHGHANI ET AL.
The findings of the present review show that UVC is the most
common method used in disinfecting objects mostly N95 masks,
contaminated air, and other contact objects with the possibility of
viral contamination. UVC efficacy ranges from 36.4% to
100%.29,30,34,48,60,61 Efficacy variability is attributed to the mode of
usage as reported by the studies.30,45
Ozone as a physical disinfectant has very good efficacy in reducing
viral transmissibility and infectivity.62 The most widely used substance or
disinfection agent is alcohol with very high efficacy in reducing SARS‐
COV‐2 viral infectivity and transmissibility.40,45,49,63 Studies reported
disinfection of face masks (N95) at 75−85°C for 20−30min.64 This
recycling of N95 masks also proved to be very effective with minimal
disruption of the structure of the mask to deactivate the virus.64
4 | DISCUSSION
The present pandemic has clearly affected almost every part of
human life across the world. Although there are currently several
vaccines available, their inability to confer full immunity coupled with
a low vaccination uptake still drives the pandemic. It is therefore
paramount to continue implementing other traditional ways of
preventing and reducing infection with the virus such as using
disinfectants and adhering to public health protocols since these are
the most effective and primary strategies to reduce viral transmis-
sion. Inhalation of infectious particles dispersed in the air, direct
deposition on mucosal membranes, and indirect contact via
contaminated surfaces are all ways for the virus to spread.
Aerosol‐mediated SARS‐CoV‐2 transmission has been well docu-
mented57,65,66; therefore, methods of disinfection that can reduce
such transmission are critical to curb the pandemic and prevent
future viral outbreaks. Based on the findings of the present review,
the use of dry heat, UVC, chemical agents, titanium dioxide, ozone,
electrostatic disinfector, and a novel disinfectant known as Virus end
(TX‐10) are some of the aerosol and contact decontaminates that are
being used in the current pandemic.
Protection Approaches for Transmissions of SARS‐CoV‐2
• Physical methods
Ultraviolet radiations including UVC, UVA, UVB, visible light,
and infrared radiation have germicidal activities. UVC as one of
the germicidal agents is used in ultraviolet phototherapy. They are
radiations with wavelengths ranging from 200 to 290 nm. Our
analysis shows that UV‐C is the most common physical form of
disinfecting objects mostly N95 masks, contaminated air, and
other contact objects with the possibility of viral contamination
including inactivating human CoVs and SARS‐CoV‐2 on environ-
mental surfaces.25 This spells out the critical preventive role that it
could play in the spread of the SARS‐CoV‐2 virus. Studies have
postulated that nanofiber membrane in N95 masks and respirators
maintained their filtration efficacy after being subjected to long‐
term exposure under UV light or successive doses of 60mg/cm2
after a short drying cycle (30min, 70°C). It suggests that N95
masks and respirators can be disinfected and reused using
TABLE 1 (Continued)
Year of Reduction of viral Summary of findings (e.g., efficacy of
ID First Author Country publication Disinfection agent Time of reduction infectivity Size of particles disinfectants, etc.)
29 Widmer et al.57 Switzerland 2020 H2O2 Plasma 75% H2O2 plasma sterilization for decontamination allows
reprocessing filtering facepiece masks (FFP2),
while they still meet the filtration efficiency
30 Wu et al.58 China 2020 Water Immersion Test Meltblown: 79%, 99% Three methods for disinfection of masks are
successfully reliable ways for reusing masks
75% Alcohol Solution Nano:Meltblown: 50%, 99%
UV (long term) Nano:Melt- <100%
blown:Nano:
100%
31 Xiang et al.59 China 2020 Dry Heat 70°C 1 h 100% 0.1−10mm Heating with temperatures of 70°C for 1 h can
efficiently inactivate the H1N1virus on N95
masks without lowering filtration efficiency
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DEHGHANI ET AL. | 9 of 12
ultraviolet germicidal irradiation, especially in resource‐limited scales. Ozone is also effective in indoor locations with a good
conditions.43,55,58 However, further studies are needed to deter- advantage over liquid disinfectants since it demonstrates similar
mine the number of successive reuse cycles that a single respirator decontamination in all surfaces including interior surfaces.44 Hence,
or mask can undergo while maintaining its filtration efficacy.53 using gaseous ozone as a sterilizing agent for high‐risk indoor rooms,
Open‐air decontamination is also another way in which PPEs, and crucial or difficult‐to‐reach surfaces, particularly in
ultraviolet radiation can be employed. This method of application healthcare institutions, could help to limit the viral spread and
requires using high‐intensity UV rays (254 nm UV‐C). These maintain the safety of patients and healthcare professionals in the
circulating wind ultraviolet air disinfectors do not only kill current pandemic as well as future outbreaks.25,41 In reviewed works,
pathogenic microorganisms in the air, but they also effectively low ozone exposures, just around 0.1–0.4 mg L‐1min, achieve about
improve the flow of indoor air by circulating wind; hence, they are 4 log10 of inactivation in aerosols, while exposures between 1 and
very effective in eliminating SARS‐CoV‐2 aerosols.25,52,67,68 Other 4mg L‐1min may be needed to guarantee an inactivation of 3–4
reports indicate that SARS‐CoV‐2 viral load can be significantly log10 in different fomites. Although further studies are required,
reduced or even eliminated with as low as 10 s−3min of UVC ozone is an effective candidate to be used against SARS‐CoV‐2 or
irradiation on contaminated surfaces of personal items.61 Aside other viruses in surfaces and indoor locations. However, the
from this method, upper‐room germicidal UV fixtures seem uncertainties in front of a widespread use of ozone gas for virus
promising and effective in reducing and managing airborne inactivation are still significant.74
transmissions. This could be applied in various viral respiratory
outbreaks since it is an old technological measure known to be
effective, safe, and economical.33,69,70 4.1 | Titanium dioxide
There are, however, some disadvantages with this method.
Human exposure to UVC may cause kerato conjunctivitis and Titanium dioxide (TiO₂) is an inorganic compound that has been
erythema and requires protection of the skin and the eyes of reported by studies to possess multiantiviral effects. It is used to
people exposed to levels above recommended exposure limits. induce a photocatalytic reaction which proves to be an excellent
However, by enclosing the UVC sources or by irradiating in the disinfectant and can be used to tackle infectious diseases including
absence of human activity, human exposure is eliminated. SARS‐COV‐2.47 Furthermore, TiO2 is reported to be environmen-
Another form of physical decontamination reported is the use tally friendly, hence, does not have any substantial adverse effects
of dry heat usually between 60°C and 85°C. With as low as 5min on human health. However, it is time and medium dependent
to 1‐hour, dry heat applied to surgical face masks and N95 showing a faster disinfection rate for aerosols. Although this
respirators showed efficient decontamination of SARS‐CoV‐2, difference exists, the reduction in infectivity is similar.75 A novel
human coronavirus NL63 (HCoV‐NL63), and chikungunya virus disinfectant worth mentioning is Virusend (TX‐10). This antimicro-
vaccine strain 181/25 (CHIKV‐181/25), without any reduction in bial agent is very effective in reducing SARS‐CoV‐2 virus
the filtration ability as well as the structural composition of the transmission through indirect contact and aerosols. As a new
masks and respirators. The efficiency of this particular method is method, it could be explored further for wide‐scale applications.60
very promising and nondestructive even at different relative Electrostatic disinfectors and elastomeric respirators have also
humidity. It is regarded as the best method to sterilize N95 masks been reported to have high disinfection and filtration efficiency,
at 70°C−80°C. However, this method of decontamination can be respectively. They both present highly efficient methods of
repeated only 3 times on masks and respirators.25,36,56,59,71 Also, terminating aerosol viral transmission.54,76
evidence demonstrates that autoclaving and dry heat at tempera-
tures greater than 90°C cause physical degradation of melt‐blown
fabric and consequently affects the filtration efficiency.72 4.2 | Other chemical protection methods
• Chemical methods
Ozone (O3) is a physical disinfectant, a highly reactive gas that As a chemical method, alcohol is the most widely used substance
consists of three oxygen atoms. This particular gaseous disinfectant or disinfection agent with almost 100% efficacy in reducing
has been reported to be a very strong agent that can inactivate and SARS‐CoV‐2 viral infectivity and transmissibility. Many forms of
consequently eliminate enveloped pseudoviruses including influenza chemical agents like ethanol, hydrogen peroxide, sodium hypo-
A H1N1, MERS‐CoV, SARS‐CoV‐1, and SARS‐CoV‐2 even at minimal chlorite, quaternary ammonium compounds, and phenolic com-
exposure in aerosols or fomites.73,74 This method of disinfection has pounds have been used successfully to inactivate the coronavirus
a positive correlation between surface hydrophilicity and disinfection. on surfaces.66,68 Plasma peroxide is also another chemical agent that
Its efficacy may depend on the type of surface it is being used on. is used in the decontamination of FFP2 respirators for recycling.57 A
Studies have reported that infected surfaces made of aluminum alloy combinatorial chemical method formed from an aerosolized mixture
are properly disinfected with ozone in comparison with surfaces like of peroxyacetic acid and hydrogen peroxide (aPAA‐HP) demonstrates
copper, nickel, and brass. There seems to be a gap in this regard and excellent disinfection ability against the SARS‐CoV‐2 virus. It is highly
further studies may be needed to implement its usage on larger microbicidal, efficient, rapid, sturdy, eco‐friendly, and an effective
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10 of 12 | DEHGHANI ET AL.
form of airborne disinfection.42 The use of peracetic acid also proves CONFLICT OF INTEREST
to be very effective in decontaminating N95 respirators. This method The authors declare no conflict of interest.
is capable of disinfecting G. stearothermophilus spores as well as
bacteriophage MS2. Therefore, this room disinfection system is DATA AVAILABILITY STATEMENT
effective in reducing SARS‐CoV‐2 viral transmission.35 The authors stated that all information provided in this article could
The fact that all included studies are based on in vitro be share.
circumstances and that only a few thorough experiments attempt
to replicate in vivo conditions is one of the major limitations of this TRANSPARENCY STATEMENT
systematic review. However, more investigation and evaluation are The lead author Esmaeil Mehraeen affirms that this manuscript is an
needed to determine the true efficacy of in vivo settings. The authors honest, accurate, and transparent account of the study being
found it challenging to select papers that were both pertinent and of reported; that no important aspects of the study have been omitted;
the highest caliber due to the large amount of research on and that any discrepancies from the study as planned (and, if relevant,
COVID‐19. This was also one of the most notable study drawbacks. registered) have been explained.
ORCID
5 | CONCLUSION SeyedAhmad SeyedAlinaghi http://orcid.org/0000-0003-
3210-7905
To fully immune the population against SARS‐CoV‐2, we still need to Amirali Karimi http://orcid.org/0000-0003-1241-7754
continue using disinfectants, as the discovery of vaccines and Marcarious M. Tantuoyir http://orcid.org/0000-0002-7645-9999
antiviral drugs against COVID‐19 have not been as effective as Omid Dadras http://orcid.org/0000-0001-9385-2170
expected in eliminating the incidence of new cases in the long term. Alireza Barzegary http://orcid.org/0000-0002-0512-7014
In this review we have gathered together the current knowledge of Esmaeil Mehraeen http://orcid.org/0000-0003-4108-2973
characteristics of available disinfection methods, such as UVC, heat,
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