N95 Respirators vs Medical Masks in Outpatient Settings

Respirators in Healthcare: Material, Design, Regulatory, Environmental, and Economic Considerations for Clinical Efficacy

Maintaining an ample supply of personal protective equipment continues to be a challenge for the healthcare industry, especially during emergency situations and times of strain on the supply chain. Most critically, healthcare workers exposed to potential airborne hazards require sufficient respiratory protection. Respirators are the only type of personal protective equipment able to provide adequate respiratory protection. However, their ability to shield hazards depends on design, material, proper fit, and environmental conditions. As a result, not all respirators may be adequate for all scenarios. Additionally, factors including user comfort, ease of use, and cost contribute to respirator effectiveness. Therefore, a careful consideration of these parameters is essential for ensuring respiratory protection for those working in the healthcare industry. Here respirator design and material characteristics are reviewed, as well as properties of airborne hazards and potential filtration mechanisms, regulatory standards of governmental agencies, respirator efficacy in the clinical setting, attitude of healthcare personnel toward respiratory protection, and environmental and economic considerations of respirator manufacturing and distribution.

Performance Comparison of Single and Double Masks: Filtration Efficiencies, Breathing Resistance and CO2 Content

The emergence of a pandemic affecting the respiratory system has resulted in a significant demand for face masks. Masks have always been mentioned as an effective tool against environmental threats. This includes the use of double masks by large sections of the public, as can be seen during the current global spread of COVID-19. However, there is limited knowledge available on the performance of the various commonly available double face masks used. In this study, we have compared the performance of single and double face configurations. Three types of 3-ply face mask (FM), three types of fabric face mask (CM) and nine configurations of these face masks were investigated based on morphology, filtration efficiencies, breathing resistance and carbon dioxide (CO2) content. The filtration efficiencies of the double face masks are enhanced when combined with a fabric mask, and were found to improve by 500% compared to those of a fabric mask. The lowest breathing resistance among the double masking was observed in the combination of FM1 and fabric face masks. From the results, it was found that all combinations of double face mask are suitable to use since the measurements indicate that the breathing resistance and CO2 contents are still lower than the acceptable value set by the Malaysian Standard (MS 2323:2010) and European Standard (EN 149:2001 + A1:2009). The performance of double masks is comparable with that of N95 respirators. The double masking combination can be used as an alternative method to reduce inhalation exposure to airborne contaminants.

Face masks and respirators in the fight against the COVID-19 pandemic: An overview of the standards and testing methods

The COVID-19 outbreak has resulted in a shortage of personal protective equipment (PPE) throughout the world. This shortage has resulted in an increase in production of PPE to meet the demand, and as a result, several substandard equipment has entered the market. With face masks and respirators now beginning to see widespread use throughout the world, the standards and test with which they are required to undertake have become points of interest. The filtration efficiency of the masks is a key testing element that examines its ability to filter particles, bacteria and viruses; this examines the penetration efficiency percentage of each with lower results being preferable. Masks are also subjected to NaCl testing method, which allows a range of particle sizes to be examined and their penetration to be observed. The masks must also show considerable resistance to fluids and flames, to prevent the penetration of liquids and to be non-flammable. Various PPE testing protocols such as biological, chemical, fluid and flame resistances, protective ensemble, facepiece fit testing, NIOSH NaCl method and impact protection have been discussed. In addition, various tests involving bacterial and viral filtration efficiencies are also discussed. Differential pressure is examined to ascertain the comfort, airflow and breathability of the masks, whilst fit testing is examined to ensure a correct fit of the mask.

The need of health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the N95 respirators effectiveness

Protecting Health Care Workers (HCWs) during routine care of suspected or confirmed COVID-19 patients is of paramount importance to halt the SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) pandemic. The WHO, ECDC and CDC have issued conflicting guidelines on the use of respiratory filters (N95) by HCWs. We searched PubMed, Embase and The Cochrane Library from the inception to March 21, 2020 to identify randomized controlled trials (RCTs) comparing N95 respirators versus surgical masks for prevention of COVID-19 or any other respiratory infection among HCWs. The grading of recommendations, assessment, development, and evaluation (GRADE) was used to evaluate the quality of evidence. Four RCTs involving 8736 HCWs were included. We did not find any trial specifically on prevention of COVID-19. However, wearing N95 respirators can prevent 73 more (95% CI 46-91) clinical respiratory infections per 1000 HCWs compared to surgical masks (2 RCTs; 2594 patients; low quality of evidence). A protective effect of N95 respirators in laboratory-confirmed bacterial colonization (RR = 0.41; 95%CI 0.28-0.61) was also found. A trend in favour of N95 respirators was observed in preventing laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection, and influenza like illness. We found no direct high quality evidence on whether N95 respirators are better than surgical masks for HCWs protection from SARS-CoV-2. However, low quality evidence suggests that N95 respirators protect HCWs from clinical respiratory infections. This finding should be contemplated to decide the best strategy to support the resilience of healthcare systems facing the potentially catastrophic SARS-CoV-2 pandemic.