1
|
Khairul Hasni NA, Ismail R, Muhamad Robat R, Mohamad N, Suib FA, Pahrol MA, Mahmud H, Osman B, Lim YC, Seman Z, Shaharudin R. The effect of N95 designs on respirator fit and its associations with gender and facial dimensions. PLoS One 2023; 18:e0288105. [PMID: 38019763 PMCID: PMC10686483 DOI: 10.1371/journal.pone.0288105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/28/2023] [Indexed: 12/01/2023] Open
Abstract
This study examined the association of various brands of NIOSH-certified N95 filtering face-piece respirators (FFR) fit with facial dimensions and gender. One hundred and thirty-five participants (77 females and 58 males) were recruited from the previous facial anthropometry study among Malaysians in 2020. Quantitative respirator fit testing of six FFR were performed using the TSI Portacount Pro+ 8038 which comprised of four exercises (bending over, talking, up-down head movement, and side to side head movement). An overall fit factor (FF) of ≥ 100 was considered a pass for each FFR. Analysis was done using T-test, Pearson's correlations, and generalised linear regression. The passing rates for the six FFR were 36.3% (Cup B), 50.4% (Trifold A), 54.1% (Duckbill A), 57.0% (Cup A), 74.1% (Trifold B), and 83.7% (Duckbill B). Both Duckbill B and Trifold B had the highest passing rates for both genders. However, certain FFR models (Cup B, Trifold A, Trifold B, and Duckbill A) fit better for participants with large facial size who were mostly males, while others (Cup A and Duckbill B) specifically fit better for those with small facial size, who were mostly females. This study showed significant positive effect of nose protrusion, nasal root and subnasale-sellion and the negative effect of menton-sellion, bigonial breadth and nose breadth on fit factors of various FFR. The results of this study emphasized the importance of choosing and designing FFR based on local anthropometry data, with careful consideration on the dimensions that affect the respirator fit. Since N95 are commonly used in the healthcare settings to prevent airborne transmission, the practice of respirator fit testing and selecting N95 with high passing rates for healthcare workers need to be emphasized.
Collapse
Affiliation(s)
- Nurul Amalina Khairul Hasni
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Rohaida Ismail
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Rosnawati Muhamad Robat
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Nadia Mohamad
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Fatin Amirah Suib
- Infectious Disease Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Muhammad Alfatih Pahrol
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Haalah Mahmud
- National Institute of Occupational Safety and Health, Ministry of Human Resources, Malaysia
| | - Baderin Osman
- National Institute of Occupational Safety and Health, Ministry of Human Resources, Malaysia
| | - Yin Cheng Lim
- Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Zamtira Seman
- Sector for Biostatistics & Data Repository, National Institutes of Health, Ministry of Health, Malaysia
| | - Rafiza Shaharudin
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Malaysia
| |
Collapse
|
2
|
Fakherpour A, Jahangiri M, Jansz J. A systematic review of passing fit testing of the masks and respirators used during the COVID-19 pandemic: Part 1-quantitative fit test procedures. PLoS One 2023; 18:e0293129. [PMID: 37883443 PMCID: PMC10602271 DOI: 10.1371/journal.pone.0293129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND During respiratory infection pandemics, masks and respirators are highly sought after, especially for frontline healthcare workers and patients carrying respiratory viruses. The objective of this study was to systematically review fit test pass rates and identify factors influencing the fitting characteristics. METHODS Potentially relevant studies were identified using PubMed, Scopus, Web of Science, and Science Direct during the COVID-19 pandemic from February 5, 2020, to March 21, 2023. The search strategy using the following keywords was conducted: Quantitative Fit Test, Condensation Nuclei Counter, Controlled Negative Pressure, PortaCount, Sibata, Accufit, Fit, Seal, Mask, Respirator, Respiratory Protective Device, Respiratory Protective Equipment, Protective Device, Personal Protective Equipment, COVID-19, Coronavirus, and SARS-CoV-2. The quality of the included studies was also assessed using the Newcastle-Ottawa scale. RESULTS A total of 137 articles met the eligibility criteria. Fifty articles had a quality score of less than 7 (good quality). A total of 21 studies had a fit test pass rate of less than 50%. 26 studies on disposable respirators and 11 studies on reusable respirators had an FF of less than 50 and less than 200, respectively. The most influential factors include respirator brand/model, style, gender, ethnicity, facial dimensions, facial hair, age, reuse, extensive movement, seal check, comfort and usability assessment, and training. CONCLUSION 37.36% of the disposable respirator studies and 43% of the reusable respirator studies did not report fit test results. 67.86% of the disposable respirator studies had a fit test pass rate greater than 50%, and 35.84% of these studies had an FF greater than 100. Also, 85.71% of the reusable respirator studies had a fit test pass rate greater than 50%, and 52.77% of these studies had an FF greater than 1000. Overall, the fit test pass rate was relatively acceptable. Newly developed or modified respirators must undergo reliable testing to ensure the protection of HCWs. Subject and respirator characteristics should be considered when implementing fit testing protocols. An optimal fit test panel should be developed prior to respirator design, certification, procurement decisions, and selection procedures.
Collapse
Affiliation(s)
- Anahita Fakherpour
- Student Research Committee, Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Jahangiri
- Department of Occupational Health and Safety Engineering, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Janis Jansz
- School of Mines: Minerals, Energy and Chemical Engineering, Faculty of Science and Engineering, Curtin University, Perth, Australia
| |
Collapse
|
3
|
Caggiari S, Bader D, Packman Z, Robinson J, Tranka S, Böhning D, Worsley P. Retrospective evaluation of factors affecting successful fit testing of respiratory protective equipment during the early phase of COVID-19. BMJ Open 2023; 13:e065068. [PMID: 37230519 DOI: 10.1136/bmjopen-2022-065068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES Respiratory protective equipment is critical to protect healthcare workers from COVID-19 infection, which includes filtering facepiece respirators (FFP3). There are reports of fitting issues within healthcare workers, although the factors affecting fitting outcomes are largely unknown. This study aimed to evaluate factors affecting respirator fitting outcomes. DESIGN This is a retrospective evaluation study. We conducted a secondary analysis of a national database of fit testing outcomes in England between July and August 2020. SETTINGS The study involves National Health Service (NHS) hospitals in England. PARTICIPANTS A total of 9592 observations regarding fit test outcomes from 5604 healthcare workers were included in the analysis. INTERVENTION Fit testing of FFP3 on a cohort of healthcare workers in England, working in the NHS. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome measure was the fit testing result, that is, pass or fail with a specific respirator. Key demographics, including age, gender, ethnicity and face measurements of 5604 healthcare workers, were used to compare fitting outcomes. RESULTS A total of 9592 observations from 5604 healthcare workers were included in the analysis. A mixed-effects logistic regression model was used to determine the factors which affected fit testing outcome. Results showed that males experienced a significantly (p<0.05) higher fit test success than females (OR 1.51; 95% CI 1.27 to 1.81). Those with non-white ethnicities demonstrated significantly lower odds of successful respirator fitting; black (OR 0.65; 95% CI 0.51 to 0.83), Asian (OR 0.62; 95% CI 0.52 to 0.74) and mixed (OR 0.60; 95% CI 0.45 to 0.79. CONCLUSION During the early phase of COVID-19, females and non-white ethnicities were less likely to have a successful respirator fitting. Further research is needed to design new respirators which provide equal opportunity for comfortable, effective fitting of these devices.
Collapse
Affiliation(s)
- Silvia Caggiari
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Dan Bader
- School of Health Sciences, University of Southampton, Southampton, UK
| | | | | | | | - Dankmar Böhning
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, UK
| | - Peter Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
| |
Collapse
|
4
|
Chopra J, Abiakam N, Kim H, Metcalf C, Worsley P, Cheong Y. The influence of gender and ethnicity on facemasks and respiratory protective equipment fit: a systematic review and meta-analysis. BMJ Glob Health 2021; 6:e005537. [PMID: 34764145 PMCID: PMC8587533 DOI: 10.1136/bmjgh-2021-005537] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 09/12/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Black, Asian and minority ethnic (BAME) people are disproportionately affected by COVID-19. Respiratory protective equipment (RPE) has conventionally been developed for a predominantly white male population that does not represent the healthcare workforce. The literature was reviewed to determine the protection offered to female and BAME users. METHODS Five databases were searched. Eligible studies related to respirator fit in the context of anthropometrics, gender and ethnicity. Meta-analysis was performed for gender-based anthropometric differences. A priori protocol registration was not performed. RESULTS 32 studies were included and anthropometric data was extracted from 15 studies. Meta-analysis revealed 14 anthropometric measurements were significantly smaller for females. Mean differences ranged from 0.37 mm to 22.05 mm. Gender-based anthropometric differences did not always translate to lower fit factor scores, with 12 studies reporting worse performance and fit for females and 10 reporting no gender effect. No studies provided disaggregate anthropometric data by ethnic group. Pass rates (PR) were low or moderate in 12 BAME or mixed-ethnicity cohorts. 14 studies reported associations between facial dimensions (FD) and respirator fit. Three comparative studies showed lower PR among selective BAME people. 18 studies reported RPE performance differed with model and design. Most studies did not prespecify inclusion/exclusion criteria. Small sample size and lack of justification or power calculations was a concern. Significant heterogeneity in study designs limited comparisons, particularly relating to respirator selection or availability and defining study outcomes relating to RPE performance. CONCLUSION The literature reports on largely Caucasian or single ethnic populations, and BAME people remain under-represented, limiting comparisons between ethnic groups. Facial anthropometrics vary between gender and likely between ethnicity, which may contribute to lower PR among females and ethnic minorities, particularly Asians. There is a need for studies including a broader spectrum of ethnicities and for consideration of female and BAME users during RPE development.
Collapse
Affiliation(s)
- Jagrati Chopra
- Scool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nkemjika Abiakam
- School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Hansung Kim
- School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Cheryl Metcalf
- School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Peter Worsley
- School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, UK
| | - Ying Cheong
- Scool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
- Complete Fertility Southampton, Princess Anne Hospital, Southampton, UK
| |
Collapse
|
5
|
Fakherpour A, Jahangiri M, Banaee S. Qualitative fitting characteristics of elastomeric half face-piece respirators using Isoamyl acetate agent. INDUSTRIAL HEALTH 2021; 59:272-282. [PMID: 33658473 PMCID: PMC8426545 DOI: 10.2486/indhealth.2020-0199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/24/2021] [Indexed: 06/12/2023]
Abstract
To examine the fit testing of elastomeric half face-piece respirators (EHRs), a total of 41 candidates were randomly assigned into seven EHRs equipped with organic vapor (OV) cartridges which were commonly used in the Iranian industrial workplaces. The qualitative fitting into the facial dimensions was assessed using the Allegro Isoamyl Acetate fit test kit. While the studied EHRs showed very low passing fit testing rates, the 3M, AoSafety (Medium), and AoSafety (Large) had the highest passing rates with 22.0%, 14.60%, and 9.76%, respectively. The AoSafety (All sizes) delivered a higher passing fit test rate than the 3M brand (29.30 vs. 22.0%). The one size fits all respirators including the DUO and Climax showed lower proportions of passing fit tests compared with AoSafety three-size system brands (2.40% and 4.90% vs. 29.30%). Low fit test passing rates were determined among different respirators. The respirators with various sizes and styles had more opportunities for different wearers to pass the fit test than single size models. The initial and annual fit testing requirements shall be developed by local government. Also, the manufacturers are required to pay attention to respirator features and subject characteristics during the production to obtain satisfactory protection for the end-users.
Collapse
Affiliation(s)
- Anahita Fakherpour
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Iran
| | - Mehdi Jahangiri
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Iran
| | - Sean Banaee
- Community and Environmental Health, College of Health Sciences, Old Dominion University, USA
| |
Collapse
|
6
|
Fakherpour A, Jahangiri M, Seif M, Charkhand H, Abbaspour S, Floyd EL. Quantitative fit testing of filtering face-piece respirators during the COVID-19 pandemic reveals anthropometric deficits in most respirators available in Iran. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2021; 19:805-817. [PMID: 33875931 PMCID: PMC8047558 DOI: 10.1007/s40201-021-00648-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/08/2021] [Indexed: 05/02/2023]
Abstract
PURPOSE Frontline health care workers (HCWs) must wear a standard N95 or FFP2 respirator during worldwide pandemics of respiratory diseases including COVID-19 to protect against airborne infectious pathogens when performing care activities. This study aimed to quantitatively investigate the fit of most of the common FFRs used during the COVID-19 pandemic in Iran. METHODS A total of 37 volunteers were fit tested in 20 selected FFRs in a randomized order. The selected FFRs were underwent quantitative fit testing by PortaCount® model 8038. To determine the effects of face sizes on respirator fit, the participants' facial dimensions were measured using a digital caliper. RESULTS The rate of passing fit tests for the studied FFRs were surprisingly low with 11 out of 20 FFRs having less than 10% passing fit tests and the best performers having only 43% and 27% passing fit tests (brands 2 and 20, respectively). Cup-shaped respirators provided significantly greater fit than the vertical flat-fold ones (p < 0.001). A significantly different FFs were found among the respirator brands (F = 13.60, p < 0.001). CONCLUSION Overall, unacceptably low fit factors were obtained from the studied FFRs. The main reasons for this are suspected to single size and style for each studied FFR. It confirms the importance and requirement of the proper respirator selection in that way fitted optimally into facial dimensions, appropriate usage, and properly performing the fit testing procedure. A unique fit test panel should be developed to guide respirator wearers in selecting the appropriate FFR for their specific face sizes.
Collapse
Affiliation(s)
- Anahita Fakherpour
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Jahangiri
- Department of Occupational Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Siamak Abbaspour
- Department of HSE, Arya Sasol Petrochemical Company, Bushehr, Iran
| | - Evan L. Floyd
- Department of Occupational and Environmental Health, Hudson College of Public Health, University of Oklahoma – Health Sciences Center, Oklahoma City, OK USA
| |
Collapse
|