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Ketoja JA, Saurio K, Rautkoski H, Kenttä E, Tanaka A, Koponen AI, Virkajärvi J, Heinonen K, Kostamo K, Järvenpää A, Hyry N, Heikkilä P, Hankonen N, Harlin A. Design of biodegradable cellulose filtration material with high efficiency and breathability. Carbohydr Polym 2024; 336:122133. [PMID: 38670771 DOI: 10.1016/j.carbpol.2024.122133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Using respiratory protective equipment is one of the relevant preventive measures for infectious diseases, including COVID-19, and for various occupational respiratory hazards. Because experienced discomfort may result in a decrease in the utilization of respirators, it is important to enhance the material properties to resolve suboptimal usage. We combined several technologies to produce a filtration material that met requirements set by a cross-disciplinary interview study on the usability of protective equipment. Improved breathability, environmental sustainability, and comfort of the material were achieved by electrospinning poly(ethylene oxide) (PEO) nanofibers on a thin foam-formed fabric from regenerated cellulose fibers. The high filtration efficiency of sub-micron-sized diethylhexyl sebacate (DEHS) aerosol particles resulted from the small mean segment length of 0.35 μm of the nanofiber network. For a particle diameter of 0.6 μm, the filtration efficiency of a single PEO layer varied in the range of 80-97 % depending on the coat weight. The corresponding pressure drop had the level of 20-90 Pa for the airflow velocity of 5.3 cm/s. Using a multilayer structure, a very high filtration efficiency of 99.5 % was obtained with only a slightly higher pressure drop. This opens a route toward designing sustainable personal protective media with improved user experience.
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Affiliation(s)
- Jukka A Ketoja
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland.
| | - Kaisa Saurio
- Faculty of Social Sciences, Tampere University, Finland
| | - Hille Rautkoski
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | - Eija Kenttä
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | - Atsushi Tanaka
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | - Antti I Koponen
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | - Jussi Virkajärvi
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | - Kimmo Heinonen
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | - Katri Kostamo
- Faculty of Social Sciences, Tampere University, Finland
| | - Anastasia Järvenpää
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | - Niina Hyry
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | - Pirjo Heikkilä
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
| | | | - Ali Harlin
- VTT Technical Research Centre of Finland Ltd, P.O. Box 1000, FI-02044 Espoo, Finland
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Hackett L, Zhang MM, Casey M, Miller J, Smith J, Low C, Aldridge E, Owen PJ, Buntine P. N-95/P2 respirator compliance with fit testing recommendations and respirator satisfaction amongst hospital staff. Infect Dis Health 2024:S2468-0451(24)00023-3. [PMID: 38702235 DOI: 10.1016/j.idh.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Filtering Facepiece Respirators (FFRs) are an important and readily scalable infection control measure; however their effectiveness is ultimately determined by compliance. We aimed to examine staff compliance and satisfaction with wearing the N95/P2 FFRs assigned to them via the standardised fit testing protocol implemented in a single large healthcare network in Victoria, Australia. METHODS In this cross-sectional survey, employees from five hospital campuses who participated in the health networks N95/P2 FFR fit testing process were invited in person to participate in the study. Data were analysed descriptively, after which chi-squared analysis was performed to determine differences between respirator types, gender, and age groups. RESULTS Amongst the 258 staff members surveyed, 28% had either never or only sometimes worn an FFR to which they had been successfully fit tested, and 11% had experienced facial changes that potentially rendered their most recent fit test invalid. More than half (53%) of those surveyed had experienced side effects, the most common being skin irritation and pressure sores. A majority (87%) of staff felt that wearing an FFR had some impact on their ability to perform their duties. Pooled mean self-reported satisfaction ratings were highest for three-panel flat-fold and duckbill models. CONCLUSION 28% of HCWs surveyed described not wearing N-95/P2 FFRs for which they had successfully been fit tested. Reasons for non-compliance remain unclear, but rates of side effects and interference with duties were high. Further research is required to determine and address potential causative factors and ascertain ongoing optimal organisation-level fit test strategies.
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Affiliation(s)
- Liam Hackett
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia.
| | - Melanie Meilun Zhang
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of General Surgery, Eastern Health, Melbourne, Victoria, Australia
| | - Matthew Casey
- OHS, Emergency Management and Wellbeing, Eastern Health, Melbourne, Victoria, Australia
| | - Joseph Miller
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Jesse Smith
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Caitlin Low
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Anaesthesia, Pain and Perioperative Medicine, Eastern Health, Melbourne, Victoria, Australia; Department of Anaesthesia, Austin Health, Melbourne, Victoria, Australia
| | - Emogene Aldridge
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Patrick J Owen
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Paul Buntine
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
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Harber P, Beckett WS. Health effects of filtering facepiece respirators: Research and clinical implications of comfort, thermal, skin, psychologic, and workplace effects. Am J Ind Med 2023; 66:1017-1032. [PMID: 37702368 DOI: 10.1002/ajim.23535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
Filtering facepiece respirators (FFR's) such as N95s have become widely used in appropriate settings for personal respiratory protection and are increasingly used beyond workplace settings. Concerns about possible adverse effects have appeared in many publications, particularly since the COVID-19 pandemic led to much more widespread use. This paper synthesizes known effects based upon review of publications in PubMed since 1995, addressing effects other than pulmonary and cardiovascular (reviewed elsewhere). Findings: (1) Subjective discomfort is very frequently reported; this includes general discomfort or organ-system-specific complaints such as respiratory, headache, dermatologic, and heat. Research methods are widely divergent, and we propose a taxonomy to classify such studies by methodology, study population (subjects, experimental vs. observational methodology, comparator, specificity, and timeframe) to facilitate synthesis. (2) Objective measures of increased heat and humidity within the mask are well documented. (3) Frequency and characteristics of dermatologic effects have been insufficiently evaluated. (4) Physical mask designs are varied, making generalizations challenging. (5) More studies of impact on work performance and communication are needed. (6) Studies of effect of FFR design and accompanying training materials on ease and consistency of use are needed.
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Affiliation(s)
- Philip Harber
- Environmental Health Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - William S Beckett
- Mount Auburn Hospital (Emeritus Status), Cambridge, Massachusetts, USA
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Castro PASVD, Freire BR, Petroianu A. Effects of face mask on pulse rate and blood oxygenation. EINSTEIN-SAO PAULO 2023; 21:eAO0349. [PMID: 37970950 DOI: 10.31744/einstein_journal/2023ao0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/01/2022] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE The World Health Organization and Centers for Disease Control and Prevention recommend the use of face masks in public. This study aimed to evaluate the effects of face masks on pulse rate and partial blood oxygen saturation in patients without cardiorespiratory disorders. METHODS A total of 150 volunteers of both sexes were divided into three groups (n=50) according to age (children, young adults, and older adults). The partial blood oxygen saturation and pulse rate were measured for each volunteer using a digital oximeter while wearing a facial mask and remaining at rest. The masks were removed for two minutes, and partial blood oxygen saturation and pulse rate were remeasured. The materials and types of masks used were recorded. The t -test for paired samples was used to compare the mean values obtained before and after removing the masks. RESULTS The most frequently used mask was a two-layered cloth (64.7%). A decrease in pulse rate was observed after removing the face mask in males, particularly in children (p=0.006) and young adults (p=0.034). Partial blood oxygen saturation levels increased in young adult males after mask removal (p=0.01). CONCLUSION The two-layer cotton tissue face masks are associated with a higher pulse rate and reduced arterial blood oxygen saturation without associated clinical disorders, mainly in adult men with a lower tolerance to breathing and ear discomfort.
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Affiliation(s)
| | - Bruno Rodarte Freire
- Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , MG , Brazil
| | - Andy Petroianu
- Faculdade de Medicina , Universidade Federal de Minas Gerais , Belo Horizonte , MG , Brazil
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Kumar P, Jain M, Amirthavaali G, Mishra TS, Sasmal PK, Lubaib K, Gond PK, Sarthak S. Impact of personal protective equipment on patient safety and health care workers. Med J Armed Forces India 2023; 79:531-538. [PMID: 37719904 PMCID: PMC10499652 DOI: 10.1016/j.mjafi.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/03/2021] [Indexed: 02/06/2023] Open
Abstract
Background The study aims to assess the effect of personal protective equipment (PPE) on the physical and psychological well-being of health care workers (HCWs) and its impact on patient safety. Methods After ethical approval, a 14-point questionnaire was circulated offline and online among the HCWs of ours institute, who were involved in performing invasive procedures while wearing a PPE. The responses were analysed using the SPSS software version 26. Results Of 198 responses, the mean duration of PPE use was 4.6 ± 1.52 h. Seventy percent of respondents suggested <4 h of continuous use of PPE. Seventy-seven percent found difficulties during the procedures while wearing PPE and agreed to errors while performing a procedure. Poor visibility (95.5%), fogging (84.9%), communication difficulty (75.3%), sweating (74.2%), posture-related discomfort (56.1%) and poor concentration (51%) were major causes. Anxiety (39.9%) and fear of spreading an infection to the family (42.9%) were major psychological effects. Eighty percent of HCWs raised concern over the quality of PPE, N95 mask and eye protector. The HCWs felt the need to improve the quality of PPEs, use extra padding around the ears, sealing the N95 mask with adhesive tape, besides using sign language for communication for more safety. Fifty percent graded the procedure-related difficulty level >6 on a Likert scale of 1-10. Conclusion PPE-related discomfort is common among the HCWs and could contribute to errors during an invasive procedure. Efforts to alleviate the physical and psychological well-being of the HCWs will be essential for reducing procedural error while wearing a PPE.
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Affiliation(s)
- Pankaj Kumar
- Associate Professor (General Surgery), AIIMS, Bhubaneswar, India
| | - Mantu Jain
- Associate Professor (Orthopedic Surgery), AIIMS, Bhubaneswar, India
| | | | | | | | - K.P. Lubaib
- Resident (Orthopedic Surgery), AIIMS, Bhubaneswar, India
| | - Preeti K. Gond
- Resident (Orthopedic Surgery), AIIMS, Bhubaneswar, India
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Bray C, Vanberkel PT. A framework for comparing N95 and elastomeric facepiece respirators on cost and function for healthcare use during a pandemic- A literature review. Health Policy 2023; 134:104857. [PMID: 37336164 DOI: 10.1016/j.healthpol.2023.104857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
SARS-CoV-2 has posed implications for personal protective equipment supply. In this literature review we examine if elastomeric facepiece respirators (EFRs) are effective substitutes for N95 respirators through comparing their functionality and cost. We reviewed 30 articles which researched the advantages and disadvantages of each respirator. We compiled the reported results and found, among other things, that users favour N95 respirators for comfort but prefer EFRs for protection. EFRs are more cost effective when N95s are used as designed (single use) but mixed strategies minimize costs when N95s are reused (as practiced during shortages). Future research is needed on multicriteria analyses and to incorporate SARS-CoV-2 specific data to support future pandemic planning.
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Affiliation(s)
- Ceilidh Bray
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada
| | - Peter T Vanberkel
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada.
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Demirag ME, Akyil M, Karasal M, Bayram S, Metin SK, Tokgoz FA, Baysungur V, Evman S. Prospective analysis of the physiological changes caused by prolonged use of N95-type masks. Ann Thorac Med 2023; 18:86-89. [PMID: 37323373 PMCID: PMC10263074 DOI: 10.4103/atm.atm_429_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/29/2023] [Accepted: 02/09/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION The clinical and physiological effects of long-duration use of N95-type masks without ventilation valves, on health-care workers during the coronavirus disease-2019 (COVID-19) pandemic, were evaluated. METHODS All volunteering personnel working in operating theater or intensive care unit, using nonventilated N95 type respiratory masks, minimum for a 2-h noninterrupted duration were observed. The partial oxygen saturation (SpO2) and heart rate (HR) were recorded before wearing the N95 mask and at 1st and 2nd h. Volunteers were then questioned for any symptoms. RESULTS A total of 210 measurements were completed in 42 (24 males and 18 females) eligible volunteers, each having 5 measurements, on different days. The median age was 32.7. Premask, 1st h, and 2nd h median values for SpO2 were 99%, 97%, and 96%, respectively (P < 0.001). The median HR was 75 premask, 79 at 1st h, and 84/min at 2nd h (P < 0.001). A significant difference between all three consecutive measurements of HR was achieved. Statistical difference was only reached between premask and other SpO2 measurements (1st and 2nd h). Complaints seen in the group were head ache (36%), shortness of breath (27%), palpitation (18%), and nausea feeling (2%). Two individuals took off their masks to breathe, on 87th and 105th min, respectively. CONCLUSIONS Long duration (>1 h) use of N95-type masks causes a significant reduction in SpO2 measurements and increase in HR. Despite being an essential personal protective equipment in COVID-19 pandemic, it should be used with short intermittent time periods in health-care providers with known heart disease, pulmonary insufficiency, or psychiatric disorders.
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Affiliation(s)
- Melis E. Demirag
- Department of Otorhinolaryngology, Kartal Lutfi Kirdar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Akyil
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Merve Karasal
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serkan Bayram
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serda Kanbur Metin
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatma A. Tokgoz
- Department of Pulmonology, Yedikule Chest Diseases Hospital, University of Health Sciences, Istanbul, Turkey
| | - Volkan Baysungur
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Serdar Evman
- Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Wells AD, Mermier CM, Bellovary BN, Deyhle MR, Hsiao YY, Amorim FT. The physiological, perceptual, and thermoregulatory responses to facemask use during exercise. J Sports Med Phys Fitness 2023; 63:264-272. [PMID: 35912891 DOI: 10.23736/s0022-4707.22.14032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The use of masks in public settings and when around people has been recommended to limit the spread of Coronavirus disease 2019 (COVID-19) by major public health agencies. Several different types of masks classified as either medical- or non-medical grade are commonly used among the public. However, concerns with difficulty breathing, re-breathing exhaled carbon dioxide, a decrease in arterial oxygen saturation, and a decrease in exercise performance have been raised regarding the use of mask during exercise. We review the current knowledge related to the effect of different masks during exercise on cardiorespiratory, metabolic, thermoregulatory, and perceptual responses. As such, the current literature seems to suggest that there are minimal changes to cardiovascular, metabolic, and no changes to thermoregulatory parameters with facemask use. However, differences in ventilatory parameters have been reported with submaximal and maximal intensity exercise to volitional fatigue. Literature on perceptual responses to exercise indicate an impact on ratings of perceived exertion, dyspnea, and overall discomfort dependent on mask use as well as exercise intensity. In conclusion, data from the current literature suggests a minimal impact on physiological, perceptual, and thermoregulatory responses dependent on the type of mask used during exercise.
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Affiliation(s)
- Andrew D Wells
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA - .,Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA -
| | - Christine M Mermier
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | | | - Michael R Deyhle
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
| | - Yu-Yu Hsiao
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM, USA
| | - Fabiano T Amorim
- Department of Health, Exercise and Sports Sciences, University of New Mexico, Albuquerque, NM, USA
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9
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Wang AB, Zhang X, Gao LJ, Zhang T, Xu HJ, Bi YJ. A Review of Filtration Performance of Protective Masks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2346. [PMID: 36767714 PMCID: PMC9915213 DOI: 10.3390/ijerph20032346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Masks are essential and effective small protective devices used to protect the general public against infections such as COVID-19. However, available systematic reviews and summaries on the filtration performance of masks are lacking. Therefore, in order to investigate the filtration performance of masks, filtration mechanisms, mask characteristics, and the relationships between influencing factors and protective performance were first analyzed through mask evaluations. The summary of filtration mechanisms and mask characteristics provides readers with a clear and easy-to-understand theoretical cognition. Then, a detailed analysis of influencing factors and the relationships between the influencing factors and filtration performance is presented in. The influence of the aerosol size and type on filtration performance is nonlinear and nonconstant, and filtration efficiency decreases with an increase in the gas flow rate; moreover, fitness plays a decisive role in the protective effects of masks. It is recommended that the public should wear surgical masks to prevent COVID-19 infection in low-risk and non-densely populated areas. Future research should focus on fitness tests, and the formulation of standards should also be accelerated. This paper provides a systematic review that will be helpful for the design of masks and public health in the future.
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Affiliation(s)
- Ao-Bing Wang
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
| | - Xin Zhang
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
| | - Li-Jun Gao
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
| | - Tao Zhang
- School of Chemistry and Chemical Engineering, Jiangsu University, Zhenjiang 212013, China
| | - Hui-Juan Xu
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
| | - Yan-Jun Bi
- Hebei Key Laboratory of Man-machine Environmental Thermal Control Technology and Equipment, Filtration Performance and Environmental Health of Protective Materials, Xingtai 054000, China
- Advanced Research Center of Thermal and New Energy Technologies, Hebei Vocational University of Technology and Engineering, Xingtai 054000, China
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Balestracci B, La Regina M, Di Sessa D, Mucci N, Angelone FD, D'Ecclesia A, Fineschi V, Di Tommaso M, Corbetta L, Lachman P, Orlandini F, Tanzini M, Tartaglia R, Squizzato A. Patient safety implications of wearing a face mask for prevention in the era of COVID-19 pandemic: a systematic review and consensus recommendations. Intern Emerg Med 2023; 18:275-296. [PMID: 36103082 PMCID: PMC9472745 DOI: 10.1007/s11739-022-03083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
In the past, the use of face masks in western countries was essentially limited to occupational health. Now, because of the COVID-19 pandemic, mask-wearing has been recommended as a public health intervention. As potential side effects and some contraindications are emerging, we reviewed the literature to assess the impact of them in daily life on patient safety and to provide appropriate guidelines and recommendations. We performed a systematic review of studies investigating physiological impact, safety, and risk of masks in predefined categories of patients, which have been published in peer-reviewed journals with no time and language restrictions. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. Wearing a N95 respirator is more associated with worse side effects than wearing a surgical mask with the following complications: breathing difficulties (reduced FiO2, SpO2, PaO2 increased ETCO2, PaCO2), psychiatric symptoms (panic attacks, anxiety) and skin reactions. These complications are related to the duration of use and/or disease severity. Difficulties in communication is another issue to be considered especially with young children, older person and people with hearing impairments. Even if benefits of wearing face masks exceed the discomfort, it is recommended to take an "air break" after 1-2 h consecutively of mask-wearing. However, well-designed prospective studies are needed. The COVID-19 pandemic could represent a unique opportunity for collecting large amount of real-world data.
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Affiliation(s)
- Beatrice Balestracci
- SC Governo e rischio clinico, programmazione sanitaria e controllo di gestione, Azienda Sociosanitaria Ligure 5 (ASL5), La Spezia, Italy
| | - Micaela La Regina
- SC Governo e rischio clinico, programmazione sanitaria e controllo di gestione, Azienda Sociosanitaria Ligure 5 (ASL5), La Spezia, Italy.
| | - Domenico Di Sessa
- SC Governo e rischio clinico, programmazione sanitaria e controllo di gestione, Azienda Sociosanitaria Ligure 5 (ASL5), La Spezia, Italy
| | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University, Rome, Italy
| | - Mariarosaria Di Tommaso
- Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy
| | - Lorenzo Corbetta
- Department of Interventional Pneumology, University of Florence, Florence, Italy
| | - Peter Lachman
- Lead Faculty Quality Improvement Programme- Royal College of Physicians of Ireland, Dublin, Ireland
| | | | | | - Riccardo Tartaglia
- Department of Innovation and Information Engineering, G. Marconi University, Rome, Italy
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11
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Zhuang E, Chen HH, Kolesnik O, Hines SE. Tolerability, User Acceptance and Preference for a Novel Reusable Respirator Among Healthcare Workers. Am J Infect Control 2022:S0196-6553(22)00673-3. [PMID: 36122632 DOI: 10.1016/j.ajic.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The CleanSpace Technology Halo respirator combines a clear face mask and a powered air supply, without belts or hoses. Although providing higher protection than other respirators used in healthcare, user acceptance of this device has not been assessed with validated tools. METHODS We surveyed healthcare workers (HCWs) within a US medical system using Halo respirators in 2021. Subjects completed three surveys over eight weeks, which included the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), a validated tool to assess respirator tolerability. The survey included additional questions about user acceptability and respirator preference. Responses were evaluated for change over time and for significant predictors. RESULTS Of 113 HCWs who completed the initial survey (29% response rate), mean ± SD R-COMFI score was 9.1± 5.1, (scale 0-47, lower = more tolerable) and did not change over time (p = 0.42). Fewer years in healthcare significantly predicted better R-COMFI score (p=0.01). Many users preferred Halo in both usual care (45-52%) and care of patients with COVID-19 (60-64%). DISCUSSION Halo respirators received favorable tolerability scores by HCWs, who often preferred them, especially during care of patients with COVID-19. CONCLUSIONS Given demand for respirator use in healthcare, the innovative design provides higher protection than other respirators with a favorable user experience.
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Affiliation(s)
- Eileen Zhuang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA
| | - Hegang H Chen
- Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Howard Hall, Suite 109, 660 W. Redwood Street, Baltimore, MD, 21201, USA
| | - Olga Kolesnik
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA
| | - Stella E Hines
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA; Department of Medicine, Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, 11 S. Paca Street #200, Baltimore, MD, 21201, USA.
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12
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Chaaban O, Balanay JAG, Sousan S. Assessment of best-selling respirators and masks: Do we have acceptable respiratory protection for the next pandemic? Am J Infect Control 2022; 51:388-395. [PMID: 35901992 PMCID: PMC9313532 DOI: 10.1016/j.ajic.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 12/04/2022]
Abstract
Background COVID-19 pandemic caused a high demand for respiratory protection, caused a scarcity of approved respirators and the production of alternative respiratory protection. To raise public awareness through the scientific community, bestselling respirators and masks in the United States’ leading online retailer, Amazon.com, were evaluated. Methods Ten respirators and masks, 5 Face Protective Equipment (FPE) and 5 Cloth Face Masks (CFMs), were evaluated compared to the N95 standard. Two groups were established with the intention of comparing all masks together. The fractional efficiency and pressure drop were measured and compared to the National Institute for Occupational Safety and Health (NIOSH) standards. In addition, grading factors for protection, comfort, and affordability were developed that can be used by the scientific community to readily disseminate to consumers for the selection of the appropriate respiratory protection. Results Two FPE provided acceptable efficiency (>95%) similar to the N95, while the remaining products were below or extremely below NIOSH standards. All products provided pressure drops within NIOSH standards (≤35 mmH2O) ranging from 2.3-10.3 mmH2O. The grading factors show that the CFMs have minimal protection, and the N95 has average comfort and affordability compared to all the products. Conclusion The N95 remains the best respiratory protection, and in the event of the next airborne pandemic, FPEs could serve as adequate alternative protection against the viral spread.
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Affiliation(s)
- Omar Chaaban
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC
| | - Jo Anne G Balanay
- Environmental Health Sciences Program, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC
| | - Sinan Sousan
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC; North Carolina Agromedicine Institute, Greenville, NC.
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13
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Ng I, Kave B, Begg F, Bodas CR, Segal R, Williams D. N95
respirators: quantitative fit test pass rates and usability and comfort assessment by health care workers. Med J Aust 2022; 217:88-93. [PMID: 35645035 PMCID: PMC9347558 DOI: 10.5694/mja2.51585] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022]
Abstract
Objectives To compare the performance of four N95 respirator types with respect to quantitative fit test pass rate and health care worker‐rated usability and comfort. Design, setting, participants Health care workers who participated in the respiratory protection program at the Royal Melbourne Hospital, 1 October 2020 – 31 May 2021. Participants underwent quantitative N95 respirator fit testing (at least three of four types: semi‐rigid cup, flat‐fold cup, duckbill, and three‐panel flat‐fold types), and were invited to complete an online usability and comfort assessment for respirators for which their fit test results were passes. Main outcome measures Fit test pass rate, and user‐rated overall comfort and assessment ratings (five‐point Likert scales), by N95 respirator type. Results A total of 2161 health care workers underwent quantitative fit testing (women, 1586 [73.4%]; nurses, 1271 [58.8%]). The overall fit test pass rates were 65.0% for the semi‐rigid cup respirators (1029/1583 tests), 32.4% for the flat‐fold respirator (660/2035 tests), 59.2% for the duckbill respirators (2005/3387 tests), and 96.4% for the three‐panel flat‐fold respirator (1876/1946 tests). 378 health care workers completed the comfort and usability survey. Overall comfort and assessment ratings each differed by respirator group (P < 0.001); the median overall comfort (4; IQR, 3–4) and overall assessment values (4; IQR, 3–5) were highest for the three‐panel flat‐fold respirator and lowest for the semi‐rigid cup respirators (comfort: 2 [IQR, 1–3]; assessment: 2 [IQR, 2–3]). Conclusions The three‐panel flat‐fold N95 respirator outperformed the three alternative types with regard to fit test pass rate and user‐rated comfort and usability. To maximise respiratory protection for health care workers, these factors should be considered when making respirator procurement decisions.
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Affiliation(s)
- Irene Ng
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
| | | | - Fiona Begg
- The Royal Melbourne Hospital Melbourne VIC
| | | | - Reny Segal
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
| | - Daryl Williams
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
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14
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Cloet A, Griffin L, Yu M, Durfee W. Design considerations for protective mask development: A remote mask usability evaluation. APPLIED ERGONOMICS 2022; 102:103751. [PMID: 35339761 PMCID: PMC8943342 DOI: 10.1016/j.apergo.2022.103751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
The design of N95 filtering facepiece respirators (FFRs) continues to pose usability concerns for healthcare workers, which have been exacerbated by the COVID-19 pandemic. The aim of this study was to develop a holistic model to guide mask design improvement. Dental students (n = 38) with experience wearing N95 FFRs participated in a randomized wear trial of three alternative protective masks. A mixed methods survey was used to examine usability of individual mask design components, the relationship of facial/head area to mask features, and overall mask design. Survey results indicated MNmask v1 demonstrated higher usability in seal confidence (M = 3.46), while MNmask v2 performed higher in satisfactory fit (M = 3.50). Design components of nose wire and head/neck bands were the most problematic, while conditions of skin irritation and tight/loose fit created an unfavorable wear experience. To consider healthcare workers' needs in improving the usability of protective masks, a model is presented to consider characteristics of fit, comfort, material, and design.
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Affiliation(s)
- Alison Cloet
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA
| | - Linsey Griffin
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA.
| | - Minji Yu
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA
| | - William Durfee
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA
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15
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Kunstler B, Newton S, Hill H, Ferguson J, Hore P, Mitchell BG, Dempsey K, Stewardson AJ, Friedman D, Cole K, Sim MR, Ferguson B, Burns P, King N, McGloughlin S, Dicks M, McCarthy S, Tam B, Hazelton B, McGurgan C, McDonald S, Turner T. P2/N95 respirators & surgical masks to prevent SARS-CoV-2 infection: Effectiveness & adverse effects. Infect Dis Health 2022; 27:81-95. [PMID: 35151628 PMCID: PMC8769935 DOI: 10.1016/j.idh.2022.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/03/2022] [Accepted: 01/05/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Millions of people have acquired and died from SARS-CoV-2 infection during the COVID-19 pandemic. Healthcare workers (HCWs) are required to wear personal protective equipment (PPE), including surgical masks and P2/N95 respirators, to prevent infection while treating patients. However, the comparative effectiveness of respirators and masks in preventing SARS-CoV-2 infection and the likelihood of experiencing adverse events (AEs) with wear are unclear. METHODS Searches were carried out in PubMed, Europe PMC and the Cochrane COVID-19 Study Register to 14 June 2021. A systematic review of comparative epidemiological studies examining SARS-CoV-2 infection or AE incidence in HCWs wearing P2/N95 (or equivalent) respirators and surgical masks was performed. Article screening, risk of bias assessment and data extraction were duplicated. Meta-analysis of extracted data was carried out in RevMan. RESULTS Twenty-one studies were included, with most having high risk of bias. There was no statistically significant difference in respirator or surgical mask effectiveness in preventing SARS-CoV-2 infection (OR 0.85, [95%CI 0.72, 1.01]). Healthcare workers experienced significantly more headaches (OR 2.62, [95%CI 1.18, 5.81]), respiratory distress (OR 4.21, [95%CI 1.46, 12.13]), facial irritation (OR 1.80, [95%CI 1.03, 3.14]) and pressure-related injuries (OR 4.39, [95%CI 2.37, 8.15]) when wearing respirators compared to surgical masks. CONCLUSION The existing epidemiological evidence does not enable definitive assessment of the effectiveness of respirators compared to surgical masks in preventing infection. Healthcare workers wearing respirators may be more likely to experience AEs. Effective mitigation strategies are important to ensure the uptake and correct use of respirators by HCWs.
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Affiliation(s)
- Breanne Kunstler
- BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, 8 Scenic Boulevard, Clayton, Melbourne, VIC, 3800, Australia.
| | - Skye Newton
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Australia
| | - Hayley Hill
- Adelaide Health Technology Assessment (AHTA), School of Public Health, University of Adelaide, Australia
| | - John Ferguson
- Division of Medicine, John Hunter Hospital, Newcastle Regional Mail Centre, NSW, 2310, Australia
| | - Phillipa Hore
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Brett G. Mitchell
- The University of Newcastle, School of Nursing and Midwifery, Level 9, 77a Holden St, Gosford Hospital, Gosford, NSW, Australia, 2250
| | - Kathy Dempsey
- The Clinical Excellence Commission, 1 Reserve Road, St Leonards, NSW, Australia, 2065
| | - Andrew J. Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, 85 Commercial Rd, Melbourne, VIC, Australia, 3004
| | - Deborah Friedman
- Deputy Chief Health Officer, Victorian Department of Health Melbourne, VIC, Australia, 3004
| | - Kate Cole
- Cole Health Pty Ltd, Balmain, NSW, Australia, 2041
| | - Malcolm R. Sim
- Monash Centre for Occupational & Environmental Health (MonCOEH), School of Public Health & Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Rd, Melbourne, VIC, Australia, 3004
| | - Bridget Ferguson
- Central Queensland University, School of Nursing, Midwifery and Social Sciences; 554-700 Yaamba Rd, Norman Gardens, QLD, 4701, Australia
| | - Penelope Burns
- Academic Unit of General Practice, ANU Medical School, The Australian National University, Building 4, Hospital Road, Garran, ACT, 2605, Australia
| | - Nicole King
- North Shore Private Hospital, 3 Westbourne St, St Leonard's, 2065, Australia
| | - Steven McGloughlin
- Alfred Health and School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, Australia, 3004
| | - Melanie Dicks
- Ernst & Young, 121 Marcus Clarke Street, Canberra, ACT, Australia, 2601
| | - Sally McCarthy
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Barry Tam
- Health Infrastructure NSW, 60 Day Road, Cheltenham, NSW, 2119, Australia
| | - Briony Hazelton
- PathWest Laboratory Medicine, QEII Medical Centre, Hospital Avenue, Nedlands, WA, Australia, 6009
| | - Cherylynn McGurgan
- Royal Melbourne Hospital Emergency Department, 300 Grattan Street, Parkville, VIC, Australia, 3050
| | - Steve McDonald
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Tari Turner
- Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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16
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Gholamreza F, Nadaraja AV, Milani AS, Golovin K. Enhanced protection face masks do not adversely impact thermophysiological comfort. PLoS One 2022; 17:e0265126. [PMID: 35390014 PMCID: PMC8989302 DOI: 10.1371/journal.pone.0265126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/24/2022] [Indexed: 11/19/2022] Open
Abstract
The World Health Organization has advocated mandatory face mask usage to combat the spread of COVID-19, with multilayer masks recommended for enhanced protection. However, this recommendation has not been widely adopted, with noncompliant persons citing discomfort during prolonged usage of face masks. And yet, a scientific understanding on how face mask fabrics/garment systems affect thermophysiological comfort remains lacking. We aimed to investigate how fabric/garment properties alter the thermal and evaporative resistances responsible for thermophysiological strain. We constructed 12 different layered facemasks (D1-D5, T1-T6, Q1) with various filters using commercially available fabrics. Three approaches were employed: (1) the evaporative and thermal resistances were measured in all the test face masks using the medium size to determine the effect of fabric properties; (2) the effect of face mask size by testing close-fitted (small), fitted (medium) and loose fitted (large) face mask T-6; (3) the effect of face mask fit by donning a large size face mask T-6, both loose and tightened using thermal manikin, Newton. ANOVA test revealed that the additional N95 middle layer filter has no significant effect on the thermal resistances of all the face masks, and evaporative resistances except for face masks T-2 and T-3 (P-values<0.05) whereas size significantly affected thermal and evaporative resistances (P-values<0.05). The correlation coefficient between the air gap size and the thermal and evaporative resistance of face masks T-6 were R2 = 0.96 and 0.98, respectively. The tight fit large face mask had superior performance in the dissipation of heat and moisture from the skin (P-values <0.05). Three-layer masks incorporating filters and water-resistant and antimicrobial/antiviral finishes did not increase discomfort. Interestingly, using face masks with fitters improved user comfort, decreasing thermal and evaporative resistances in direct opposition to the preconceived notion that safer masks decrease comfort.
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Affiliation(s)
- Farzan Gholamreza
- School of Engineering, University of British Columbia, Kelowna, Canada
| | | | - Abbas S. Milani
- School of Engineering, University of British Columbia, Kelowna, Canada
| | - Kevin Golovin
- School of Engineering, University of British Columbia, Kelowna, Canada
- Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, Canada
- * E-mail:
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17
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Janson DJ, Clift BC, Dhokia V. PPE fit of healthcare workers during the COVID-19 pandemic. APPLIED ERGONOMICS 2022; 99:103610. [PMID: 34740070 PMCID: PMC8516797 DOI: 10.1016/j.apergo.2021.103610] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
Historically, PPE (Personal Protective Equipment) has generally been designed around the size and shape of an average European or US white man's face and body. There is little academic evidence to support anecdotal reports that women are at a greater disadvantage than men from ill-fitting PPE. This is especially relevant in healthcare settings where women make up at least 75% of frontline workers. The COVID-19 pandemic has exacerbated problems associated with the fit of PPE that until now have been mainly anecdotal. This research presents results and analysis of a quantitative and qualitative survey concerning the fit of PPE worn by 248 healthcare workers, in a variety of healthcare roles and settings, during the COVID-19 pandemic. The analysis of the survey results showed that women were less likely than men to feel safe carrying out their roles, with only 30.5% of women and 53.3% of men stating that they felt safe all of the time. A statistically significant link is made between women suffering more with poor fit than men with certain categories of PPE (gowns, masks, visors, goggles). Over four times as many women (54.8%) as men (13.3%) reported their surgical gowns being large to some degree and women were nearly twice as likely (53.5%) to experience oversized surgical masks than men (28.6%). However, it was recognized that PPE fit problems are not exclusive to women as many men also do not conform to the underlying shape and size of PPE designs. Survey results indicated that both sexes felt equally hampered due to the fit of their PPE and around a third of both women and men had modified their PPE to address fit issues. Oversized and modified PPE presents its own set of unintended consequences. Following strict processes for doffing and removing PPE is key to virus control but doffing modified PPE can fall outside of these processes, risking cross infection. In addition, wearers of critical items of PPE (such as respirators) currently undergo a "fit test"; however, fit does not reconcile with comfort and over-tightened PPE can cause headaches, discomfort and distraction when worn for long periods. Requirements and fit tests are also not setting-specific; qualitative responses from the survey give an indication that this must be a future consideration.
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Affiliation(s)
- D J Janson
- Department of Mechanical Engineering, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - B C Clift
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom
| | - V Dhokia
- Department of Mechanical Engineering, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom.
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18
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Elkington PT, Dickinson AS, Mavrogordato MN, Spencer DC, Gillams RJ, De Grazia A, Rosini S, Garay-Baquero DJ, Diment LE, Mahobia N, Mant A, Baynham T, Morgan H. A Personal Respirator to Improve Protection for Healthcare Workers Treating COVID-19 (PeRSo). FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:664259. [PMID: 35047921 PMCID: PMC8757800 DOI: 10.3389/fmedt.2021.664259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/14/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: SARS-CoV-2 infection is a global pandemic. Personal Protective Equipment (PPE) to protect healthcare workers has been a recurrent challenge in terms of global stocks, supply logistics and suitability. In some settings, around 20% of healthcare workers treating COVID-19 cases have become infected, which leads to staff absence at peaks of the pandemic, and in some cases mortality. Methods: To address shortcomings in PPE, we developed a simple powered air purifying respirator, made from inexpensive and widely available components. The prototype was designed to minimize manufacturing complexity so that derivative versions could be developed in low resource settings with minor modification. Results: The “Personal Respirator – Southampton” (PeRSo) delivers High-Efficiency Particulate Air (HEPA) filtered air from a battery powered fan-filter assembly into a lightweight hood with a clear visor that can be comfortably worn for several hours. Validation testing demonstrates that the prototype removes microbes, avoids excessive CO2 build-up in normal use, and passes fit test protocols widely used to evaluate standard N95/FFP2 and N99/FFP3 face masks. Feedback from doctors and nurses indicate the PeRSo prototype was preferred to standard FFP2 and FFP3 masks, being more comfortable and reducing the time and risk of recurrently changing PPE. Patients report better communication and reassurance as the entire face is visible. Conclusion: Rapid upscale of production of cheaply produced powered air purifying respirators, designed to achieve regulatory approval in the country of production, could protect healthcare workers from infection and improve healthcare delivery during the COVID-19 pandemic.
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Affiliation(s)
- Paul T Elkington
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alexander S Dickinson
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Mark N Mavrogordato
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Daniel C Spencer
- School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Richard J Gillams
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Antonio De Grazia
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Sebastian Rosini
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana J Garay-Baquero
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Laura E Diment
- Mechanical Engineering Department, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
| | - Nitin Mahobia
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Alexandra Mant
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Tom Baynham
- INDO Lighting Ltd., Southampton, United Kingdom
| | - Hywel Morgan
- Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.,School of Electronics & Computer Science, Faculty of Engineering & Physical Sciences, University of Southampton, Southampton, United Kingdom
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19
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Mumma JM, Jordan E, Ayeni O, Kaufman N, Wheatley MJ, Grindle A, Morgan J. Development and validation of the discomfort of cloth Masks-12 (DCM-12) scale. APPLIED ERGONOMICS 2022; 98:103616. [PMID: 34688120 PMCID: PMC8527896 DOI: 10.1016/j.apergo.2021.103616] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 05/13/2023]
Abstract
During the COVID-19 pandemic, the use of face masks by the public has helped to slow the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the community. Cloth masks have been recommended because of their effectiveness, availability, and reusability. Like other types of face masks, however, user discomfort while wearing cloth masks is thought to engender behaviors that limit the effectiveness of cloth masks as source control (e.g., adjusting or removing one's mask temporarily while in public). To design cloth masks that are more tolerable, a measurement instrument for assessing subjective user discomfort is needed. Across two studies, we identified and confirmed a two-dimensional factor structure underlying the discomfort of cloth masks - discomfort related to the breathability and discomfort related to the tightness of the mask against the face and head. Additionally, we provide replicable evidence that both factor-subscales predict the self-reported frequencies of problematic mask-wearing behaviors.
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Affiliation(s)
- Joel M Mumma
- Emory University School of Medicine, Division of Infectious Diseases, Department of Medicine, 1364 Clifton Road Northeast, GG17A, Atlanta, GA, 30322, USA.
| | - Ellen Jordan
- Emory University School of Medicine, Division of Infectious Diseases, Department of Medicine, Atlanta, GA, USA
| | - Oluwateniola Ayeni
- Emory University School of Medicine, Division of Infectious Diseases, Department of Medicine, Atlanta, GA, USA
| | - Noah Kaufman
- Emory University School of Medicine, Division of Infectious Diseases, Department of Medicine, Atlanta, GA, USA
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20
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Koh E, Ambatipudi M, Boone DL, Luehr JBW, Blaise A, Gonzalez J, Sule N, Mooney DJ, He EM. Quantifying face mask comfort. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:23-34. [PMID: 34747682 DOI: 10.1080/15459624.2021.2002342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Face mask usage is one of the most effective ways to limit SARS-CoV-2 transmission, but a mask is only useful if user compliance is high. Through anonymous surveys (n = 679), it was shown that mask discomfort is the primary source of noncompliance in mask wearing. Further, through these surveys, three critical predicting variables that dictate mask comfort were identified: air resistance, water vapor permeability, and face temperature change. To validate these predicting variables in a physiological context, experiments (n = 9) were performed to measure the respiratory rate and change in face temperature while wearing different types of three commonly used masks. Finally, using values of these predicting variables from experiments and the literature, and surveys asking users to rate the comfort of various masks, three machine learning algorithms were trained and tested to generate overall comfort scores for those masks. Although all three models performed with an accuracy of approximately 70%, the multiple linear regression model provides a simple analytical expression to predict the comfort scores for common face masks provided the input predicting variables. As face mask usage is crucial during the COVID-19 pandemic, the goal of this quantitative framework to predict mask comfort is hoped to improve user experience and prevent discomfort-induced noncompliance.
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Affiliation(s)
- Esther Koh
- Harvard College, Harvard University, Cambridge, Massachusetts
| | | | - DaLoria L Boone
- Harvard College, Harvard University, Cambridge, Massachusetts
| | - Julia B W Luehr
- Harvard College, Harvard University, Cambridge, Massachusetts
| | - Alena Blaise
- Harvard College, Harvard University, Cambridge, Massachusetts
| | - Jose Gonzalez
- Harvard College, Harvard University, Cambridge, Massachusetts
| | - Nishant Sule
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, Massachusetts
| | - Emily M He
- Harvard College, Harvard University, Cambridge, Massachusetts
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21
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Sinha D, Bhandary SK, Aroor R, Reddy R, Alva S. Effect of N-95 Mask on Oxygen Saturation Level in Health Care Workers and Their Experience While Using N-95 Mask. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1740329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Background N-95 masks are in high demand during this COVID-19 pandemic but wearing an N-95 mask is a real challenge to the health workers during their duty hours. The present study aims to measure the effect of the N-95 mask on oxygen saturation level in the blood and the discomforts experienced while using it.
Materials and Methods Oxygen saturation was measured in 80 health care workers before and after wearing the N-95 mask continuously for more than 6 hours. The participants were asked to fill a questionnaire regarding various discomforts of N-95 mask usage, which consisted of 14 questions.
Results The most common discomfort was pain around the pinna followed by difficulty in breathing and fogging of spectacles or goggles. In addition, 71% of them had decreased oxygen saturation by 1%.
Conclusion N-95 mask can alter the oxygen saturation but it does not produce significant effects in healthy individuals. It can significantly affect patients with compromised airways.
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Affiliation(s)
- Devika Sinha
- Department of Otorhinolaryngology, KS Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
| | - Satheesh Kumar Bhandary
- Department of Otorhinolaryngology, KS Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
| | - Rajeshwary Aroor
- Department of Otorhinolaryngology, KS Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
| | - Rashmitha Reddy
- Department of Otorhinolaryngology, KS Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
| | - Shravan Alva
- Department of Otorhinolaryngology, KS Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
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Li R, Zhang M, Wu Y, Tang P, Sun G, Wang L, Mandal S, Wang L, Lang J, Passalacqua A, Subramaniam S, Song G. What We Are Learning from COVID-19 for Respiratory Protection: Contemporary and Emerging Issues. Polymers (Basel) 2021; 13:4165. [PMID: 34883668 PMCID: PMC8659889 DOI: 10.3390/polym13234165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 02/07/2023] Open
Abstract
Infectious respiratory diseases such as the current COVID-19 have caused public health crises and interfered with social activity. Given the complexity of these novel infectious diseases, their dynamic nature, along with rapid changes in social and occupational environments, technology, and means of interpersonal interaction, respiratory protective devices (RPDs) play a crucial role in controlling infection, particularly for viruses like SARS-CoV-2 that have a high transmission rate, strong viability, multiple infection routes and mechanisms, and emerging new variants that could reduce the efficacy of existing vaccines. Evidence of asymptomatic and pre-symptomatic transmissions further highlights the importance of a universal adoption of RPDs. RPDs have substantially improved over the past 100 years due to advances in technology, materials, and medical knowledge. However, several issues still need to be addressed such as engineering performance, comfort, testing standards, compliance monitoring, and regulations, especially considering the recent emergence of pathogens with novel transmission characteristics. In this review, we summarize existing knowledge and understanding on respiratory infectious diseases and their protection, discuss the emerging issues that influence the resulting protective and comfort performance of the RPDs, and provide insights in the identified knowledge gaps and future directions with diverse perspectives.
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Affiliation(s)
- Rui Li
- Department of Apparel, Events, and Hospitality Management, Iowa State University, Ames, IA 50010, USA; (R.L.); (M.Z.); (Y.W.); (L.W.)
| | - Mengying Zhang
- Department of Apparel, Events, and Hospitality Management, Iowa State University, Ames, IA 50010, USA; (R.L.); (M.Z.); (Y.W.); (L.W.)
| | - Yulin Wu
- Department of Apparel, Events, and Hospitality Management, Iowa State University, Ames, IA 50010, USA; (R.L.); (M.Z.); (Y.W.); (L.W.)
| | - Peixin Tang
- Department of Biological and Agricultural Engineering, University of California, Davis, CA 95616, USA; (P.T.); (G.S.)
| | - Gang Sun
- Department of Biological and Agricultural Engineering, University of California, Davis, CA 95616, USA; (P.T.); (G.S.)
| | - Liwen Wang
- Department of Apparel, Events, and Hospitality Management, Iowa State University, Ames, IA 50010, USA; (R.L.); (M.Z.); (Y.W.); (L.W.)
| | - Sumit Mandal
- Department of Design, Housing and Merchandising, Oklahoma State University, Stillwater, OK 74078, USA;
| | - Lizhi Wang
- Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA 50010, USA;
| | - James Lang
- Department of Kinesiology, Iowa State University, Ames, IA 50010, USA;
| | - Alberto Passalacqua
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50010, USA; (A.P.); (S.S.)
| | - Shankar Subramaniam
- Department of Mechanical Engineering, Iowa State University, Ames, IA 50010, USA; (A.P.); (S.S.)
| | - Guowen Song
- Department of Apparel, Events, and Hospitality Management, Iowa State University, Ames, IA 50010, USA; (R.L.); (M.Z.); (Y.W.); (L.W.)
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Suen WS, Huang G, Kang Z, Gu Y, Fan J, Shou D. Development of wearable air-conditioned mask for personal thermal management. BUILDING AND ENVIRONMENT 2021; 205:108236. [PMID: 34393325 PMCID: PMC8349477 DOI: 10.1016/j.buildenv.2021.108236] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 05/24/2023]
Abstract
A mask that creates a physical barrier to protect the wearer from breathing in airborne bacteria or viruses, reducing the risk of infection in polluted air and potentially contaminated environments, has become a daily necessity for the public especially as COVID-19 has exploded around the world. However, the use of masks often causes soaring temperatures and thick humid air, leading to thermal and wear discomfort and breathing difficulties for a number of people, and further increasing the elevated risk of heat illnesses including heat stroke and heat exhaustion. When wearers become highly active or work under high tension, the excess sweat generated negatively affects the functionality of masks. Here, we report on an innovative design of an air-conditioned mask (AC Mask) system, facilitating thermoregulation in the mask microclimate, ease of breathing, and wear comfort. The AC Mask system is developed by integrating a cost-effective and lightweight thermoelectric (TE) and ventilation unit in a wearable 3D printed mask device, compatible with existing disposable masks, to protect end users safely against toxic particles such as viruses. A wind-guided tunnel has been developed for quick and efficient ventilation of cooling air. Based on a human trial, reductions in the apparent microclimate temperature and the humidity by 3.5 °C and 50%, respectively, have been achieved under a low voltage. With the excellent thermal management properties, the AC Mask will find also wide application among professional end-users such as construction workers, firefighters, and medical personnel.
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Affiliation(s)
- Wing Sze Suen
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Guanghan Huang
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Zhanxiao Kang
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Yuheng Gu
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Jintu Fan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Dahua Shou
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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Nwosu ADG, Ossai EN, Onwuasoigwe O, Ahaotu F. Oxygen saturation and perceived discomfort with face mask types, in the era of COVID-19: a hospital-based cross-sectional study. Pan Afr Med J 2021; 39:203. [PMID: 34603584 PMCID: PMC8464215 DOI: 10.11604/pamj.2021.39.203.28266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023] Open
Abstract
Introduction the COVID-19 pandemic has necessitated the prolonged use of facemasks by healthcare workers. Facemask non-compliance has been largely blamed on discomfort associated with the mask, and apprehension regarding potential health hazards such as asphyxia from mask usage. We sought to evaluate the impact of different respiratory mask types on the comfort of healthcare workers and their arterial oxygen saturation during periods of active clinical duty. Methods we conducted a cross-sectional study on healthcare workers donning different types of facemasks in the normal course of duty. Objective non-invasive determination of arterial oxygen saturation of each participant was done using a portable pulse oximeter. Subjective self-assessment of global discomfort was scored by means of a 11-point numerical scale from 0 (no discomfort) to 10 (worst discomfort imaginable). The user's perceived elements of the discomfort were also evaluated. A statistical significance was accepted when P <0.05. Results seventy-six healthcare workers completed the study, and wore the masks for periods ranging from 68-480 minutes. The discomfort experienced with the use of the N95 mask; 4.3 (2.0) was greater than the surgical mask; 2.7 (1.8); P=0.001. No significant change in arterial oxygen saturation was observed with the use of either of the mask types. The tight strapping of the N95 mask was perceived as a contributor to the discomfort experienced with mask usage; P=0.009. Conclusion the N95 masks imposed greater discomfort than the surgical masks, but neither of the masks impacted on the arterial oxygen saturation of the healthcare workers.
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Affiliation(s)
| | - Edmund Ndudi Ossai
- Department of Community Medicine, College of Health Sciences, Ebonyi State University, Abakaliki, Nigeria
| | - Okechukwu Onwuasoigwe
- Department of Orthopaedics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Francis Ahaotu
- Department of Orthopaedics, National Orthopaedic Hospital, Enugu, Nigeria
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25
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Efficacy of cardiopulmonary resuscitation performance while wearing a powered air-purifying respirator. Am J Emerg Med 2021; 51:22-25. [PMID: 34655816 DOI: 10.1016/j.ajem.2021.09.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/06/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The use of personal protective equipment for respiratory infection control during cardiopulmonary resuscitation (CPR) is a physical burden to healthcare providers. The duration for which CPR quality according to recommended guidelines can be maintained under these circumstances is important. We investigated whether a 2-min shift was appropriate for chest compression and determined the duration for which chest compression was maintained in accordance with the recommended guidelines while wearing personal protective equipment. METHODS This prospective crossover simulation study was performed at a single center from September 2020 to October 2020. Five indicators of CPR quality were measured during the first and second sessions of the study period. All participants wore a Level D powered air-purifying respirator (PAPR), and the experiment was conducted using a Resusci Anne manikin, which can measure the quality of chest compressions. Each participant conducted two sessions. In Session 1, the sequence of 2 min of chest compressions, followed by a 2-min rest, was repeated twice; in Session 2, the sequence of 1-min chest compressions followed by a 1-min rest was repeated four times. RESULTS All 34 participants completed the study. The sufficiently deep compression rate was 65.9 ± 31.1% in the 1-min shift group and 61.5 ± 30.5% in the 2-min shift group. The mean compression depth was 52.8 ± 4.3 mm in the 1-min shift group and 51.0 ± 6.1 mm in the 2-min shift group. These two parameters were significantly different between the two groups. There was no significant difference in the other values related to CPR quality. CONCLUSIONS Our findings indicated that 1 min of chest compressions with a 1-min rest maintained a better quality of CPR while wearing a PAPR.
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Sahota R. COVID-19, beards and BAME: how ethnic minorities with religious beards are being let down. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:477-480. [PMID: 34410218 DOI: 10.1080/15459624.2021.1963446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Spang RP, Pieper K. The tiny effects of respiratory masks on physiological, subjective, and behavioral measures under mental load in a randomized controlled trial. Sci Rep 2021; 11:19601. [PMID: 34599253 PMCID: PMC8486780 DOI: 10.1038/s41598-021-99100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/20/2021] [Indexed: 02/08/2023] Open
Abstract
Since the outbreak of the coronavirus disease (COVID-19), face coverings are recommended to diminish person-to-person transmission of the SARS-CoV-2 virus. Some public debates concern claims regarding risks caused by wearing face masks, like, e.g., decreased blood oxygen levels and impaired cognitive capabilities. The present, pre-registered study aims to contribute clarity by delivering a direct comparison of wearing an N95 respirator and wearing no face covering. We focused on a demanding situation to show that cognitive efficacy and individual states are equivalent in both conditions. We conducted a randomized-controlled crossover trial with 44 participants. Participants performed the task while wearing an N95 FFR versus wearing none. We measured physiological (blood oxygen saturation and heart rate variability), behavioral (parameters of performance in the task), and subjective (perceived mental load) data to substantiate our assumption as broadly as possible. We analyzed data regarding both statistical equivalence and differences. All of the investigated dimensions showed statistical equivalence given our pre-registered equivalence boundaries. None of the dimensions showed a significant difference between wearing an FFR and not wearing an FFR.Trial Registration: Preregistered with the Open Science Framework: https://osf.io/c2xp5 (15/11/2020). Retrospectively registered with German Clinical Trials Register: DRKS00024806 (18/03/2021).
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Affiliation(s)
- Robert P Spang
- Quality and Usability Lab, Institute of Software Engineering and Theoretical Computer Science, Electrical Engineering and Computer Science, Technical University of Berlin, Berlin, Germany.
| | - Kerstin Pieper
- Quality and Usability Lab, Institute of Software Engineering and Theoretical Computer Science, Electrical Engineering and Computer Science, Technical University of Berlin, Berlin, Germany
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Effect of Different Types of Face Masks on the Ventilatory and Cardiovascular Response to Maximal-Intensity Exercise. BIOLOGY 2021; 10:biology10100969. [PMID: 34681068 PMCID: PMC8533493 DOI: 10.3390/biology10100969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
The development of new models of face masks makes it necessary to compare their impact on exercise. Therefore, the aim of this work was to compare the cardiopulmonary response to a maximal incremental test, perceived ventilation, exertion, and comfort using FFP2 or Emotion masks in young female athletes. Thirteen healthy sportswomen (22.08 ± 1.75 years) performed a spirometry, and a graded exercise test on a treadmill, with a JAEGER® Vyntus CPX gas analyzer using an ergospirometry mask (ErgoMask) or wearing the FFP2 or the Emotion mask below the ErgoMask, randomized on 3 consecutive days. Also, menstrual cycle status was monitored to avoid possible intrasubject alterations. The results showed lower values for the ErgoMask+FFP2, compared to ErgoMask or ErgoMask+Emotion, in forced vital capacity (3.8 ± 0.2, 4.5 ± 0.2 and 4.1 ± 0.1 l, respectively); forced expiratory volume in 1 s (3.3 ± 0.2, 3.7 ± 0.2 and 3.5 ± 0.1 l); ventilation (40.9 ± 1.5, 50.6 ± 1.5 and 46.9 ± 1.2 l/min); breathing frequency (32.7 ± 1.1, 37.4 ± 1.1 and 35.3 ± 1.4 bpm); VE/VO2 (30.5 ± 0.7, 34.6 ± 0.9 and 33.6 ± 0.7); VE/VCO2 (32.2 ± 0.6, 36.2 ± 0.9 and 34.4 ± 0.7) and time to exhaustion (492.4 ± 9.7, 521.7 ± 8.6 and 520.1 ± 9.5 s) and higher values in inspiratory time (0.99 ± 0.04, 0.82 ± 0.03 and 0.88 ± 0.03 s). In conclusion, in young healthy female athletes, the Emotion showed better preservation of cardiopulmonary responses than the FFP2.
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Balanay JAG, Oh J. Adsorption Characteristics of Activated Carbon Fibers in Respirator Cartridges for Toluene. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168505. [PMID: 34444254 PMCID: PMC8393755 DOI: 10.3390/ijerph18168505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
Respirator use has been shown to be associated with overall discomfort. Activated carbon fiber (ACF) has potential as an alternative adsorbent for developing thinner, lightweight, and efficient respirators due to its larger surface area, microporosity, and fabric form. The purpose of this pilot study was to determine the adsorption characteristics of commercially available ACF in respirator cartridges with varying ACF composition for toluene protection. Seven ACF types (one cloth, six felt) with varying properties were tested. Seven ACF cartridge configurations with varying ACF composition were challenged with five toluene concentrations (20–500 ppm) at constant air temperature (23 °C), relative humidity (50%), and air flow (32 LPM). Breakthrough curves were obtained using photoionization detectors. Breakthrough times (10%, 50%, and 5 ppm) and adsorption capacities were compared among ACF cartridge configurations to determine their suitable application in respiratory protection. Results showed that ACF cartridges containing the densest ACF felt types had the longest average breakthrough times (e.g., ~250–270 min to reach 5 ppm breakthrough time) and those containing ACF felt types with the highest specific surface areas had the highest average adsorption capacity (~450–470 mg/g). The ACF cartridges demonstrated breakthrough times of <1 h for 500 ppm toluene and 8–16 h for 20 ppm toluene. The ACF cartridges are more reliable for use at low ambient toluene concentrations but still have potential for use at higher concentrations for short-term protection. ACF felt forms with appropriate properties (density of ~0.07 g/cm3; specific surface area of ~2000 m2/g) have shown promising potential for the development of lighter and thinner respirators for protection against toluene.
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Affiliation(s)
- Jo Anne G. Balanay
- Environmental Health Sciences Program, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA
- Correspondence:
| | - Jonghwa Oh
- Department of Environmental Health Sciences, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, USA;
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Fietsam AC, Deters JR, Workman CD, Rudroff T. Personal Protective Equipment Alters Leg Muscle Fatigability Independent of Transcranial Direct Current Stimulation: A Comparison with Pre-COVID-19 Pandemic Results. Brain Sci 2021; 11:brainsci11080962. [PMID: 34439581 PMCID: PMC8392507 DOI: 10.3390/brainsci11080962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/02/2021] [Accepted: 07/19/2021] [Indexed: 01/12/2023] Open
Abstract
In response to the COVID-19 pandemic, the use of personal protective equipment (PPE; e.g., face mask) has increased. Mandating subjects to wear PPE during vigorous exercise might affect the fatigue outcomes of transcranial direct current stimulation (tDCS) studies. The purpose of this study was to investigate whether the use of PPE affected the performance of a tDCS-influenced fatigue task in healthy adults. A total of 16 young and healthy subjects were recruited and wore PPE during an isokinetic fatigue task in conjunction with sham, 2 mA, and 4 mA tDCS conditions. Subjects were matched to subjects who did not wear PPE during our previous pre-pandemic study in which right knee extensor fatigability increased under these same conditions. The results show that right knee extensor fatigability, derived from torque and work (FI-T and FI-W, respectively), was higher in the PPE study compared to the No PPE study in the sham condition. Additionally, there were no differences in knee extensor fatigability or muscle activity between sham, 2 mA, and 4 mA tDCS in the present study, which contrasts with our previous results. Thus, PPE worn by subjects and researchers might have a detrimental effect on fatigue outcomes in tDCS studies irrespective of the stimulation intervention.
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Affiliation(s)
- Alexandra C. Fietsam
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (J.R.D.); (C.D.W.)
| | - Justin R. Deters
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (J.R.D.); (C.D.W.)
| | - Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (J.R.D.); (C.D.W.)
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (J.R.D.); (C.D.W.)
- Department of Neurology, University of Iowa Health Clinics, Iowa City, IA 52242, USA
- Correspondence: ; Tel.: +1-319-467-0363
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Ong JJY, Chan ACY, Bharatendu C, Teoh HL, Chan YC, Sharma VK. Headache Related to PPE Use during the COVID-19 Pandemic. Curr Pain Headache Rep 2021; 25:53. [PMID: 34129112 PMCID: PMC8203491 DOI: 10.1007/s11916-021-00968-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Personal protection equipment (PPE)-associated headache is an unusual secondary headache disorder that predominantly occurs in healthcare workers as a consequence of the donning of protective respirators, face masks and/or eyewear. The appreciation of this entity is important given the significant ramifications upon the occupational health of healthcare workers and could additionally have an impact on persons living with pre-existing headache disorder(s). RECENT FINDINGS There has been a renewed interest and recognition of PPE-associated headaches amongst healthcare professionals, largely brought about by the ongoing COVID-19 pandemic which has besieged healthcare systems worldwide. De novo PPE-associated headaches may present with migrainous or tension-type features and can be viewed as a subtype of external compression headache. The prognosis of the disorder is generally favourable, given that most headaches are short-lived without long-term sequalae. Several aetiologies have been postulated to account for the development of these headaches. Notably, these headaches can affect the occupational health and work performance of healthcare workers. In this review, we discuss the epidemiology, clinical characteristics, probable etiopathogenesis, management and prognosis of PPE-associated headaches in the context of the COVID-19 pandemic. Future directions for research and PPE development are proposed.
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Affiliation(s)
- Jonathan J Y Ong
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Amanda C Y Chan
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Chandra Bharatendu
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Stead Family Department of Pediatrics, Division of Medical Genetics and Genomics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Hock Luen Teoh
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Yee Cheun Chan
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Vijay K Sharma
- Division of Neurology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block, Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
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Ong SK, Birgersson E, Low HY. Tuning Pressure Drop in Isoporous Membranes: Design with Fabrication Variability. ADVANCED THEORY AND SIMULATIONS 2021. [DOI: 10.1002/adts.202100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Shi Ke Ong
- Engineering Product Development Singapore University of Technology and Design 8 Somapah Road Singapore 487372 Singapore
| | - Erik Birgersson
- Department of Mechanical Engineering National University of Singapore 9 Engineering Drive 1 Singapore 117574 Singapore
| | - Hong Yee Low
- Engineering Product Development Singapore University of Technology and Design 8 Somapah Road Singapore 487372 Singapore
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Karuppasamy K, Obuchowski N. Comparison of Fit for Sealed and Loose-Fitting Surgical Masks and N95 Filtering Facepiece Respirators. Ann Work Expo Health 2021; 65:463-474. [PMID: 33458738 PMCID: PMC7929389 DOI: 10.1093/annweh/wxaa125] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/03/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022] Open
Abstract
Objectives N95 filtering facepiece respirators (N95 FFRs) and surgical masks are comprised of multiple layers of nonwoven polypropylene. Tight-fitting N95 FFRs are respiratory protective devices (RPDs) designed to efficiently filter aerosols. During the COVID-19 pandemic, health care workers (HCWs) throughout the world continue to face shortages of disposable N95 FFRs. Existing version of widely available FDA cleared loose-fitting surgical masks with straps do not provide reliable protection against aerosols. We tested the faceseal of a modified strapless form-fitting sealed version of surgical mask using quantitative fit testing (QNFT) and compared the performance of this mask with that of N95 FFRs and unmodified loose-fitting surgical masks. Methods Twenty HCWs participated in the study (10 women; 10 men; age 23–59 years). To create the sealed surgical masks, we removed the straps from loose-fitting surgical masks, made new folds, and used adhesive medical tape to secure the new design. All participants underwent QNFT with a loose-fitting surgical mask, the sealed surgical mask, and an N95 FFR; fit factors were recorded. Each QNFT was performed using a protocol of four exercises: (i) bending over, (ii) talking, (iii) moving head side to side, and (iv) moving head up and down. When the overall fit factor for the sealed surgical mask or N95 FFR was <100, the participant retook the test. Participants scored the breathability and comfort of the sealed surgical mask and N95 FFR on a visual analog scale (VAS) ranging from 0 (unfavorable) to 10 (favorable). Results The median fit factor for the sealed surgical mask (53.8) was significantly higher than that of the loose-fitting surgical mask (3.0) but lower than that of the N95 FFR (177.0) (P < 0.001), equating to significantly lower inward leakage of ambient aerosols (measuring 0.04–0.06 µm) with the sealed surgical mask (geometric mean 1.79%; geometric standard deviation 1.45%; range 0.97–4.03%) than with the loose-fitting surgical mask (29.5%; 2.01%; 25–100.0%) but still higher than with the N95 FFR (0.66%; 1.46%; 0.50–1.97%) (P < 0.001). Sealed surgical masks led to a marked reduction (range 60–98%) in inward leakage of aerosols in all the participants, compared to loose-fitting surgical masks. Among the exercises, talking had a greater effect on reducing overall fit factor for the sealed surgical mask than for the N95 FFR; when talking was excluded, the fit factor for the sealed surgical mask improved significantly (median 53.8 to 81.5; P < 0.001). The sealed surgical mask, when compared with the N95 FFR, offered better reported breathability (median VAS 9 versus 5; P < 0.001) and comfort (9 versus 5; P < 0.001). Conclusions Widely available loose-fitting surgical masks can be easily modified to achieve faceseal with adhesives. Unlike loose-fitting surgical masks, sealed surgical masks can markedly reduce inward leakage of aerosols and may therefore offer useful levels of respiratory protection during an extreme shortage of N95 FFRs and could benefit HCWs who cannot comply with N95 FFRs due to intolerance. However, because a wide range of surgical masks is commercially available, individual evaluation of such masks is highly recommended before sealed versions are used as RPDs.
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Affiliation(s)
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, JJN3, Cleveland, OH, USA
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Preparing for an Influenza Pandemic: Hospital Acceptance Study of Filtering Facepiece Respirator Decontamination Using Ultraviolet Germicidal Irradiation. J Patient Saf 2021; 16:117-122. [PMID: 32175970 PMCID: PMC7224602 DOI: 10.1097/pts.0000000000000600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objectives Predictions estimate supplies of filtering facepiece respirators (FFRs) would be limited in the event of a severe influenza pandemic. Ultraviolet decontamination and reuse (UVDR) is a potential approach to mitigate an FFR shortage. A field study sought to understand healthcare workers’ perspectives and potential logistics issues related to implementation of UVDR methods for FFRs in hospitals. Methods Data were collected at three hospitals using a structured guide to conduct 19 individual interviews, 103 focus group interviews, and 285 individual surveys. Data were then evaluated using thematic analysis to reveal key themes. Results Data revealed noteworthy variation in FFR use across the sample, along with preferences and requirements for the use of UVDR, unit design, and FFR reuse. Based on a scale of 1 (low) to 10 (high), the mean perception of safety in a high mortality pandemic wearing no FFR was 1.25 of 10, wearing an FFR for an extended period without decontamination was 4.20 of 10, and using UVDR was 7.72 of 10. Conclusions In addition to technical design and development, preparation and training will be essential to successful implementation of a UVDR program. Ultraviolet decontamination and reuse program design and implementation must account for actual clinical practice, compliance with regulations, and practical financial considerations to be successfully adopted so that it can mitigate potential FFR shortages in a pandemic.
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Bakhit M, Krzyzaniak N, Scott AM, Clark J, Glasziou P, Del Mar C. Downsides of face masks and possible mitigation strategies: a systematic review and meta-analysis. BMJ Open 2021; 11:e044364. [PMID: 33619199 PMCID: PMC7903088 DOI: 10.1136/bmjopen-2020-044364] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify, appraise and synthesise studies evaluating the downsides of wearing face masks in any setting. We also discuss potential strategies to mitigate these downsides. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, CENTRAL and EuropePMC were searched (inception-18 May 2020), and clinical registries were searched via CENTRAL. We also did a forward-backward citation search of the included studies. INCLUSION CRITERIA We included randomised controlled trials and observational studies comparing face mask use to any active intervention or to control. DATA EXTRACTION AND ANALYSIS Two author pairs independently screened articles for inclusion, extracted data and assessed the quality of included studies. The primary outcomes were compliance, discomforts, harms and adverse events of wearing face masks. RESULTS We screened 5471 articles, including 37 (40 references); 11 were meta-analysed. For mask wear adherence, 47% (95% CI 25% to 68%, p<0.0001), more people wore face masks in the face mask group compared with control; adherence was significantly higher (26%, 95% CI 8% to 46%, p<0.01) in the surgical/medical mask group than in N95/P2 group. The largest number of studies reported on the discomfort and irritation outcome (20 studies); fewest reported on the misuse of masks, and none reported on mask contamination or risk compensation behaviour. Risk of bias was generally high for blinding of participants and personnel and low for attrition and reporting biases. CONCLUSIONS There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks. New research on face masks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of face mask wearing, particularly the assessment of possible alternatives. SYSTEMATIC REVIEW REGISTRATION Open Science Framework website https://osf.io/sa6kf/ (timestamp 20-05-2020).
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Affiliation(s)
- Mina Bakhit
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Natalia Krzyzaniak
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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Round M, Isherwood P. Speech intelligibility in respiratory protective equipment - Implications for verbal communication in critical care. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2021; 36:23-29. [PMID: 38620262 PMCID: PMC7428718 DOI: 10.1016/j.tacc.2020.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 11/20/2022]
Abstract
Respiratory protective equipment (RPE) such as filtering facepiece respirators, elastomeric respirators and powered air-purifying respirators are routinely worn in the critical care unit as a component of personal protective equipment (PPE) when caring for patients with coronavirus disease 2019 (COVID-19). It is the authors' anecdotal experience that RPE may, however, inadvertently interfere with verbal communication between critical care staff. The literature pertaining to the effects of RPE wear on verbal communication was therefore reviewed. A literature search returned 98 articles, and 4 records were identified from other sources; after screening for content relevancy, 15 experimental studies were included in the narrative synthesis. Previous studies in both healthcare and other occupational settings suggest a detrimental impact on speech intelligibility, varying according to RPE type and test conditions. The effects of background noise and potential for increased cognitive load through compensatory behaviours are also identified. The clinical significance of these effects remains uncertain though, as evidence measuring clinical outcomes or errors is lacking. Mitigating strategies include increasing speech intelligibility through environmental changes and technology; modifying verbal communication strategies; and decreasing reliance on verbal communication where possible.
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Affiliation(s)
- Matthew Round
- University Hospitals Birmingham NHS Foundation Trust, UK
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Burton C, Coles B, Adisesh A, Smith S, Toomey E, Chan XHS, Ross L, Greenhalgh T. Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review. Occup Environ Med 2021; 78:679-690. [PMID: 33504624 DOI: 10.1136/oemed-2020-107058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
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Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Briana Coles
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | - Anil Adisesh
- Occupational Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Simon Smith
- Canadian Standards Biological Aerosols Group, Canadian Standards Association, Toronto, Ontario, Canada
| | - Elaine Toomey
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | - Lawrence Ross
- Infectious Diseases, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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Strauch AL, Brady TM, Niezgoda G, Almaguer CM, Shaffer RE, Fisher EM. Evaluación de la eficacia de las lengüetas en las tiras de la mascarilla autofiltrante para mejorar las técnicas de retirada adecuadas al mismo tiempo que se reduce la transmisión por contacto de los patógenos. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:S35-S43. [PMID: 33822693 DOI: 10.1080/15459624.2021.1877058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
RESUMENLas mascarillas respiratorias autofiltrantes (filtering facepiece respirators, FFR) N95 certificadas por el Instituto Nacional de Seguridad y Salud Laborales (National Institute for Occupational Safety and Health, NIOSH) se utilizan en los centros de atención sanatoria como medida de control para mitigar las exposiciones a partículas atmosféricas infecciosas. Cuando la superficie externa de una FFR se contamina, supone un riesgo de transmisión para el usuario. La guía de los Centros para el Control y Prevención de Enfermedades (Centers for Disease Control and Prevention, CDC) recomienda que el personal sanitario retire las FFR agarrando las tiras en la parte posterior de la cabeza para evitar el contacto con la superficie posiblemente contaminada. Al parecer, la adherencia a la técnica de retirada adecuada es baja, debido a numerosos factores que incluyen la dificultad para ubicar y agarrar las tiras. En este estudio se compara el impacto de lengüetas ubicadas en las tiras de la FFR con el de mascarillas comparativas (sin lengüetas) sobre la retirada adecuada, la facilidad de uso, la comodidad y la reducción de la transmisión de la contaminación al usuario. El uso de un agente fluorescente como rastreador de contactos para explorar la contaminación de las FFR en manos y áreas de la cabeza de 20 sujetos humanos demostró que no hubo diferencia entre las tiras de la FFR con lengüetas y las mascarillas comparativas en el sentido de estimular la retirada adecuada de las mismas (p = 0.48), pero la hizo más fácil (p = 0.04), según indican siete de ocho sujetos que usaron las lengüetas. Siete de 20 sujetos opinaron que las FFR con lengüetas son más fáciles de retirar, mientras que solo dos de 20 sujetos indicaron que las FFR sin lengüetas son más fáciles de retirar. La incomodidad no fue un factor relevante para ninguno de los tipos de tiras de las FFR. Al retirar una FFR con las manos contaminadas, el uso de lengüetas redujo de forma importante la cantidad del rastreador de contactos transferida en comparación con las tiras sin lengüetas (p = 0.012). Las FFR con lengüetas en las tiras están asociadas con la facilidad de la retirada y una transferencia notablemente menor del rastreador de contactos fluorescente.
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Affiliation(s)
- Amanda L Strauch
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Tyler M Brady
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - George Niezgoda
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Claudia M Almaguer
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Ronald E Shaffer
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Edward M Fisher
- National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
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Ramirez-Moreno JM, Ceberino D, Gonzalez Plata A, Rebollo B, Macias Sedas P, Hariramani R, Roa AM, Constantino AB. Mask-associated 'de novo' headache in healthcare workers during the COVID-19 pandemic. Occup Environ Med 2020; 78:oemed-2020-106956. [PMID: 33380516 PMCID: PMC7780429 DOI: 10.1136/oemed-2020-106956] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/14/2020] [Accepted: 12/07/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The pandemic caused by the new coronavirus (COVID-19) has changed care activities of health professionals. We analysed the possible association between the appearance of 'de novo' headache according to the type of mask used, the related factors and the impact of the cephalalgia on health professionals. METHODS Cross-sectional study in a tertiary hospital in Extremadura, Spain. We provided an online questionnaire to healthcare workers during the period of maximum incidence of COVID-19 in our setting. RESULTS The subjects are n=306, 244 women (79.7%), with an average age of 43 years (range 23-65). Of the total, 129 (42.2%) were physicians, 112 (36.6%) nurses and 65 (21.2%) other health workers. 208 (79.7%) used surgical masks and 53 (20.3%) used filter masks. Of all those surveyed, 158 (51.6%) presented 'de novo' headache. The occurrence of a headache was independently associated with the use of a filter mask, OR 2.14 (95% CI 1.07 to 4.32); being a nurse, OR 2.09 (95% CI 1.18 to 3.72) or another health worker, OR 6.94 (95% CI 3.01 to 16.04); or having a history of asthma, OR 0.29 (95% CI 0.09 to 0.89). According to the type of mask used, there were differences in headache intensity, and the impact of a headache in the subjects who used a filter mask was worse in all the aspects evaluated. CONCLUSION The appearance of 'de novo' headache is associated with the use of filter masks and is more frequent in certain healthcare workers, causing a greater occupational, family, personal and social impact.
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Affiliation(s)
- José María Ramirez-Moreno
- Biomedical Sciences, University of Extremadura, Faculty of Medicine, Badajoz, Spain
- Neurology, Badajoz University Hospital, Badajoz, Spain
| | | | | | - Belen Rebollo
- Neurology, Badajoz University Hospital, Badajoz, Spain
| | | | | | - Ana M Roa
- Neurology, Badajoz University Hospital, Badajoz, Spain
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Perna G, Cuniberti F, Daccò S, Nobile M, Caldirola D. Impact of respiratory protective devices on respiration: Implications for panic vulnerability during the COVID-19 pandemic. J Affect Disord 2020; 277:772-778. [PMID: 33065816 PMCID: PMC7476564 DOI: 10.1016/j.jad.2020.09.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The wearing of respiratory protective devices (RPDs) correctly and continually in situations where people are at risk of respiratory infections is crucial for infection prevention. Certain people are poorly compliant with RPDs due to RPD-related annoyance, including respiratory discomfort. We hypothesized that individuals vulnerable to panic attacks are included in this group. No published studies on this topic are available. The evidence for our hypothesis was reviewed in this study as a starting point for future research. METHODS We selected a set of experimental studies that measured the respiratory physiological burden in RPD wearers through objective and validated methods. We conducted a bibliographic search of publications in the PubMed database (January 2000-May 2020) to identify representative studies that may be of interest for panic respiratory pathophysiology. RESULTS Five studies were included. Wearing RPDs exerted significant respiratory effects, including increased breathing resistance, CO2 rebreathing due to CO2 accumulation in the RPD cavity, and decreased inhaled O2 concentration. We discussed the implications of these effects on the respiratory pathophysiology of panic. LIMITATIONS Most studies had a small sample size, with a preponderance of young participants. Different methodologies were used across the studies. Furthermore, differences in physical responses between wearing RPDs in experimental settings or daily life cannot be excluded. CONCLUSIONS This research supports the idea that panic-prone individuals may be at higher risk of respiratory discomfort when wearing RPDs, thereby reducing their tolerance for these devices. Strategies to decrease discomfort should be identified to overcome the risk of poor compliance.
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Affiliation(s)
- Giampaolo Perna
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, 22032 Albese con Cassano, Como, Italy.
| | - Francesco Cuniberti
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, 22032 Albese con Cassano, Como, Italy
| | - Silvia Daccò
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, 22032 Albese con Cassano, Como, Italy
| | - Maria Nobile
- Scientific Institute IRCCS Eugenio Medea, Bosisio Parini 23842, Lecco, Italy
| | - Daniela Caldirola
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy,Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, 22032 Albese con Cassano, Como, Italy
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Zaheer R, Khan M, Tanveer A, Farooq A, Khurshid Z. Association of Personal Protective Equipment with De Novo Headaches in Frontline Healthcare Workers during COVID-19 Pandemic: A Cross-Sectional Study. Eur J Dent 2020; 14:S79-S85. [PMID: 33368069 PMCID: PMC7775222 DOI: 10.1055/s-0040-1721904] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to determine the association of personal protective equipment (PPE) usage with new-onset headaches and exacerbation of pre-existing headache disorders among healthcare workers at the frontlines during coronavirus disease 2019 (COVID-19) pandemic. MATERIALS AND METHODS A descriptive cross-sectional survey was conducted across Pakistan in June-July 2020. The study was approved by Ethical Committee, Armed Forces Institute of Dentistry, Rawalpindi (IRB form no.905/Trg-ABP 1K2). A qualitative questionnaire was developed and was shared via different social networks. The questionnaire was closed when 241 responses were received. STATISTICAL ANALYSIS Descriptive analysis was performed on demographic data. Chi-squared analysis was performed between demographic data and PPE-usage patterns among participants with or without de novo headaches. Univariable and multivariable logistic regression models were used to compare variables with the development of new-onset headaches. Chi-squared test was also performed between demographic data and other factors that may be causing new-onset headaches. A p-value < 0.05 was considered significant. RESULTS A total of 241 healthcare workers participated, of which 68 participants (28.2%) reported de novo headaches since the start of the pandemic. Incidence of pre-existing headaches (odds ratio [OR] = 1.91; 95% confidence interval [CI]: 0.99-0.37; p = 0.049) was associated with new-onset headaches. Post hoc multivariable logistic regression analysis stated that incidence of pre-existing headaches (OR = 1.88; 95% CI: 0.94-3.78; p = 0.75) and age (OR = 2.21; 95% CI: 0.47-10.33; p = 0.36) was independently associated with new-onset PPE-induced headaches but was not statistically significant. Chi-squared analysis showed a statistically significant relationship between other factors (sleep deprivation, emotional stress, etc.) and department of activity, gender, and occupation (p < 0.05). CONCLUSION Healthcare workers with previous history of pre-existing headaches were found to be more susceptible to PPE-induced headaches during COVID-19 pandemic. However, age and the department where the healthcare workers performed may also be risk factors.
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Affiliation(s)
- Rumeesha Zaheer
- Orthodontics Department, Armed Forces Institute of Dentistry, Combined Military Hospital, Rawalpindi, Pakistan
| | - Maheen Khan
- Prosthodontics Department, Khyber College of Dentistry, Peshawar, Pakistan
| | - Ahmed Tanveer
- National University of Medical Sciences, Rawalpindi, Pakistan
| | - Amal Farooq
- National University of Medical Sciences, Rawalpindi, Pakistan
| | - Zohaib Khurshid
- Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al Ahsa, Saudi Arabia
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Self-reported impact of respirator use on health care worker ability to perform patient care. Am J Infect Control 2020; 48:1556-1558. [PMID: 32534121 PMCID: PMC7286820 DOI: 10.1016/j.ajic.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
In a study of 1,152 health care workers surveyed prior to the COVID-19 pandemic, most disagreed that respiratory protective equipment use interferes with patient care but reported that it would affect respirator use compliance if it did. A patient's fear reaction variably influenced self-reported health care worker compliance with respirator use. Strategies to improve protective equipment design may remove potential barriers to respirator use and allow better health care worker-patient relationships.
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Bradford Smith P, Agostini G, Mitchell JC. A scoping review of surgical masks and N95 filtering facepiece respirators: Learning from the past to guide the future of dentistry. SAFETY SCIENCE 2020; 131:104920. [PMID: 32834515 PMCID: PMC7406415 DOI: 10.1016/j.ssci.2020.104920] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 05/03/2023]
Abstract
With the 2019 emergence of coronavirus disease 19 (colloquially called COVID-19) came renewed public concern about airborne and aerosolized virus transmission. Accompanying this concern were many conflicting dialogues about which forms of personal protective equipment best protect dental health care practitioners and their patients from viral exposure. In this comprehensive review we provide a thorough and critical assessment of face masks and face shields, some of the most frequently recommended personal safeguards against viral infection. We begin by describing the function and practicality of the most common mask types used in dentistry: procedural masks, surgical masks, and filtering respirator facemasks (also called N95s). This is followed by a critical assessment of mask use based on a review of published evidence in three key domains: the degree to which each mask type is shown to protect against airborne and aerosolized disease, the reported likelihood for non-compliance among mask users, and risk factors associated with both proper and improper mask use. We use this information to conclude our review with several practical, evidence-based recommendations for mask use in dental and dental educational clinics.
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Key Words
- ADA, American Dental Association
- ARI, Acute Respiratory Infections
- ASTM, American Society of Testing Materials
- CDC, Center for Disease Control
- COVID-19, Coronavirus Disease, first detected in 2019
- CRI, Confirmed respiratory infection
- DHCP, Dental Health Care Practitioner
- ER, Emergency Room
- Evidence-based review
- FDA, Food and Drug Administration
- FFR, Filtering Facepiece Respirators
- H1N1, H1N1 Subtype of Influenza-A
- HCW, Healthcare Workers
- HVE, High-Volume Evacuation
- ICP, Infection Control Protocol
- ILI, Influenza-like Illness
- Infectious disease transmission
- LCI, Laboratory-confirmed Influenza
- MERS, Middle East Respiratory Syndrome (a coronavirus formally identified in 2012)
- N95 respirator
- N95, Non-oil-resistant, filtering facepiece respirator filtering 95% of airborne particles
- NASIOM, National Academy of Sciences’ Institute of Medicine
- NIOSH, National Institute for Occupational Safety and Health
- OSHA, Occupational Safety and Health Administration
- PPE, Personal protective equipment
- RCT, Randomized Controlled Trial
- SARS, Severe Acute Respiratory Syndrome (a coronavirus formally identified in 2003
- Surgical facemask
- WHO, World Health Organization
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Affiliation(s)
- P Bradford Smith
- Midwestern University College of Dental Medicine, AZ, United States
| | - Gina Agostini
- Midwestern University College of Dental Medicine, AZ, United States
| | - John C Mitchell
- Midwestern University College of Dental Medicine, AZ, United States
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Reusable Face Masks as Alternative for Disposable Medical Masks: Factors that Affect their Wear-Comfort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186623. [PMID: 32932918 PMCID: PMC7558362 DOI: 10.3390/ijerph17186623] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
The coronavirus outbreak that commenced at the end of 2019 has led to a dramatic increase in the demand for face masks. In countries that are experiencing a shortage of face masks as a result of panic buying or inadequate supply, reusable fabric masks have become a popular option, because they are often considered more cost-effective and environmentally friendly than disposable medical masks. Nevertheless, there remains a significant variation in the quality and performance of existing face masks; not all are simultaneously able to provide protection against the extremely contagious virus and be comfortable to wear. This study aims to examine the influential factors that affect the comfort of reusable face masks, but not to assess the antimicrobial or antiviral potential. Seven types of masks were selected in this study and subjected to air and water vapor permeability testing, thermal conductivity testing and a wear trial. The results indicate that washable face masks made of thin layers of knitted fabric with low density and a permeable filter are more breathable. Additionally, masks that contain sufficient highly thermally conductive materials and have good water vapor permeability are often more comfortable to wear as they can transfer heat and moisture from the body quickly, and thus do not easily dampen and deteriorate.
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Shi AH, Guo W, Chng CK, Chan BH. Precautions When Providing Dental Care During Coronavirus Disease 2019
(COVID-19) Pandemic. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2020. [DOI: 10.47102/annals-acadmedsg.2020111] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Transmission of coronavirus disease 2019 (COVID-19)—caused by novel severe acute respiratory syndrome coronavirus 2—through aerosolised saliva and respiratory droplets is possible when aerosol-generating dental procedures are performed. Consequently, dental practitioners are at increased risk of being infected when treating COVID-19 patients. A comprehensive review of the current literature on precautions when providing dental care during the COVID-19 pandemic is discussed and recommendations for dental practitioners are made. Dental practitioners should actively keep themselves abreast of the guidelines published by both national and international authorities and adhere strictly to them.
Ann Acad Med Singapore 2020;49:312–19
Keywords: Aerosol-generating procedures, Infection control, Infectious disease, Severe acute respiratory syndrome coronavirus, Transmission
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Affiliation(s)
| | - Weidi Guo
- Singapore Armed Forces Headquarters Medical Corps, Singapore
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Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, Tan BYQ, Teoh HL, Ong ST, Allen DM, Sharma VK. Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache 2020; 60:864-877. [PMID: 32232837 DOI: 10.1111/head.13811] [Citation(s) in RCA: 251] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an emerging infectious disease of pandemic proportions. Healthcare workers in Singapore working in high-risk areas were mandated to wear personal protective equipment (PPE) such as N95 face mask and protective eyewear while attending to patients. OBJECTIVES We sought to determine the risk factors associated with the development of de novo PPE-associated headaches as well as the perceived impact of these headaches on their personal health and work performance. The impact of COVID-19 on pre-existing headache disorders was also investigated. METHODS This is a cross-sectional study among healthcare workers at our tertiary institution who were working in high-risk hospital areas during COVID-19. All respondents completed a self-administered questionnaire. RESULTS A total of 158 healthcare workers participated in the study. Majority [126/158 (77.8%)] were aged 21-35 years. Participants included nurses [102/158 (64.6%)], doctors [51/158 (32.3%)], and paramedical staff [5/158 (3.2%)]. Pre-existing primary headache diagnosis was present in about a third [46/158 (29.1%)] of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001] or medical ICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001]. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE-associated headaches. A pre-existing primary headache diagnosis (OR = 4.20, 95% CI 1.48-15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35-11.31; P = .012) were independently associated with de novo PPE-associated headaches. Since COVID-19 outbreak, 42/46 (91.3%) of respondents with pre-existing headache diagnosis either "agreed" or "strongly agreed" that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance. CONCLUSION Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.
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Affiliation(s)
- Jonathan J Y Ong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chandra Bharatendu
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Jonathan Z Y Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Emergency Medicine, National University Hospital, Singapore, Singapore
| | - Kenneth W X Sooi
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yi Lin Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shi T Ong
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
| | - David M Allen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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47
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Park SH, Hwang SY, Lee G, Park JE, Kim T, Shin TG, Sim MS, Jo IJ, Kim S, Yoon H. Are loose-fitting powered air-purifying respirators safe during chest compression? A simulation study. Am J Emerg Med 2020; 44:235-240. [PMID: 32307296 PMCID: PMC7163180 DOI: 10.1016/j.ajem.2020.03.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/08/2020] [Accepted: 03/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The application of appropriate personal protective equipment for respiratory protection to health care workers is a cornerstone for providing safe healthcare in emergency departments. We investigated the protective effect and usefulness of loose-fitting powered air-purifying respirators (PAPRs) during chest compression. METHODS This was a single-center simulation study performed from May 2019 to July 2019 in a tertiary hospital. We measured the concentrations of ambient aerosol and particles inside the loose-fitting PAPR during chest compression, and this ratio was set as the simulated workplace protecting factor (SWPF). According to the National Institute for Occupational Safety and Health regulations, the assigned protection factor (APF) of loose-fitting PAPRs is 25. Thus, the loose-fitting PAPRs were assumed to have a protective effect when the SWPF were ≥ 250 (APF × 10). We measured the SWPF of PAPR in real time during chest compression and also investigated the problems encountered during its use. RESULTS Ninety-one participants (median age 29 [interquartile range (IQR): 26-32] years; 74% female) completed the simulation. None of the participants failed with SWPF below 250 during three sessions of chest compression. The median (IQR) values of SWPF at three cycles were 17,063 (10,145-26,373), 15,683 (9477-32,394), and 16,960 (7695-27,279). There was no disconnection of equipment or mechanical failures during chest compression. In addition, most participants (83%) replied that they rarely or never experienced difficulty in verbal communication and felt that the loose-fitting PAPR was comfortable. CONCLUSIONS The loose-fitting PAPRs provided sufficient respiratory protection without disturbances during chest compression.
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Affiliation(s)
- Soo Hyun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Guntak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Taerim Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seonwoo Kim
- Statistics and Data Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Yoon
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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48
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Chughtai AA, Seale H, Rawlinson WD, Kunasekaran M, Macintyre CR. Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings. Ann Work Expo Health 2020; 64:368-377. [DOI: 10.1093/annweh/wxaa020] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 02/03/2020] [Accepted: 02/13/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Infection control policies and guidelines recommend using facemasks and respirators to protect healthcare workers (HCWs) from respiratory infections. Common types of respirators used in healthcare settings are filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). Aims of this study were to examine the current attitudes and practices of HCWs regarding the selection and use of respiratory protection and determine the acceptability of a novel PAPR.
Methods
In-depth interviews were undertaken with 20 HCWs from a large tertiary hospital in Sydney, Australia. Participants were fit tested with a lightweight tight-fitting half-facepiece PAPR (CleanSpace2™ Power Unit, PAF-0034, by CleanSpace Technology®) using the TSI™ Portacount quantitative fit test method.
Results
Interview results showed that HCWs had a limited role in the selection and use of facemasks and respirators and had been using the devices provided by the hospital. The majority of subjects had no knowledge of hospital policy for the use of facemasks and respirators, had not been trained on the use of respirators, and had not been fit tested previously. Compliance with the use of facemasks and respirators was perceived as being low and facemasks and respirators were typically used only for short periods of time.
All 20 participants were successfully fit tested to the CleanSpace2™ PAPR (overall geometric mean fit factor—6768). According to the exit surveys, CleanSpace2™ PAPRs were easy to don (14/20) and doff (15/20) and comfortable to wear (14/20). Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations.
Conclusions
HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs.
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Affiliation(s)
- Abrar Ahmad Chughtai
- School of Public Health and Community Medicine, The University of New South Wales, , Sydney, NSW, Australia
| | - Holly Seale
- School of Public Health and Community Medicine, The University of New South Wales, , Sydney, NSW, Australia
| | - William D Rawlinson
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
| | - C Raina Macintyre
- Biosecurity Program, The Kirby Institute, The University of New South Wales, Sydney, NSW, Australia
- College of Public Service & Community Solutions, Arizona State University, Phoenix, AZ, USA
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49
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Goh DYT, Mun MW, Lee WLJ, Teoh OH, Rajgor DD. A randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children. Sci Rep 2019; 9:18952. [PMID: 31831801 PMCID: PMC6908682 DOI: 10.1038/s41598-019-55451-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/20/2019] [Indexed: 01/08/2023] Open
Abstract
Children are more vulnerable to the risks of air pollution, including susceptibility to acquiring chronic diseases in their developing lungs. Despite these, there are no specific masks designed for and tested in children that are available to protect our young from the common particulate air pollutants today. We evaluated safety, fit and comfort of a specially designed paediatric N95 mask with an optional micro ventilator (micro fan, MF) in healthy children aged 7-14 years, in a randomized, two-period crossover design. The subjects' cardiorespiratory physiological measurements were assessed in different states of physical activity under different interventions (mask without and with MF). A total of 106 subjects were recruited between July-August 2016. The use of the mask without MF increased the End-Tidal CO2 (ETCO2) and Fractional concentration of Inspired CO2 (FICO2) at rest and on mild exertion, as expected. The use of the mask with MF brought FICO2 levels comparably closer to baseline levels without the mask for both activities. The mask, with or without the MF, was found to be well fitting, comfortable and safe for use in children at rest and on mild exertion. The N95 mask tested offers a promising start for more studies in the paediatric population.
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Affiliation(s)
- Daniel Yam Thiam Goh
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore.
| | | | | | - Oon Hoe Teoh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Dimple D Rajgor
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore, Singapore
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50
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Roh S, Park K, Kim J. Design of Web-to-Web Spacing for the Reduced Pressure Drop and Effective Depth Filtration. Polymers (Basel) 2019; 11:E1822. [PMID: 31698747 PMCID: PMC6918413 DOI: 10.3390/polym11111822] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
The study aims at lowering the pressure drop and extending the service life at a given set of filter materials implementing a space between the filter layers. As design factors, the web-to-web space was implemented by inserting either a bulk air gap or porous spacer web between the filter webs. The effect of spacing, either by the air gap or by the spacer web, on the pressure drop reduction was apparent for 4-layer constructions, and the effect was greater at the higher face velocity. The use of spacer web was more effective than the air gap in reducing the pressure drop, because the porous, fluffy spacer web acted as an effective air flow channel between the compact filter layers. The loading capacity was also increased with the spacer web implementation, effectively delaying the clogging point and extending the service life. Employing both experimental investigation and numerical simulation, this study intended to provide a practical design solution to the important problem in the field of air filtration. The results of this study can be used as a practical design guide to reduce pressure drop via depth filtration.
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Affiliation(s)
- Sanghyun Roh
- Department of Textiles, Merchandising and Fashion Design, Seoul National University, Seoul 08826, Korea
| | - Kangsoo Park
- R & D Center, Satrec Initiative Co., Ltd., Daejeon 34054, Korea;
| | - Jooyoun Kim
- Department of Textiles, Merchandising and Fashion Design, Seoul National University, Seoul 08826, Korea
- Research Institute of Human Ecology, Seoul National University, Seoul 08826, Korea
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