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Griffin JS, McInroe EM, Pennington ER, Steinhardt W, Chen H, Prince SE, Samet JM. Craniometric determinants of the fitted filtration efficiency of disposable masks. Front Public Health 2024; 12:1444411. [PMID: 39228845 PMCID: PMC11368739 DOI: 10.3389/fpubh.2024.1444411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 07/25/2024] [Indexed: 09/05/2024] Open
Abstract
Introduction Exposure to harmful aerosols is of increasing public health concern due to the SARS-CoV-2 pandemic and wildland fires. These events have prompted risk reduction behaviors, notably the use of disposable respiratory protection. This project investigated whether craniofacial morphology impacts the efficiency of disposable masks (N95, KN95, surgical masks, KF94) most often worn by the public to protect against toxic and infectious aerosols. This project was registered with ClinicaltTrials.gov (NCT05388201; registration May 18, 2022). Methods One-hundred participants (50 men, 50 women) visited the Environmental Protection Agency's Human Studies Facility in Chapel Hill, NC between 2022-2023. Craniometrics and 3D scans were used to separate participants into four clusters. Boosting and elastic net regression yielded five measurements (bizygomatic breadth, nose length, bizygomatic nasal arc, neck circumference, ear breadth) that were the best predictors of filtration efficiency based on overall model fit. Fitted filtration efficiency was quantified for each mask at baseline and when tightened using an ear-loop clip. Results The mean unmodified mask performance ranged from 55.3% (15.7%) in the large KF94 to 69.5% (12.3%) in the KN95. Modified performance ranged from 66.3% (9.4%) in the surgical to 80.7% (12.0%) in the KN95. Clusters with larger face width and neck circumference had higher unmodified mask efficiency. Larger nose gap area and nose length decreased modified mask performance. Discussion We identify face width, nose size, nose shape, neck circumference, and ear breadth as specific features that modulate disposable mask fit in both unmodified and modified conditions. This information can optimize guidance on respiratory protection afforded by disposable ear-loop masks.
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Affiliation(s)
- Jacob S. Griffin
- Oak Ridge Institute for Science Education, Oak Ridge, TN, United States
| | - E. Melissa McInroe
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - Edward R. Pennington
- Oak Ridge Institute for Science Education, Oak Ridge, TN, United States
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | | | - Hao Chen
- Oak Ridge Institute for Science Education, Oak Ridge, TN, United States
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Nanning, China
| | - Steven E. Prince
- Public Health and Environmental Systems Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
| | - James M. Samet
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, United States
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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; 29:144-151. [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] [MESH Headings] [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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Pennington ER, Griffin JS, McInroe EM, Steinhardt W, Chen H, Samet JM, Prince SE. Variation in the fitted filtration efficiency of disposable face masks by sex. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2024:10.1038/s41370-024-00697-4. [PMID: 38956275 DOI: 10.1038/s41370-024-00697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 06/05/2024] [Accepted: 06/10/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND & OBJECTIVE Disposable face masks are a primary protective measure against the adverse health effects of exposure to infectious and toxic aerosols such as airborne viruses and particulate air pollutants. While the fit of high efficiency respirators is regulated in occupational settings, relatively little is known about the fitted filtration efficiencies of ear loop style face masks worn by the public. METHODS We measured the variation in fitted filtration efficiency (FFE) of four commonly worn disposable face masks, in a cohort of healthy adult participants (N = 100, 50% female, 50% male, average age = 32.3 ± 9.2 years, average BMI = 25.5 ± 3.4) using the U.S. Occupational Safety and Health Administration Quantitative Fit Test, for an N95 (respirator), KN95, surgical, and KF94 masks. The latter three ear loop style masks were additionally tested in a clip-modified condition, tightened using a plastic clip to centrally fasten loops in the back of the head. RESULTS The findings show that sex is a major determinant of the FFE of KN95, surgical, and KF94 masks. On average, males had an 11% higher FFE relative to females, at baseline testing. We show that a simple modification using an ear loop clip, results in improvements in the average FFE for females but provides comparatively minor changes for males. On average, females had a 20% increased FFE when a clip was worn behind the head, relative to a 6% increase for males. IMPACT The efficacy of a disposable face mask as protection against air contaminants depends on the efficiency of the mask materials and how well it fits the wearer. We report that the sex of the wearer is a major determinant of the baseline fitted filtration efficiency (FFE) of commonly available ear loop style face masks. In addition, we show that a simple fit modifier, an ear loop clip fastened behind the head, substantially improves baseline FFE for females but produces only minor changes for males. These findings have significant public health implications for the use of face masks as a protective intervention against inhalational exposure to airborne contaminants.
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Affiliation(s)
- Edward R Pennington
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
- Oak Ridge Institute for Science Education, Oak Ridge, TN, USA
| | - Jacob S Griffin
- Oak Ridge Institute for Science Education, Oak Ridge, TN, USA
| | - E Melissa McInroe
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | | | - Hao Chen
- Oak Ridge Institute for Science Education, Oak Ridge, TN, USA
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, 530021, China
| | - James M Samet
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Steven E Prince
- Public Health and Environmental Systems Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, NC, USA.
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Wang G, Luo C, Cui C, Huang J. Study on the relationship between the fitness of three types of N95 respirators and facial dimensions. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2024; 21:319-325. [PMID: 38416473 DOI: 10.1080/15459624.2024.2311295] [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: 02/29/2024]
Abstract
N95 respirators are the core equipment used by healthcare workers to prevent the spread of respiratory diseases. The protective effect of N95 against infection spread depends on the fit of the N95 to the wearer, which is related to the wearer's facial dimensions. The purpose of this cross-sectional study was to assess the relationship between the fit of three types of N95 and facial dimensions. A total of 305 healthcare workers from ten hospitals in Beijing were recruited for this study. Facial dimensions of workers were measured using Intel RealSense Depth Camera D435. Fit testing was conducted on three types of N95 using the TSI-8038 Porta Count Pro + Respirator Fit Tester. Possible associations between the fit test results and facial dimension data were examined. A Porta Count reading of 100 was used as the criterion for an acceptable fit. The fit of the folding respirators was positively correlated with nose length (r = 0.13, p = 0.02), nose height (r = 0.14, p = 0.02), and face width (r = 0.12, p = 0.03), whereas that of flat respirators was correlated with nose width (r = 0.16, p < 0.01), chin length (r = 0.18, p < 0.01), and pro-face width (r = 0.13, p = 0.02), and that of arched respirators was correlated with the nose length (r = 0.13, p = 0.03). The fit of N95 for wearers depends on their facial features. The results of this study can provide advice for medical workers to choose the appropriate N95. Medical staff should fully consider their facial dimensions when choosing an appropriate N95 to improve the protective efficacy of respirators and to reduce the risk of infection by respiratory diseases.
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Affiliation(s)
- Guifang Wang
- Department of Infection Management and Disease Control and Prevention, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Changwei Luo
- Department of Electronic Engineering, Tsinghua University, Beijing, China
- Academy of Military Sciences, Beijing, China
| | - Can Cui
- Department of Infection Management and Disease Control and Prevention, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Jing Huang
- Department of Infection Control, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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Abstract
Ubiquitous environmental exposures increase cardiovascular disease risk via diverse mechanisms. This review examines personal strategies to minimize this risk. With regard to fine particulate air pollution exposure, evidence exists to recommend the use of portable air cleaners and avoidance of outdoor activity during periods of poor air quality. Other evidence may support physical activity, dietary modification, omega-3 fatty acid supplementation, and indoor and in-vehicle air conditioning as viable strategies to minimize adverse health effects. There is currently insufficient data to recommend specific personal approaches to reduce the adverse cardiovascular effects of noise pollution. Public health advisories for periods of extreme heat or cold should be observed, with limited evidence supporting a warm ambient home temperature and physical activity as strategies to limit the cardiovascular harms of temperature extremes. Perfluoroalkyl and polyfluoroalkyl substance exposure can be reduced by avoiding contact with perfluoroalkyl and polyfluoroalkyl substance-containing materials; blood or plasma donation and cholestyramine may reduce total body stores of perfluoroalkyl and polyfluoroalkyl substances. However, the cardiovascular impact of these interventions has not been examined. Limited utilization of pesticides and safe handling during use should be encouraged. Finally, vasculotoxic metal exposure can be decreased by using portable air cleaners, home water filtration, and awareness of potential contaminants in ground spices. Chelation therapy reduces physiological stores of vasculotoxic metals and may be effective for the secondary prevention of cardiovascular disease.
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Affiliation(s)
- Luke J Bonanni
- Grossman School of Medicine (L.J.B.), NYU Langone Health, New York, NY
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Williams DL, Kave B, Bodas C, Begg F, Roberts M, Ng I. Prospective comprehensive evaluation of an elastic-band beard cover for filtering facepiece respirators in healthcare workers. Infect Control Hosp Epidemiol 2024; 45:89-95. [PMID: 37435792 PMCID: PMC10782203 DOI: 10.1017/ice.2023.141] [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: 03/25/2023] [Revised: 05/21/2023] [Accepted: 05/23/2023] [Indexed: 07/13/2023]
Abstract
OBJECTIVE To undertake a healthcare-based multimodal evaluation of the combination of filtering facepiece respirator (FFR) with the elastic-band beard cover technique, including quantitative fit test (QNFT) results, skills assessment, and usability assessment. DESIGN AND SETTING We conducted a prospective study through the Respiratory Protection Program at the Royal Melbourne Hospital from May 2022 to January 2023. PARTICIPANTS Healthcare workers who required respiratory protection and could not shave for religious, cultural, or medical reasons. INTERVENTION Online education and personal face-to-face training on the use of FFR with the elastic-band beard cover technique. RESULTS Among 87 participants (median beard length 38 mm; interquartile range [IQR], 20-80), 86 (99%) passed 3 QNFTs consecutively with the elastic-band beard cover under a Trident P2 respirator and 68 (78%) passed 3 QNFTs consecutively with a 3M 1870+ Aura respirator. The first QNFT pass rate and the overall fit factors were significantly higher when using the technique than without the elastic-band beard cover. Most participants displayed a high skill level in their donning, doffing, and user seal-check techniques. Of 87 participants, 83 (95%) completed the usability assessment. The overall ease of use, comfort, and overall assessment were rated highly. CONCLUSIONS The elastic-band beard cover technique can provide safe and effective respiratory protection for bearded healthcare workers. The technique was easily taught, comfortable, well tolerated and accepted by healthcare workers, potentially allowing them full participation in the workforce during pandemics with airborne transmission. We recommend further research and evaluation of this technique in a broader health workforce.
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Affiliation(s)
- Daryl Lindsay Williams
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Kave
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Charles Bodas
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Fiona Begg
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Megan Roberts
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Irene Ng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Victoria, Australia
- University of Melbourne, Parkville, Victoria, Australia
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Fakherpour A, Jahangiri M, Jansz J. A systematic review of passing fit testing of the masks and respirators used during the COVID-19 pandemic: Part 1-quantitative fit test procedures. PLoS One 2023; 18:e0293129. [PMID: 37883443 PMCID: PMC10602271 DOI: 10.1371/journal.pone.0293129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND During respiratory infection pandemics, masks and respirators are highly sought after, especially for frontline healthcare workers and patients carrying respiratory viruses. The objective of this study was to systematically review fit test pass rates and identify factors influencing the fitting characteristics. METHODS Potentially relevant studies were identified using PubMed, Scopus, Web of Science, and Science Direct during the COVID-19 pandemic from February 5, 2020, to March 21, 2023. The search strategy using the following keywords was conducted: Quantitative Fit Test, Condensation Nuclei Counter, Controlled Negative Pressure, PortaCount, Sibata, Accufit, Fit, Seal, Mask, Respirator, Respiratory Protective Device, Respiratory Protective Equipment, Protective Device, Personal Protective Equipment, COVID-19, Coronavirus, and SARS-CoV-2. The quality of the included studies was also assessed using the Newcastle-Ottawa scale. RESULTS A total of 137 articles met the eligibility criteria. Fifty articles had a quality score of less than 7 (good quality). A total of 21 studies had a fit test pass rate of less than 50%. 26 studies on disposable respirators and 11 studies on reusable respirators had an FF of less than 50 and less than 200, respectively. The most influential factors include respirator brand/model, style, gender, ethnicity, facial dimensions, facial hair, age, reuse, extensive movement, seal check, comfort and usability assessment, and training. CONCLUSION 37.36% of the disposable respirator studies and 43% of the reusable respirator studies did not report fit test results. 67.86% of the disposable respirator studies had a fit test pass rate greater than 50%, and 35.84% of these studies had an FF greater than 100. Also, 85.71% of the reusable respirator studies had a fit test pass rate greater than 50%, and 52.77% of these studies had an FF greater than 1000. Overall, the fit test pass rate was relatively acceptable. Newly developed or modified respirators must undergo reliable testing to ensure the protection of HCWs. Subject and respirator characteristics should be considered when implementing fit testing protocols. An optimal fit test panel should be developed prior to respirator design, certification, procurement decisions, and selection procedures.
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Affiliation(s)
- Anahita Fakherpour
- Student Research Committee, Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Jahangiri
- Department of Occupational Health and Safety Engineering, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Janis Jansz
- School of Mines: Minerals, Energy and Chemical Engineering, Faculty of Science and Engineering, Curtin University, Perth, Australia
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Lavell AHA, Tijdink J, Buis DTP, Smulders YM, Bomers MK, Sikkens JJ. Why not to pick your nose: Association between nose picking and SARS-CoV-2 incidence, a cohort study in hospital health care workers. PLoS One 2023; 18:e0288352. [PMID: 37531335 PMCID: PMC10395815 DOI: 10.1371/journal.pone.0288352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/23/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Hospital health care workers (HCW) are at increased risk of contracting SARS-CoV-2. We investigated whether certain behavioral and physical features, e.g. nose picking and wearing glasses, are associated with infection risk. AIM To assess the association between nose picking and related behavioral or physical features (nail biting, wearing glasses, and having a beard) and the incidence of SARS-CoV-2-infection. METHODS In a cohort study among 404 HCW in two university medical centers in the Netherlands, SARS-CoV-2-specific antibodies were prospectively measured during the first phase of the pandemic. For this study HCW received an additional retrospective survey regarding behavioral (e.g. nose picking) and physical features. RESULTS In total 219 HCW completed the survey (response rate 52%), and 34/219 (15.5%) became SARS-CoV-2 seropositive during follow-up from March 2020 till October 2020. The majority of HCW (185/219, 84.5%) reported picking their nose at least incidentally, with frequency varying between monthly, weekly and daily. SARS-CoV-2 incidence was higher in nose picking HCW compared to participants who refrained from nose picking (32/185: 17.3% vs. 2/34: 5.9%, OR 3.80, 95% CI 1.05 to 24.52), adjusted for exposure to COVID-19. No association was observed between nail biting, wearing glasses, or having a beard, and the incidence of SARS-CoV-2 infection. CONCLUSION Nose picking among HCW is associated with an increased risk of contracting a SARS-CoV-2 infection. We therefore recommend health care facilities to create more awareness, e.g. by educational sessions or implementing recommendations against nose picking in infection prevention guidelines.
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Affiliation(s)
- A. H. Ayesha Lavell
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Joeri Tijdink
- Department Ethics, Law and Humanities, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Philosophy, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David T. P. Buis
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Yvo M. Smulders
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Marije K. Bomers
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Jonne J. Sikkens
- Department of Internal Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
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Xu X, Zhao L, Zhu Y, Du B, Zhu B, Zhang H, Han L, Liu X. Conducting quantitative mask fit tests: application details and affecting factors. Front Public Health 2023; 11:1218191. [PMID: 37521986 PMCID: PMC10372483 DOI: 10.3389/fpubh.2023.1218191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Respirators chosen based on their assigned protection factor (APF) enable wearers to effectively reduce particulate matter concentrations to safe levels when used correctly. As a crucial factor in achieving the intended APF, the fit test has become a necessary procedure in respiratory disease protection. Methods This study involved 225 participants who underwent a fit test using two reusable types of half masks and two types of full masks. Condensation nuclei counting (CNC) and controlled negative pressure (CNP) were performed. Results The results revealed that the passing rate of full masks was higher compared to half masks. Specifically, the passing rate for the half masks and the full masks were 84.7 and 91.6%, respectively. Gender exerted a statistically significant effect on the passing rate. Nevertheless, age, educational background, and training exhibited relatively negligible effects. Certain movements, such as facing forward, were identified as key actions with strong correlation. Additionally, talking was considered a key action with a high failure rate due to instantaneous leakages. Most participants failed at the initial step of CNP, but nearly all of them passed the fit test using CNC. Discussion Therefore, putting on full masks, especially for women, provides optimal protection during work. Furthermore, attention should be given to the displacement and deformation of the respirator during the key actions. When it comes to fit test methods, CNC was found to be more practical and comprehensive compared to CNP. Moreover, additional physiological characteristics, such as double chins, could be explored as potential influential factors.
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Affiliation(s)
- Xiaodan Xu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Occupational Disease Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
| | - Liangliang Zhao
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Occupational Disease Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
| | - Yong Zhu
- Pudong New Area Center for Disease Control and Prevention, Shanghai, China
| | - Bing Du
- BASF-YPC Company Limited, Nanjing, China
| | - Baoli Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Occupational Disease Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
| | - Hengdong Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Occupational Disease Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
| | - Lei Han
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Occupational Disease Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
| | - Xin Liu
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Occupational Disease Prevention, Nanjing, China
- Jiangsu Province Engineering Research Center of Health Emergency, Nanjing, China
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10
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Knobloch JK, Franke G, Knobloch MJ, Knobling B, Kampf G. Overview of tight fit and infection prevention benefits of respirators (filtering face pieces). J Hosp Infect 2023; 134:89-96. [PMID: 36738992 PMCID: PMC9894678 DOI: 10.1016/j.jhin.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
Regulations for measures to protect against SARS-CoV-2 transmission vary widely around the world, with very strict regulations in Germany where respirators (filtering face piece FFP2 or comparable) are often mandatory. The efficiency of respirators, however, depends essentially on the tight facial fit avoiding the bypass of contaminated air via gaps between mask and wearer's face. The facial fit can be verified in a fit test. The aim of this review was to describe the quantitative fit test results depending on the respirator designs. A literature search revealed 29 suitable studies. Of all respirators with circumferential head straps, three-panel folded dome-shaped respirators showed the best fit (80.8% of 4625 fit tests passed), followed by rigid-dome-shaped respirators (72.4% of 8234 fit tests passed), duckbill-shaped respirators (31.6% of 2120 fit tests passed), and coffee-filter-shaped respirators (30.9% of 3392 fit tests passed). Respirators with ear loops showed very poor tight fit (3.6% of 222 fit tests passed). In four randomized control trials, single-use respirators were not shown to be superior to surgical masks for the prevention of laboratory-confirmed viral respiratory infections, even when adjusted with a fit test. Therefore, we consider the mandatory use of respirators to be disproportionate and not supported by evidence. Further evidence should be generated, in which scenarios respirators might provide an effective benefit as part of occupational health and safety. For situations with confirmed benefits, only high-quality disposable respirators with head straps or respiratory protective equipment of higher protective levels should be used.
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Affiliation(s)
- J K Knobloch
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - G Franke
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M J Knobloch
- University Medicine Göttingen, Göttingen, Germany
| | - B Knobling
- Institute of Medical Microbiology, Virology, and Hygiene, Department for Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Kampf
- University Medicine Greifswald, Greifswald, Germany
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11
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Williams DL, Kave B, Bodas C, Begg F, Roberts M, Ng I. Protocol of a prospective comprehensive evaluation of an elastic band beard cover for filtering facepiece respirators in healthcare. PLoS One 2023; 18:e0281152. [PMID: 36719896 PMCID: PMC9888701 DOI: 10.1371/journal.pone.0281152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/08/2022] [Indexed: 02/01/2023] Open
Abstract
Individuals who are unable to be clean shaven for religious, medical or cultural reasons are unable to wear a filtering facepiece respirator (FFR), as the respirator cannot provide adequate protection against aerosol-transmissible diseases. There is currently a paucity of validated techniques to ensure the safe inclusion of bearded healthcare workers in the pandemic workforce. We propose to undertake a healthcare-based multi-modal evaluation study on the elastic band beard cover for FFR technique, examining the quantitative fit test (QNFT) results, usability and skill level of participants with repeated assessments over time. This is a prospective study conducted through the Respiratory Protection Program at the Royal Melbourne Hospital. Healthcare workers are invited to participate if they require respiratory protection and cannot shave for religious, cultural or medical reasons. An online education package on the use of respiratory protective equipment and the elastic band beard cover for FFR technique is provided. This is followed by a face-to-face session, where the participant will receive: one-on-one training; undergo a skill assessment on their donning, doffing and user seal check techniques; complete QNFTs and a usability survey. Participants will be invited to repeat the assessment within 3 months of the first session and at 12 months. This study involves multimodal and repeated assessments of an elastic band beard cover for FFRs. The findings of this study will provide information on: whether this simple technique can provide safe, consistent and effective respiratory protection; whether it will interfere with occupational activities; and whether it is comfortable and tolerable for the duration of wear. This is of significant importance to the health workforce around the world, who cannot shave but require access to respiratory protective equipment during the COVID-19 pandemic.
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Affiliation(s)
- Daryl Lindsay Williams
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Kave
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
| | - Charles Bodas
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Australia
| | - Fiona Begg
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Australia
| | - Megan Roberts
- Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Australia
| | - Irene Ng
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
- Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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12
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Tsuji M, Hori H, Koriyama C, Tanaka R, Isse T, Ishihara Y, Ishizuka T, Hasegawa W, Goto M, Yatera K, Kunugita N, Kuwamura M, Sakuragi T, Yasumura Y, Yamamoto M, Ueno S. The effect of mask fit test on the association between the concentration of metals in biological samples and the results of time-weighted average personal exposure: A study on Japanese male welders. J Occup Health 2023; 65:e12399. [PMID: 37130744 PMCID: PMC10154167 DOI: 10.1002/1348-9585.12399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/13/2023] [Accepted: 03/29/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES The mask fit test confirms whether the wearing condition of the wearer's face and the facepiece of the respirators are used appropriately. This study aimed to examine whether the results of the mask fit test affect the association between the concentration of metals related to welding fumes in biological samples and the results of time-weighted average (TWA) personal exposures. METHODS A total of 94 male welders were recruited. Blood and urine samples were obtained from all participants to measure the metal exposure levels. Using personal exposure measurements, the 8-h TWA (8 h-TWA) of respirable dust, TWA of respirable Mn, and 8-h TWA of respirable Mn were calculated. The mask fit test was performed using the quantitative method specified in the Japanese Industrial Standard T8150:2021. RESULTS Fifty-four participants (57%) passed the mask fit test. Only in the Fail group of the mask fit test, it was observed that blood Mn concentrations be positively associated with the results of TWA personal exposure after adjusting for multivariate factors (8-h TWA of respirable dust; coefficient, 0.066; standard error (SE), 0.028; P = 0.018, TWA of respirable Mn: coefficient, 0.048; SE, 0.020; P = 0.019, 8 h-TWA of respirable Mn: coefficient, 0.041; SE, 0.020; P = 0.041). CONCLUSIONS The results clarify that welders with high concentrations of welding fumes in their breathing air zone are exposed to dust and Mn if there is leaking air owing to the lack of fitness between respirators and the wearer's face when using human samples in Japan.
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Affiliation(s)
- Mayumi Tsuji
- Department of Environmental Health, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Hajime Hori
- Department of Occupational Hygiene, School of Health SciencesUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Chihaya Koriyama
- Department of Epidemiology and Preventive MedicineKagoshima University Graduate School of Medical and Dental SciencesKagoshimaJapan
| | - Rie Tanaka
- Department of Environmental Health, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Toyohi Isse
- Section of Postgraduate Guidance School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Yasuhiro Ishihara
- Program of Biomedical Science, Graduate School of Integrated Sciences for LifeHiroshima UniversityHiroshimaJapan
| | - Tsunetoshi Ishizuka
- Department of Occupational Toxicology, Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Wataru Hasegawa
- Department of Occupational Toxicology, Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Motohide Goto
- Department of Occupational Toxicology, Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Naoki Kunugita
- Department of Occupational and Community Health Nursing, School of Health SciencesUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Mami Kuwamura
- Department of Environmental Health, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Toshihide Sakuragi
- Department of Environmental Health, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Yoshiko Yasumura
- Department of Environmental Health, School of MedicineUniversity of Occupational and Environmental HealthFukuokaJapan
| | - Megumi Yamamoto
- Department of Environment and Public HealthNational Institute for Minamata DiseaseKumamotoJapan
| | - Susumu Ueno
- Department of Occupational Toxicology, Institute of Industrial Ecological SciencesUniversity of Occupational and Environmental HealthFukuokaJapan
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13
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Schreiber J, Brüggmann D, Braun M, Groneberg DA. The measuring aerosol spreading during countermeasures (MASC) study presents an automated system to investigate face mask efficacy and other aerosol countermeasures in varying environments. Sci Rep 2022; 12:21349. [PMID: 36494375 PMCID: PMC9734563 DOI: 10.1038/s41598-022-25210-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic exemplified the importance of research on personal protective equipment. In specific, understanding how effective surgical masks or particulate filter respirators are at reducing the transmission of infectious diseases has suddenly become one of the most pressing issues for legislators, regulators, and everyday life. However, there was a lack of available scientific platforms to assess this issue. Therefore, we designed and built a system entitled MASC: measuring aerosol spreading during countermeasures. This platform allows the simulation of various everyday situations and evaluation of the efficacy of masks and respirators in reducing the amount of inhaled particulate matter from the air. Furthermore, MASC can be used to investigate how aerosols propagate in closed spaces, such as offices or classrooms. It can be used to generate aerosols on command and control the room temperature, humidity, and wind speed. Up to four laser aerosol spectrometers can be read simultaneously, and a camera can automatically take pictures to evaluate the efficacy of countermeasures to prevent the spread of aerosols. The aerosol generation, measurement periods, and the number of repetitions for an experiment can be configured digitally and are executed by a computer automatically. A website displays the data in real time and allows monitoring of the experiment. Upon completion, statistical values are calculated automatically to accelerate the evaluation of the gathered data. Codes and technical drawings in this present methodology publication are open source and can be used by the scientific community to establish similar systems.
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Affiliation(s)
- Johannes Schreiber
- grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine, Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Dörthe Brüggmann
- grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine, Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - Markus Braun
- grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine, Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
| | - David A. Groneberg
- grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine, Environmental Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt Am Main, Germany
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14
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Kapote GR, Tharwani P, Vhatkar B, Sangrar S. Coronavirus outbreaks and infection prevention in dentistry: a narrative review. CANADIAN JOURNAL OF DENTAL HYGIENE : CJDH = JOURNAL CANADIEN DE L'HYGIENE DENTAIRE : JCHD 2022; 56:140-146. [PMID: 36451994 PMCID: PMC9673999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 06/17/2023]
Abstract
Objective This narrative review aims to compile and analyse infection prevention and control (IPAC) practices followed by dental clinics during 3 coronavirus outbreaks: SARS (2002-2004), MERS (2012-2014), and COVID-19 (2019-); and to draw parallels from them for future epidemics. Methods Data were collected from 3 databases: Google Scholar, PubMed, and Embase using search terms "SARS," "MERS," "COVID-19," "infection control," "disinfection," and "sterilization". Results Careful examination of 108 peer-reviewed articles on the 3 outbreaks revealed the following commonalities in the IPAC practices of dental clinics: use of sodium hypochlorite (surface disinfectant), ethanol and 1-propanol (hand hygiene), povidone-iodine (oral rinse), high-volume evacuation (HVE), rubber dam isolation, anti-retraction handpieces, and fogging. Discussion & Conclusion Ethanol, 1-propanol, sodium hypochlorite, povidone-iodine, photocatalysis, and fogging have been shown to be effective against various coronaviruses. However, more studies are required to validate the effectiveness of anti-retraction handpieces, rubber dam isolation, HVE, and cold atmospheric plasma specifically in infection control of the current coronavirus strain, SARS-CoV-2.
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Affiliation(s)
- Gaurij R Kapote
- College of Dentistry, University of Saskatchewan; Northend Dental, Saskatoon, SK, Canada
| | - Payal Tharwani
- Registered dental assistant, Vidor Dental, Beaumont, USA
| | - Bhavika Vhatkar
- Assistant professor, School of Dentistry, DY Patil University, Navi Mumbai, India
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15
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Chen H, Pennington ER, Case MW, Tong H, Rappold AG, Samet JM, Prince SE. Improvement in Fitted Filtration Efficiency of N95 Respirators With Escalating Instruction of the Wearer. AJPM FOCUS 2022; 1:100014. [PMID: 36338466 PMCID: PMC9628765 DOI: 10.1016/j.focus.2022.100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Introduction Fitted filtration performance of an N95 respirator may benefit from differing levels of instructions. Methods Using a modified Occupational Safety and Health Administration fit test protocol, we measured fitted filtration efficiency for an N95 respirator in 21 screened, healthy participants given 4 levels of escalating instruction: (1) uninstructed (baseline), (2) written/pictorial manufacturer instructions, (3) step-by-step video demonstration, and (4) staff instruction (visual inspection of respirator fit and verbal suggestions to adjust when applicable). Results Baseline fitted filtration efficiency was not significantly different between participants with or without previous experience of N95 use. Clear improvements in fitted filtration efficiency were observed progressing from baseline (average=86.1%) to manufacturer paper instructions (93.3%), video instructions (97.5%), and post staff intervention (98.3%). Baseline fitted filtration efficiency values were significantly lower than those after video instruction (p<0.037) and staff intervention (p<0.033) sessions. Conclusions Beyond uninstructed wear or provision of manufacturer instructions, efforts to train and instruct users in proper respirator fit principles with visual feedback are likely to yield benefits to public health outcomes in reducing respiratory exposure during air quality emergencies such as airborne viral outbreaks and wildland fires.
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Affiliation(s)
- Hao Chen
- Oak Ridge Institute for Science Education, Oak Ridge, Tennessee
| | | | - Martin W. Case
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Haiyan Tong
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Ana G. Rappold
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
| | - James M. Samet
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Steven E. Prince
- Public Health and Environmental Systems Division, Center for Public Health and Environmental Assessment, Office of Research and Development, U.S. Environmental Protection Agency, Research Triangle Park, North Carolina
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16
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Chen H, Samet JM, Tong H, Abzhanova A, Rappold AG, Prince SE. Can disposable masks be worn more than once? ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2022; 242:113908. [PMID: 35872486 PMCID: PMC9301359 DOI: 10.1016/j.ecoenv.2022.113908] [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: 04/13/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Disposable facemasks are a primary tool to prevent the transmission of SARS-COV-2 during the COVID-19 pandemic. However, plastic waste generated from their disposal represents a significant environmental problem that can be reduced by maximizing the service life of disposable masks. We evaluated the effect of repeated wearing on the fitted filtration efficiency (FFE) of N95, KF94, KN95, and procedure/surgical masks. The FFEs of masks were compared following extended wearing with and without washing. Results reveal that most disposable facemasks can retain a high level of their baseline FFE after extended wearing, even after 40 h of wearing. Laundering disposable masks degraded FFE in some instances. We conclude that the durability of disposable facemask performance is considerably longer than their intended single use indication, suggesting that reusing disposable masks is a safe means of reducing plastic waste in the environment.
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Affiliation(s)
- Hao Chen
- Oak Ridge Institute for Science Education, Oak Ridge, TN, USA
| | - James M Samet
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Haiyan Tong
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Aiman Abzhanova
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana G Rappold
- Public Health and Integrated Toxicology Division, Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Steven E Prince
- Public Health and Environmental Systems Division, Center for Public Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, NC, USA
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17
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Loibner M, Barach P, Wolfgruber S, Langner C, Stangl V, Rieger J, Föderl-Höbenreich E, Hardt M, Kicker E, Groiss S, Zacharias M, Wurm P, Gorkiewicz G, Regitnig P, Zatloukal K. Resilience and Protection of Health Care and Research Laboratory Workers During the SARS-CoV-2 Pandemic: Analysis and Case Study From an Austrian High Security Laboratory. Front Psychol 2022; 13:901244. [PMID: 35936273 PMCID: PMC9353000 DOI: 10.3389/fpsyg.2022.901244] [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: 03/22/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
The SARS-CoV-2 pandemic has highlighted the interdependency of healthcare systems and research organizations on manufacturers and suppliers of personnel protective equipment (PPE) and the need for well-trained personnel who can react quickly to changing working conditions. Reports on challenges faced by research laboratory workers (RLWs) are rare in contrast to the lived experience of hospital health care workers. We report on experiences gained by RLWs (e.g., molecular scientists, pathologists, autopsy assistants) who significantly contributed to combating the pandemic under particularly challenging conditions due to increased workload, sickness and interrupted PPE supply chains. RLWs perform a broad spectrum of work with SARS-CoV-2 such as autopsies, establishment of virus cultures and infection models, development and verification of diagnostics, performance of virus inactivation assays to investigate various antiviral agents including vaccines and evaluation of decontamination technologies in high containment biological laboratories (HCBL). Performance of autopsies and laboratory work increased substantially during the pandemic and thus led to highly demanding working conditions with working shifts of more than eight hours working in PPE that stressed individual limits and also the ergonomic and safety limits of PPE. We provide detailed insights into the challenges of the stressful daily laboratory routine since the pandemic began, lessons learned, and suggest solutions for better safety based on a case study of a newly established HCBL (i.e., BSL-3 laboratory) designed for autopsies and research laboratory work. Reduced personal risk, increased resilience, and stress resistance can be achieved by improved PPE components, better training, redundant safety measures, inculcating a culture of safety, and excellent teamwork.
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Affiliation(s)
- Martina Loibner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Paul Barach
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Stella Wolfgruber
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Christine Langner
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Verena Stangl
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Julia Rieger
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Melina Hardt
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Eva Kicker
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Silvia Groiss
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Martin Zacharias
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Philipp Wurm
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Gregor Gorkiewicz
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Kurt Zatloukal
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria
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18
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Temmesfeld MJ, Gorzkowska-Sobas AA, Hedlund K, Øyen MØ, Kanten L, Grant P, Jakobsen RB. Surgical helmets can be converted into efficient disinfectable powered air-purifying respirators. Am J Infect Control 2022; 50:624-630. [PMID: 34958857 DOI: 10.1016/j.ajic.2021.12.002] [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: 10/30/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Filtering facepiece respirators often fail to provide sufficient protection due to a poor fit. Powered air-purifying respirators (PAPRs) are not designed for healthcare personnel, and are challenging to disinfect. Surgical helmets (SH) are available in many United States hospitals but do not provide respiratory protection. Several modifications to SH have been suggested, but none are sufficiently compliant with safety and efficiency standards. The purpose of this investigation was the development of a filter adaptor, which converts SHs into efficient, safe, and disinfectable PAPRs. METHODS Four critical features were investigated close to regulatory requirements: total inward leakage of particles, CO2 concentrations, intra-helmet differential pressure, and automated disinfection. RESULTS The average total inward leakage in the 2 independent tests were 0.005% and 0.01%. CO2 concentrations were lower than in the original SH. The modification generates a positive differential pressure. The filter's performance was not compromised after 50 cycles in a sterilization machine. DISCUSSION The modified SH provides several hundred times better protection than FFP-3 masks. CONCLUSIONS Surgical helmets can be modified into safe, efficient, and disinfectable PAPRs, suitable for HCP and the operating room in particular. They can play a role in the preparedness for upcoming events requiring efficient respiratory protection.
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Affiliation(s)
- Max Joachim Temmesfeld
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway.
| | | | | | | | - Lars Kanten
- Department of Sterile Supplies, Akershus University Hospital, Lørenskog, Norway
| | - Peter Grant
- Department of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of Gothenburg, Gotehnburg, Sweden; Lovisenberg Diaconal Hospital, Nydalen, Oslo, Norway
| | - Rune B Jakobsen
- Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Orthopedics, Akershus University Hospital, Lørenskog, Norway
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19
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Bhatia DD, Bhatia KS, Saluja T, Saluja AP, Thind A, Bamra A, Singh G, Singh N, Clezy K, Dempsey K, Hudson B, Jain S. Under-mask beard covers achieve an adequate seal with tight-fitting disposable respirators using quantitative fit testing. J Hosp Infect 2022; 128:8-12. [PMID: 35662553 DOI: 10.1016/j.jhin.2022.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Tight-fitting respirators are a critical component of respiratory protection against airborne diseases for health workers. However, they are not recommended for health workers with facial hair. Some health workers are unable to shave for religious or medical reasons. Under-mask beard covers have been proposed as a solution to allow health workers with facial hair to wear tight-fitting respirators. However, studies to date have been limited by their predominant reliance on qualitative rather than quantitative fit testing techniques. AIM To assess the efficacy of under-mask beard covers in achieving an adequate seal with tight-fitting disposable P2/N95 respirators using quantitative fit testing. METHODS Bearded adult males underwent quantitative fit testing with an under-mask beard cover using either a TSI PortaCount Respirator Fit Tester 8038™ or AccuFit 9000 PRO™ fit testing device on up to five disposable P2/N95 respirators (3M 1860, 3M 1870+, BYD N95 Helathcare Particulate Respirator, BSN Medical ProShield N-95 Medium and Trident RTCFFP2). The primary outcome was the proportion of subjects that passed or failed quantitative fit testing with an under-mask beard cover. FINDINGS Thirty subjects were assessed, 24 (80%) passed quantitative fit testing with at least one tight-fitting P2/N95 disposable respirator. Among these subjects the median (IQR) best achieved fit factor was 200 (178-200). No subject had an adverse reaction to the under-mask beard cover. CONCLUSION The under-mask beard cover technique may be used to achieve a satisfactory seal with tight-fitting P2/N95 respirators in health workers with facial hair that cannot shave.
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