A comparison of facemask and respirator filtration test methods

A retrospective characterization of pediatric facemasks marketed in the United States and implications for future designs

BACKGROUND

Device manufacturers who seek to market their pediatric facemasks in the United States (U.S.), as part of anthropometric data requirement, need to demonstrate their mask designs are expected to fit the intended user population. However, currently there are no well accepted test methodologies for pediatric facemasks. In addition, unlike N95 respirators, the expected maximum flow rate, and the pressure drop at that expected maximum flow rate for pediatric facemasks have not been established.

METHOD

The objective of this article is three-fold; use a literature survey to determine the worst-case flow rate, and an acceptable breathing resistance; and come up with a bench-test based protocol for assessing fit of pediatric facemasks.

RESULTS & DISCUSSION

The worst-case breathing flow rate for mask testing in the pediatric population is 45-60 Liters/minute (LPM), and the acceptable pressure drop at the worst-case flow rate is 2.0 mmH2O. A retrospective assessment of all the four brands of legally marketed facemasks in the U.S. that could be purchased, revealed that majority of the brands have high filtration efficiency (>95%) at low flow rate 5 LPM which reduces to ~ 80% at 45 LPM. At 5 LPM, the pressure drop ranges from 0.3-0.6 mmH2O, remaining below the 2.0 mmH2O. However, at higher flow rates, (representing strenuous activities, or older children (> 12 years)), most masks exhibited a pressure drop within the range of 2.9 to 6.0 mmH2O. Furthermore, opening the pleats of the facemasks completely results in a notable reduction in pressure drop (a 6.6-fold decrease, p = 0.03). To assess fit of these same brands of facemasks, we then updated our previous validated adult manikin fit-test method and used it in manikins in the age group of 2 to 14 years. Either poor nose-clip adherence to the manikin, low filtration efficiency of the pediatric facemasks, or off-label use (i.e. when donned on manikins representing 2 years to 14 years) contributed to low fit.

CONCLUSIONS

A new bench-top tool to evaluate quantitative fit of pediatric facemasks was developed. In addition, based on the research reported here, we provide practical implications for the members of the community: users, academia and medical device manufacturers.

Riboflavin based setup as an alternative method for a preliminary screening of face mask filtration efficiency

Face masks are essential in reducing the transmission of respiratory infections and bacterial filtration efficiency, a key parameter of mask performances, requires the use of Staphylococcus aureus and specialised staff. This study aims to develop a novel method for a preliminary screening of masks or materials filtration efficiency by a green, easy and rapid setup based on the use of a riboflavin solution, a safe autofluorescent biomolecule. The proposed setup is composed of a commercial aerosol generator commonly used for aerosol therapy, custom 3D printed aerosol chamber and sample holder, a filter for downstream riboflavin detection and a vacuum pump. The filtration efficiency of four different masks was assessed using the riboflavin-based setup and the bacterial filtration efficiency (BFE). The averaged filtration efficiency values, measured with both methods, were similar but were higher for the riboflavin-based setup (about 2% for all tested samples) than bacterial filtration efficiency. Considering the good correlation, the riboflavin-based setup can be considered validated as an alternative method to bacterial filtration efficiency for masks and related materials fabrics filtration efficiency screening but This study aims to develop a novel method for a preliminary screening of masks or materials filtration efficiency by a green, easy and rapid setup based on the use of a riboflavin solution, a safe autofluorescent biomolecule, but not to replace regulation approaches. The proposed setup can be easily implemented at low price, is more rapid and eco-friendly and can be performed in chemical-physical laboratories without the needing of biosafety laboratory and specialised operators.

Nanofiberous facemasks as protectives against pandemic respiratory viruses

INTRODUCTION

Wearing protective face masks and respirators has been a necessity to reduce the transmission rate of respiratory viruses since the outbreak of the coronavirus (COVID-19) disease. Nevertheless, the outbreak has revealed the need to develop efficient air filter materials and innovative anti-microbial protectives. Nanofibrous facemasks, either loaded with antiviral nanoparticles or not, are very promising personal protective equipment (PPE) against pandemic respiratory viruses.

AREAS COVERED

In this review, multiple types of face masks and respirators are discussed as well as filtration mechanisms of particulates. In this regard, the limitations of traditional face masks were summarized and the advancement of nanotechnology in developing nanofibrous masks and air filters was discussed. Different methods of preparing nanofibers were explained. The various approaches used for enhancing nanofibrous face masks were covered.

EXPERT OPINION

Although wearing conventional face masks can limit viral infection spread to some extent, the world is in great need for more protective face masks. Nanofibers can block viral particles efficiently and can be incorporated into face masks in order to enhance their filtration efficiency. Also, we believe that other modifications such as addition of antiviral nanoparticles can significantly increase the protection power of facemasks.

Self-Sanitization in a Silk Nanofibrous Network for Biodegradable PM0.3 Filters with In Situ Joule Heating

In the contemporary way of life, face masks are crucial in managing disease transmission and battling air pollution. However, two key challenges, self-sanitization and biodegradation of face masks, need immediate attention, prompting the development of innovative solutions for the future. In this study, we present a novel approach that combines controlled acid hydrolysis and mechanical chopping to synthesize a silk nanofibrous network (SNN) seamlessly integrated with a wearable stainless steel mesh, resulting in the fabrication of self-sanitizable face masks. The distinct architecture of face masks showcases remarkable filtration efficiencies of 91.4, 95.4, and 98.3% for PM0.3, PM0.5, and PM1.0, respectively, while maintaining a comfortable level of breathability (ΔP = 92 Pa). Additionally, the face mask shows that a remarkable thermal resistance of 472 °C cm2 W-1 generates heat spontaneously at low voltage, deactivating Escherichia coli bacteria on the SNN, enabling self-sanitization. The SNN exhibited complete disintegration within the environment in just 10 days, highlighting the remarkable biodegradability of the face mask. The unique advantage of self-sanitization and biodegradation in a face mask filter is simultaneously achieved for the first time, which will open avenues to accomplish environmentally benign next-generation face masks.

Comparison of the inward leakage rate between N95 filtering facepiece respirators and modified surgical masks during the COVID-19 pandemic

BACKGROUND

Owing to shortage of surgical and N95 filtering facepiece respirators (FFRs) during the COVID-2019 pandemic, various masks were developed to prevent infection. This study aimed to examine the inward leakage rate (ILR) of sealed face masks and modified surgical masks using a quantitative fit test and compared it with the ILR of unmodified N95 FFRs.

METHODS

We conducted paired comparisons of ILRs of bent nose-fit wire masks, double masks, and N95 FFRs from October to December 2021. To measure the protective effectiveness of masks, participants wore masks, and the number of particles outside and inside the mask were measured. The ILR was based on the percentage of particles entering the mask using a fit tester.

RESULTS

We enrolled 54 participants (20 men and 34 women) in this study. The median ILR for surgical masks without and with a W-shaped bend in the nose-fit wire were 96.44% and 50.82%, respectively. The nose-fit wire adjustment reduced the ILR of surgical masks by a mean of 28.57%, which was significantly lower than the ILR without adjustment (P < 0.001). For double masks, with surgical or polyurethane masks on top of the W-shaped mask, the ILR did not differ significantly from that of N95. Although the filtration performance of double surgical masks matched that of N95 masks, their ILR was notably higher, indicating that double masks do not provide equivalent protection.

CONCLUSIONS

Wearing N95 masks alone is effective in many cases. However, surgical mask modifications do not guarantee consistent effectiveness. Properly selected, sealed masks with a good fit overcome leakage, emphasizing their crucial role. Without evidence, mask-wearing may lead to unexpected infections. Education based on quantitative data is crucial for preventing adverse outcomes.

Upscaling of Electrospinning Technology and the Application of Functionalized PVDF-HFP@TiO2 Electrospun Nanofibers for the Rapid Photocatalytic Deactivation of Bacteria on Advanced Face Masks

In recent years, Electrospinning (ES) has been revealed to be a straightforward and innovative approach to manufacture functionalized nanofiber-based membranes with high filtering performance against fine Particulate Matter (PM) and proper bioactive properties. These qualities are useful for tackling current issues from bacterial contamination on Personal Protective Equipment (PPE) surfaces to the reusability of both disposable single-use face masks and respirator filters. Despite the fact that the conventional ES process can be upscaled to promote a high-rate nanofiber production, the number of research works on the design of hybrid materials embedded in electrospun membranes for face mask application is still low and has mainly been carried out at the laboratory scale. In this work, a multi-needle ES was employed in a continuous processing for the manufacturing of both pristine Poly (Vinylidene Fluoride-co-Hexafluoropropylene) (PVDF-HFP) nanofibers and functionalized membrane ones embedded with TiO2 Nanoparticles (NPs) (PVDF-HFP@TiO2). The nanofibers were collected on Polyethylene Terephthalate (PET) nonwoven spunbond fabric and characterized by using Scanning Electron Microscopy and Energy Dispersive X-ray (SEM-EDX), Raman spectroscopy, and Atomic Force Microscopy (AFM) analysis. The photocatalytic study performed on the electrospun membranes proved that the PVDF-HFP@TiO2 nanofibers provide a significant antibacterial activity for both Staphylococcus aureus (~94%) and Pseudomonas aeruginosa (~85%), after only 5 min of exposure to a UV-A light source. In addition, the PVDF-HFP@TiO2 nanofibers exhibit high filtration efficiency against submicron particles (~99%) and a low pressure drop (~3 mbar), in accordance with the standard required for Filtering Face Piece masks (FFPs). Therefore, these results aim to provide a real perspective on producing electrospun polymer-based nanotextiles with self-sterilizing properties for the implementation of advanced face masks on a large scale.

Acoustic and perceptual impact of face masks on speech: A scoping review

During the COVID-19 pandemic, personal protective equipment such as facial masks and coverings were mandated all over the globe to protect against the virus. Although the primary aim of wearing face masks is to protect against viral transmission, they pose a potential burden on communication. The purpose of this scoping review was to identify the state of the evidence of the effect of facial coverings on acoustic and perceptual speech outcomes. The scoping review followed the framework created by Arksey & O'Malley (2005) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines (PRISMA-ScR; Tricco et al., 2018). The search was completed in May 2021 across the following databases: PubMed, EMBASE, PsycINFO, Web of Science, and Google Scholar. A total of 3,846 records were retrieved from the database search. Following the removal of duplicates, 3,479 remained for the title/abstract screen and 149 were selected for the full-text review. Of these, 52 were included in the final review and relevant data were extracted. The 52 articles included in the final review consisted of; 11 studied perceptual outcomes only, 16 studied acoustic outcomes only, and 14 studied both perceptual and acoustic outcomes. 13 of these investigated acoustic features that could be used for mask classification. Although the findings varied from article to article, many trends stood out. Many articles revealed that face masks act as a low pass filter, dampening sounds at higher frequencies; however, the frequency range and the degree of attenuation varied based on face mask type. All but five articles that reported on perceptual outcomes showed a common trend that wearing a face mask was associated with poorer speech intelligibility. The findings of the scoping review provided evidence that facial coverings negatively impacted speech intelligibility, which is likely due to a combination of auditory and visual cue degradation. Due to the continued prevalence of mask use, how facial coverings affect a wider variety of speaker populations, such as those with communication impairments, and strategies for overcoming communication challenges should be explored.

Determining the filtration effectiveness of non-standard respiratory protective devices by an ad-hoc laboratory methodology

The recent pandemic caused by COVID-19 profoundly changed people's habits. Wearing a face mask has become usual in everyday life to reduce the risk of infection from airborne diseases. At the beginning of the pandemic, the massive request of surgical or filtering face piece (FFP) masks resulted in a global shortage of these devices for the most exposed people, such as healthcare workers. Due to this high demand for respiratory protective devices, many industrial plants have partly converted to the production of face masks using adapted materials and not complying with any specific regulation (non-standard respiratory protective devices or community masks). In this work, an ad-hoc laboratory methodology has been developed to evaluate the filtration efficiency of the materials that compose the community masks using specific instrumentation. The instrumentation consists of three main tools: an aerosol generator, a specifically designed measuring chamber, and an optical particle sizer (OPS) for the measurement of aerosol concentration. The generated aerosol was sent into the measuring chamber, divided into two separate sections by the respiratory mask. The OPS measured the aerosol mass concentration upstream and downstream of the respiratory mask, and from the concentration difference the filtration efficiency was evaluated. The proposed methodology has been validated by evaluating the particle filtration efficiency (PFE) of certified respiratory masks and was then applied for the evaluation of the filtration efficiency of different types of non-standard or community masks to analyze their effectiveness in protecting from the risk of infection of airborne diseases.

Measuring the quantity of harmful volatile organic compounds inhaled through masks

An increase in the concentration of environmental particulate matter and the spread of the COVID-19 virus have dramatically increased our time spent wearing masks. If harmful chemicals are released from these masks, there may be harmful effects on human health. In this study, the concentration of volatile organic compounds (VOCs) emitted from some commonly used masks was assessed qualitatively and quantitatively under diverse conditions (including different mask material types, time between opening the product and wearing, and mask temperature). In KF94 masks, 1-methoxy-2-propanol (221 ± 356 µg m-3), N,N-dimethylacetamide (601 ± 450 µg m-3), n-hexane (268 ± 349 µg m-3), and 2-butanone (160 ± 244 µg m-3) were detected at concentrations 22.9-147 times higher than those found in masks made from other materials, such as cotton and other functional fabrics. In addition, in KF94 masks, the total VOC (TVOC) released amounted to 3730 ± 1331 µg m-3, about 14 times more than that released by the cotton masks (267.5 ± 51.6 µg m-3). In some KF94 masks, TVOC concentration reached over 4000 µg m-3, posing a risk to human health (based on indoor air quality guidelines established by the German Environment Agency). Notably, 30 min after KF94 masks were removed from their packaging, TVOC concentrations decreased by about 80% from their initial levels to 724 ± 5.86 µg m-3; furthermore, 6 h after removal, TVOC concentrations were found to be less than 200 µg m-3. When the temperature of the KF94 masks was raised to 40 oC, TVOC concentrations increased by 119-299%. Since the types and concentrations of VOCs that will be inhaled by mask wearers vary depending on the mask use conditions, it is necessary to comply with safe mask wearing conditions.

Size-specific filtration efficiency and pressure drop of school-aged children's woven and nonwoven masks at varying face velocities

BACKGROUND

Differences in physiology and breathing patterns between children and adults lead to disparate responses to aerosols of varying sizes. No standardized method exists for measuring the filtration efficiency (FE) of children's masks to reflect such differences.

METHODS

Using an adult N95 mask as a control and two different face velocities (v_f) (9.3 cm/s representing adults and 4.0 cm/s representing school-aged children), we tested the pressure drop (ΔP) through children's nonwoven masks (surgical and KN95) and children's woven masks (100% cotton and partially-cotton-based masks), as well as their size-specific FE between aerodynamic particle diameters of 0.02 and 2.01 μm.

RESULTS

All three types of mask showed a 1 to 9% absolute increase in minimum FE at the lower v_f and a significant decrease in ΔP. For children's surgical masks the increase in FE was significant for most of the examined particle sizes, but for children's woven masks the increase was limited to particles smaller than 0.04 μm.

CONCLUSIONS

Lower v_f for children is likely to lead to a higher FE, lower ΔP, and consequently higher filter qualities in children's masks. For woven masks, the FE for particles larger than 0.04 μm was low (typically <50%) for both v_f's studied.

A Review of Filtration Performance of Protective Masks

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.

COMPARATIVE ASSESSMENT OF BACTERIAL PERMEABILITY OF A PERSONAL PROTECTIVE RESPIRATORY EQUIPMENT AT DIFFERENT DURATIONS OF ITS CONTINUOUS OPERATION

OBJECTIVE

The aim: To establish the level of antibacterial protection of the studied personal protective respiratory equipment set and its main components and compare antibacterial resistance of the personal protective respiratory equipment set in the presence and absence of filtering components.

PATIENTS AND METHODS

Materials and methods: The proposed methodology for assessing biological protection parameters is based on testing the permeability of personal respiratory protection equipment for bacteria by the method of serial dilutions. Also additional culturing of separate components of the protective set on a separate media is carried out. The experiment was also repeated in the absence of filtering elements and when they were replaced by gauze masks.

RESULTS

Results: The use of a fully equipped pneumatic helmet counteracted the penetration of the bacterial aerosol, which was manifested in the absence of growth on the media. The results obtained with the full configuration, as well as the indicators of the spread of bacteria when removing the filter elements and replacing them with gauze masks, showed that the device creates sufficient positive air pressure inside. The latter becomes a restraining factor that does not allow microorganisms to penetrate through the lower circuit.

CONCLUSION

Conclusions: Increasing the duration of continuous operation of the conceptual model up to 24 hours, increasing the bacterial load on the filters do not lead to a deterioration in the properties of antibacterial protection. Bacterial aerosol did not penetrate into the inner space of pneumatic helmet.

Particle filtration efficiency measured using sodium chloride and polystyrene latex sphere test methods

Standards governing face masks differ in the test methods used to determine sub-micron particle filtration efficiency (PFE), such that the meaning of PFE is not universal. Unifying the meaning of PFE requires data using these different test methods to drive improvements in standards. This simple data set provides the equivalence between two major test methods used to assess PFE: (1) a test method using a neutralized, polydisperse sodium chloride (NaCl) and (2) a test method using an unneutralized, "monodisperse" polystyrene latex sphere (PSL) aerosols. Measurements are made on over 5800 real-world medical masks, leading to the establishment of a relationship between these two kinds of PFE for these products.

Assessment of Different Experimental Setups to Determine Viral Filtration Efficiency of Face Masks

As a result of the COVID-19 pandemic, many new materials and masks came onto the market. To determine their suitability, several standards specify which properties to test, including bacterial filtration efficiency (BFE), while none describe how to determine viral filtration efficiency (VFE), a property that is particularly important in times of pandemic. Therefore, we focused our research on evaluating the suitability and efficiency of different systems for determining VFE. Here, we evaluated the VFE of 6 mask types (e.g., a surgical mask, a respirator, material for mask production, and cloth masks) with different filtration efficiencies in four experimental setups and compared the results with BFE results. The study included 17 BFE and 22 VFE experiments with 73 and 81 mask samples tested, respectively. We have shown that the masks tested had high VFE (>99% for surgical masks and respirators, ≥98% for material, and 87-97% for cloth masks) and that all experimental setups provided highly reproducible and reliable VFE results (coefficient of variation < 6%). Therefore, the VFE tests described in this study can be integrated into existing standards for mask testing.

Assessing the consequences of prolonged usage of disposable face masks

Due to the SARS-CoV-2 outbreak, wearing a disposable face mask has become a worldwide daily routine, not only for medical operators or specialized personnel, but also for common people. Notwithstanding the undeniable positive effect in reducing the risk of virus transmission, it is important to understand if a prolonged usage of the same face mask can have effectiveness on filtering capability and potential health consequences. To this aim, we present three investigations. A survey, carried out in central Italy, offers an overview of the distorted public awareness of face mask usage. A functional study shows how prolonged wearing leads to substantial drops in humid air filtration efficiency. Finally, a morphological analysis reports the proliferation of fungal or bacteria colonies inside an improperly used mask. Our study highlights therefore that wearing a face mask is really beneficial only if it is used correctly.

Comparison of measurement systems for assessing number- and mass-based particle filtration efficiency

The particle filtration efficiency (PFE) of a respirator or face mask is one of its key properties. While the physics of particle filtration results in the PFE being size-dependent, measurement standards are specified using a single, integrated PFE, for simplicity. This integrated PFE is commonly defined concerning either the number (NPFE) or mass (MPFE) distribution of particles as a function of size. This relationship is non-trivial; it is influenced by both the shape of the particle distribution and the fact that multiple practical definitions of particle size are used. This manuscript discusses the relationship between NPFE and MPFE in detail, providing a guide to practitioners. Our discussion begins with a description of the theory underlying different variants of PFE. We then present experimental results for a database of size-resolved PFE (SPFE) measurements for several thousand candidate respirators and filter media, including filter media with systematically varied properties and commercial samples that span 20%-99.8% MPFE. The observed relationships between NPFE and MPFE are discussed in terms of the most-penetrating particle size (MPPS) and charge state of the media. For the sodium chloride particles used here, we observed that the MPFE was greater than NPFE for charged materials and vice versa for uncharged materials. This relationship is observed because a shift from NPFE to MPFE weights the distribution toward larger sizes, while charged materials shift the MPPS to smaller sizes. Results are validated by comparing the output of a pair of automated filter testers, which are used in gauging standards compliance, to that of MPFE computed from a system capable of measuring SPFE over the 20 nm-500 nm range.

Determination of activated carbon fiber adsorption capacity for several common organic vapors: applications for respiratory protection

In the context of workplace safety, activated carbon in the fiber form (i.e., activated carbon fiber, ACF) represents an alternative adsorbent to granular activated carbon (GAC) for use in organic vapor respiratory protection devices. ACFs are high surface area carbonaceous materials that are often available in a self-supporting non-woven form. The physical form of ACF suggests the potential for a filtration medium that is capable of supporting both organic vapor adsorption and particulate filtration. To study the application of these materials in respiratory protection devices, ACFs (ACFF 1200 m²/g, ACFF 1800 m²/g, and ACFF 2000 m²/g) were challenged with representative organic vapors (toluene, hexane, and methyl ethyl ketone (MEK)) at an occupationally relevant concentration (200 ppm). Breakthrough curves were generated for at least three different bed weights of adsorbent. Pressure drop (i.e., the resistance across the filtration media) was also measured to determine maximum ACF bed depths for use in respiratory protection devices. Breakthrough experiments indicate that ACFF 2000 has the highest adsorption capacity for toluene (381 mg/g), followed by ACFF 1800 and ACFF 1200 (344 mg/g and 239 mg/g, respectively). A similar trend was observed for hexane: 221 mg/g, 196 mg/g, and 146 mg/g for ACFF 2000, ACFF 1800, and ACFF 1200, respectively. ACFF 1200 showed the highest adsorption capacity for the polar adsorbate MEK (168 mg/g), followed by ACFF 1800 and ACFF 2000 (166 mg/g and 147 mg/g, respectively). Based on the constraints of pressure drop, it seems unlikely the exclusive use of ACF in a filtering facepiece respirator can provide an adsorbent mass sufficient for full shift protection against organic vapor contaminants at or above the legally enforceable permissible exposure level (PEL). Nevertheless, the incorporation of ACF into a facepiece respirator appears promising for "nuisance odor" applications; i.e., the further reduction of organic vapor concentrations when workplace exposures are already below PEL concentrations.Implications: This research brings innovation to the field of occupational health and air pollution control technology by investigating the adsorption performance of activated carbon fiber (ACF) media in the context of worker respiratory protection. ACF properties such as high specific surface area (m²/g), high permeability to airflow, and rapid adsorption kinetics make it ideal for use in thin, N95-style respirators for organic vapors. Respiratory protection is an exciting and relevant application for ACF media. A lightweight adsorbent such as ACF, if incorporated into an N95-style respirator, could potentially provide nuisance-level VOC protection in a physical form that is accessible to workers and consistent with OSHA's voluntary use provisions for facepiece respirators. The research presented in this manuscript represents one of several steps planned in the characterization of ACF media for this particular application.

A comprehensive review on facemask manufacturing, testing, and its environmental impacts

The coronavirus pandemic (COVID-19) is currently the biggest threat to human lives due to its rapid transmission rate causing severe damage to human health and economy. The transmission of viral diseases can be minimized at its early stages with proper planning and preventive practices. The use of facemask has proved to be most effective measure to curb the spread of virus along with social distancing and good hygiene practices. This necessitates more research on facemask technology to increase its filtration efficiencies and proper disposal, which can be accelerated with knowledge of the current manufacturing process and recent research in this field. This review article provides an overview of the importance of facemask, fundamentals of nonwoven fabrics, and its manufacturing process. It also covers topics related to recent research reported for improved facemask efficiencies and testing methods to evaluate the performance of facemask. The plastic waste associated with the facemask and measures to minimize its effect are also briefly described. A systematic understanding is given in order to trigger future research in this field to ensure that we are well equipped for any future pandemic.

Polymersomes as virus-surrogate particles for evaluating the performance of air filter materials

The development of antivirus air filter materials has attracted considerable interests due to the pandemic of coronavirus disease 2019 (COVID-19). Filtration efficiency (FE) of these materials against virus is critical in the assessment of their use in disease prevention. Due to the high cost and biosafety laboratory required for conducting research using actual virus samples, surrogates for virus are commonly used in the filtration test. Here, we explore the employment of polymersomes (polymeric vesicles) as a new type of surrogate. The polymersomes are hollow shell nanoparticles with amphiphilic bilayer membranes, which can be fabricated in nanosized, and possess similar size and structural features to virus. The performance of commercial KN95 mask and surgical mask with micro-sized fibers, and electrospun polyvinylidene fluoride (PVDF) and polyacrylonitrile (PAN) nanofibers were chosen to be evaluated. The filtration tests against fluorescent-labeled virus-surrogate particles (VSPs), i.e. polymersomes, allowed the determination of the FE of the multilayered filter materials in a layer-specific manner. The results suggested the importance of hydrophobicity in designing the nanofibrous filter materials. The employment of VSPs in filtration performance evaluation allows a cost-effective way to estimate the FE against virus, providing guidance on future development of air filter materials.

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

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

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

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

Cloth Face Coverings for Use as Facemasks During the Coronavirus (SARS-CoV-2) Pandemic: What Science and Experience Have Taught Us

The current coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) pandemic has resulted in severe shortages of personal protective equipment, including respiratory protective equipment, such as N95 respirators. This has led some government agencies to suggest the use of cloth face coverings (CFCs) by health-care providers and the general public as a last resort when standard respiratory protective equipment is unavailable. Although such coverings have been in use for over a century and have found widespread use during some previous pandemics, research data are relatively scant for the protective value of this measure. This article, a literature review, explores the development of CFCs and reviews available scientific research regarding the efficacy of this intervention as a preventive measure in the spread of airborne infectious diseases.

Effectiveness of N95 Masks against SARS-CoV-2: Performance Efficiency, Concerns, and Future Directions

The coronavirus disease 2019 (COVID-19) epidemic, which is caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has continued to spread around the world since December 2019. Healthcare workers and other medical first responders in particular need personal protective equipment to protect their respiratory system from airborne particulates, in addition to liquid splashes to the face. N95 respirator have become a critical component for reducing SARS-CoV-2 transmission and controlling the scale of the COVID-19 pandemic. However, a major dispute concerning the protective performance of N95 respirators has erupted, with a myriad of healthcare workers affected despite wearing N95 masks. This article reviews the most recent updates about the performance of N95 respirators in protecting against the SARS-CoV-2 virus in the present pandemic situation. A brief overview of the manufacturing methods, air filtration mechanisms, stability, and reusability of the mask is provided. A detailed performance evaluation of the mask is studied from an engineering point of view. This Review also reports on a comparative study about the protective performance of all commercially available surgical and respiratory masks used to combat the spread of COVID-19. With the aim of protecting healthcare providers more efficiently, we suggest some potential directions for the development of this respiratory mask that improve the performance efficiency of the mask.

Effect of cigarette smoke on the lifetime of electret air filters

The role of air filters is becoming increasingly important due to the threat of air pollution to public health. Understanding the lifetime of air filters is essential for assessing air pollution exposure. However, the effects of common environmental chemicals on filter performance have not been explored. Air filters in ventilation systems and air purifiers are commonly exposed to cigarette smoke aerosols. Moreover, due to the coronavirus pandemic, people are more likely to be in close proximity with smokers while wearing face masks, such that their masks will be exposed to cigarette aerosols. In this study, we applied a stepwise approach to analyze the effects of cigarette smoke on the filtration performance of electret melt-blown filter media that are commonly used to create face masks. We found that cigarette aerosols dramatically reduced filtration efficiency, while standard test particles of a similar loading weight did not affect filtration efficiency. After loading up to 204 μg/cm² of cigarette smoke on 100 cm² of electret filter medium, the filtration efficiency of some filters decreased from 92.5% to 33.3% (-Δ59.2%). Interestingly, we founded no changes in pressure drop following cigarette smoke exposure despite the reduction in filtration efficiency, suggesting that cigarette smoke aerosols significantly impact the electrostatic charge properties of the filters. Our results indicate that the lifetime of commonly-used air filters may be much shorter than expected and that people may unknowingly be directly exposed to airborne pollutants.

Electrospun nanofiber-based respiratory face masks-a review

The severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic of 2019 forced widespread use of face coverings as a mandatory step towards reducing infection by the virus. The face mask acts as a barrier for transmission of infected aerosols among its user and surrounding people. This has propelled pace of research and development of face masks around the world. This short review is an effort to present advances in materials and designs used for face masks. Details available in scientific literature and company brochures have been accessed and the use of nanomaterials and designs for the new generation of face masks have been discussed. Special attention was given to the face masks based on electrospun nanofiber-based membrane materials due to their nano-sized pores, light weight, and high filtration efficiency; therefore, they are commercially viable and popular among various products available in the market. Incorporation of metal organic framework (MOFs) and graphene have opened avenues to more advanced/multi-functional, reusable, and high capacity adsorption filtration membranes. Rapid prototyping/3-dimensional (3-D) printing techniques have been applied to shorten the time of manufacture of face masks. This review is expected to be very helpful for engineers, scientists, and entrepreneurs working on development of novel face masks required in plenty during this pandemic period.

Efficacy of facemasks in mitigating respiratory exposure to submicron aerosols

We designed a novel experimental set-up to pseudo-simultaneously measure size-segregated filtration efficiency (η_F), breathing resistance (η_P) and potential usage time (t_B) for 11 types of face protective equipment (FPE; four respirators; three medical; and four handmade) in the submicron range. As expected, the highest η_F was exhibited by respirators (97 ± 3%), followed by medical (81 ± 7%) and handmade (47 ± 13%). Similarly, the breathing resistance was highest for respirators, followed by medical and handmade FPE. Combined analysis of efficiency and breathing resistance highlighted trade-offs, i.e. respirators showing the best overall performance across these two indicators, followed by medical and handmade FPE. This hierarchy was also confirmed by quality factor, which is a performance indicator of filters. Detailed assessment of size-segregated aerosols, combined with the scanning electron microscope imaging, revealed material characteristics such as pore density, fiber thickness, filter material and number of layers influence their performance. η_F and η_P showed an inverse exponential decay with time. Using their cross-over point, in combination with acceptable breathability, allowed to estimate t_B as 3.2-9.5 h (respirators), 2.6-7.3 h (medical masks) and 4.0-8.8 h (handmade). While relatively longer t_B of handmade FPE indicate breathing comfort, they are far less efficient in filtering virus-laden submicron aerosols compared with respirators.

Coronavirus disease (COVID-19) transmission through aerosols in restorative and endodontic practice: Strategies for prevention

Rapid spread of coronavirus disease 2019 (COVID-19) in several countries of the world has created a state of public health emergency. COVID-19 is principally a respiratory disease, and the virus is present in respiratory secretions. Oral health-care professionals are susceptible to being infected with the disease since they work in close proximity to patient's face and oral cavity for long period of time. Restorative dentists and endodontists play a significant role in delivering "urgent" or "emergency" dental care to patients. Occupational Safety and Health Administration has categorized dentists performing aerosol-generating treatment procedures at "very high exposure risk" whereas the dentists not performing aerosol-generating procedures at "high exposure risk." Most of the restorative and endodontic treatment procedures involve generation of aerosols. Owing to the possibility of transmission of virus through aerosols, these procedures may transmit the disease to clinician or other patients. A comprehensive search of literature was conducted with the help of PubMed/MEDLINE and Scopus databases using a combination of terms, "COVID-19," "severe acute respiratory syndrome coronavirus 2," "aerosols," "restorative dentistry," and "endodontics." Along with universal precautions, some additional precautions need to be taken to prevent such transmission and cross-infection. This article reviews the research evidence about the role of aerosols in the transmission of COVID-19 and various measures which should be implemented during restorative and endodontic practice for the prevention of such transmission.

The use of personal protective equipment in endoscopy: what should the endoscopist wear during a pandemic?

Endoscopists are at high risk of exposure and nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) when performing endoscopic procedures due to the highly aerosol generating nature of these procedures. At present, there is still no consensus among endoscopists with regards to the type of protective equipment to be worn by healthcare workers, when performing endoscopy during the coronavirus 2019 (COVID-19) pandemic. This review encompasses a summary of currently published guidelines related to the use of personal protective equipment (PPE) when performing endoscopic procedures during the COVID-19 pandemic. With increasing calls to rationalize the use of PPE due to shortages in global supply chains, the review offers a concise summary on the most appropriate and adequate use of PPE when performing endoscopy during the pandemic. It is expected that these adaptations in the use of PPE during the pandemic will help to improve standards of care and safety of healthcare workers.

What We Are Learning from COVID-19 for Respiratory Protection: Contemporary and Emerging Issues

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.

Organisational Culture and Mask-Wearing Practices for Tuberculosis Infection Prevention and Control among Health Care Workers in Primary Care Facilities in the Western Cape, South Africa: A Qualitative Study

Background: Although many healthcare workers (HCWs) are aware of the protective role that mask-wearing has in reducing transmission of tuberculosis (TB) and other airborne diseases, studies on infection prevention and control (IPC) for TB in South Africa indicate that mask-wearing is often poorly implemented. Mask-wearing practices are influenced by aspects of the environment and organisational culture within which HCWs work. Methods: We draw on 23 interviews and four focus group discussions conducted with 44 HCWs in six primary care facilities in the Western Cape Province of South Africa. Three key dimensions of organisational culture were used to guide a thematic analysis of HCWs’ perceptions of masks and mask-wearing practices in the context of TB infection prevention and control. Results: First, HCW accounts address both the physical experience of wearing masks, as well as how mask-wearing is perceived in social interactions, reflecting visual manifestations of organisational culture in clinics. Second, HCWs expressed shared ways of thinking in their normalisation of TB as an inevitable risk that is inherent to their work and their localization of TB risk in specific areas of the clinic. Third, deeper assumptions about mask-wearing as an individual choice rather than a collective responsibility were embedded in power and accountability relationships among HCWs and clinic managers. These features of organisational culture are underpinned by broader systemic shortcomings, including limited availability of masks, poorly enforced protocols, and a general lack of role modelling around mask-wearing. HCW mask-wearing was thus shaped not only by individual knowledge and motivation but also by the embodied social dimensions of mask-wearing, the perceptions that TB risk was normal and localizable, and a shared underlying tendency to assume that mask-wearing, ultimately, was a matter of individual choice and responsibility. Conclusions: Organisational culture has an important, and under-researched, impact on HCW mask-wearing and other PPE and IPC practices. Consistent mask-wearing might become a more routine feature of IPC in health facilities if facility managers more actively promote engagement with TB-IPC guidelines and develop a sense of collective involvement and ownership of TB-IPC in facilities.

Systematic experimental comparison of particle filtration efficiency test methods for commercial respirators and face masks

Respirators, medical masks, and barrier face coverings all filter airborne particles using similar physical principles. However, they are tested for certification using a variety of standardized test methods, creating challenges for the comparison of differently certified products. We have performed systematic experiments to quantify and understand the differences between standardized test methods for N95 respirators (NIOSH TEB-APR-STP-0059 under US 42 CFR 84), medical face masks (ASTM F2299/F2100), and COVID-19-related barrier face coverings (ASTM F3502-21). Our experiments demonstrate the role of face velocity, particle properties (mean size, size variability, electric charge, density, and shape), measurement techniques, and environmental preconditioning. The measured filtration efficiency was most sensitive to changes in face velocity and particle charge. Relative to the NIOSH method, users of the ASTM F2299/F2100 method have commonly used non-neutralized (highly charged) aerosols as well as smaller face velocities, each of which may result in approximately 10% higher measured filtration efficiencies. In the NIOSH method, environmental conditioning at elevated humidity increased filtration efficiency in some commercial samples while decreasing it in others, indicating that measurement should be performed both with and without conditioning. More generally, our results provide an experimental basis for the comparison of respirators certified under various international methods, including FFP2, KN95, P2, Korea 1st Class, and DS2.

Electroceutical fabric lowers zeta potential and eradicates coronavirus infectivity upon contact

Coronavirus with intact infectivity attached to PPE surfaces pose significant threat to the spread of COVID-19. We tested the hypothesis that an electroceutical fabric, generating weak potential difference of 0.5 V, disrupts the infectivity of coronavirus upon contact by destabilizing the electrokinetic properties of the virion. Porcine respiratory coronavirus AR310 particles (10⁵) were placed in direct contact with the fabric for 1 or 5 min. Following one minute of contact, zeta potential of the porcine coronavirus was significantly lowered indicating destabilization of its electrokinetic properties. Size-distribution plot showed appearance of aggregation of the virus. Testing of the cytopathic effects of the virus showed eradication of infectivity as quantitatively assessed by PI-calcein and MTT cell viability tests. This work provides the rationale to consider the studied electroceutical fabric, or other materials with comparable property, as material of choice for the development of PPE in the fight against COVID-19.

Navigating Performance Standards for Face Mask Materials: A Custom-Built Apparatus for Measuring Particle Filtration Efficiency

Public health agencies have recommended the community use of face masks to reduce the transmission of airborne diseases like COVID-19. Virus transmission is reduced when masks act as efficient filters, thus evaluating mask particle filtration efficiency (PFE) is essential. However, the high cost and long lead times associated with purchasing turn-key PFE systems or hiring certified laboratories hampers the testing of filter materials. There is a clear need for "custom" PFE test systems; however, the variety of standards that prescribe (medical) face mask PFE testing (e.g., ASTM International, NIOSH) vary widely in their protocols and clarity of guidelines. Herein, the development is described of an "in-house" PFE system and method for testing face masks in the context of current standards for medical masks. Pursuant to the ASTM International standards, the system uses an aerosol of latex spheres (0.1 µm nominal size) with particle concentrations upstream and downstream of the mask material measured using a laser particle analyzer. PFE measurements are obtained for a variety of common fabrics and medical masks. The approach described in this work conforms to the current standards for PFE testing while providing the flexibility to adapt to changing needs and filtration conditions.

An accessible method for screening aerosol filtration identifies poor-performing commercial masks and respirators

BACKGROUND

The COVID-19 pandemic has presented an acute shortage of regulation-tested masks. Many of the alternatives available to hospitals have not been certified, leaving uncertainty about their ability to properly protect healthcare workers from SARS-CoV-2 transmission.

OBJECTIVE

For situations where regulatory methods are not accessible, we present experimental methods to evaluate mask filtration and breathability quickly via cost-effective approaches (e.g., ~$2000 USD) that could be replicated in communities of need without extensive infrastructure. We demonstrate the need for screening by evaluating an existing diverse inventory of masks/respirators from a local hospital.

METHODS

Two experimental approaches are presented to examine both aerosol filtration and flow impedance (i.e., breathability). For one of the approaches ("quick assessment"), screening for appropriate filtration could be performed under 10 min per mask, on average. Mask fit tests were conducted in tandem but are not the focus of this study.

RESULTS

Tests conducted of 47 nonregulation masks reveal variable performance. A number of commercially available masks in hospital inventories perform similarly to N95 masks for aerosol filtration of 0.2 μm and above, but there is a range of masks with relatively lower filtration efficiencies (e.g., <90%) and a subset with poorer filtration (e.g., <70%). All masks functioned acceptably for breathability, and impedance was not correlated with filtration efficiency.

SIGNIFICANCE

With simplified tests, organizations with mask/respirator shortages and uncertain inventories can make informed decisions about use and procurement.

Sustainable and resilient strategies for touristic cities against COVID-19: An agent-based approach

Touristic cities will suffer from COVID-19 emergency because of its economic impact on their communities. The first emergency phases involved a wide closure of such areas to support "social distancing" measures (i.e. travels limitation; lockdown of (over)crowd-prone activities). In the "second phase", individual's risk-mitigation strategies (facial masks) could be properly linked to "social distancing" to ensure re-opening touristic cities to visitors. Simulation tools could support the effectiveness evaluation of risk-mitigation measures to look for an economic and social optimum for activities restarting. This work modifies an existing Agent-Based Model to estimate the virus spreading in touristic areas, including tourists and residents' behaviours, movement and virus effects on them according to a probabilistic approach. Consolidated proximity-based and exposure-time-based contagion spreading rules are included according to international health organizations and previous calibration through experimental data. Effects of tourists' capacity (as "social distancing"-based measure) and other strategies (i.e. facial mask implementation) are evaluated depending on virus-related conditions (i.e. initial infector percentages). An idealized scenario representing a significant case study has been analysed to demonstrate the tool capabilities and compare the effectiveness of those solutions. Results show that "social distancing" seems to be more effective at the highest infectors' rates, although represents an extreme measure with important economic effects. This measure loses its full effectiveness (on the community) as the infectors' rate decreases and individuals' protection measures become predominant (facial masks). The model could be integrated to consider other recurring issues on tourist-related fruition and schedule of urban spaces and facilities (e.g. cultural/leisure buildings).

Standard hospital blanket warming cabinets can be utilized for complete moist heat SARS-CoV2 inactivation of contaminated N95 masks for re-use

Shortages of personal protective equipment for use during the SARS-CoV-2 pandemic continue to be an issue among health-care workers globally. Extended and repeated use of N95 filtering facepiece respirators without adequate decontamination is of particular concern. Although several methods to decontaminate and re-use these masks have been proposed, logistic or practical issues limit adoption of these techniques. In this study, we propose and validate the use of the application of moist heat (70 °C with humidity augmented by an open pan of water) applied by commonly available hospital (blanket) warming cabinets to decontaminate N95 masks. This report shows that a variety of N95 masks can be repeatedly decontaminated of SARS-CoV-2 over 6 h moist heat exposure without compromise of their filtering function as assessed by standard fit and sodium chloride aerosol filtration efficiency testing. This approached can easily adapted to provide point-of-care N95 mask decontamination allowing for increased practical utility of mask recycling in the health care setting.

Use of Industrial Filters by Health Care Workers During Shortages of N95 Respirators in Pandemic Times

The coronavirus disease 2019 (COVID-19) pandemic has led to a significant shortage of personal protective equipment in multiple health care facilities around the world, with the highest impact on N95 respirator masks. The N95 respirator is a mask that blocks at least 95% of very small (0.3 μm) particles and is considered a standard for enhanced respiratory precautions. The N95 mask shortage has created a need for other options for nasal and oral respiratory protection with similar filtration efficiency and "medical-grade" clearance, which can be used in health care settings. However, the literature around various filter types, their filtration capabilities, and the organizations certifying their use is dense, confusing, and not easily accessible to the public. Here, we synthesize relevant literature to analyze and disseminate information on (1) alternative viable filter options to N95s, (2) the National Institute for Occupational Safety and Health certification process, (3) the relationship of National Institute for Occupational Safety and Health certification to Food and Drug Administration certification of filtration devices and surgical masks, and (4) how this relationship may affect future filtration usage in the medical community during a pandemic. Analysis of these standards is meant to inform regarding evidence of respirator efficacy but does not imply any official endorsement of these alternatives. With this article, we illuminate viable alternative respirator options during the COVID-19 pandemic to help alleviate the dependency on N95 face masks.

Size-Specific Filtration Performance of N95 Respirators After Decontamination by Moist Heat Incubation

Background: Decontamination and reuse of respirators have been proposed to mitigate the shortage of respirators during pandemics. The U.S. National Institute for Occupational Safety and Health (NIOSH)'s respirator filtration efficiency (FE) test has been used to confirm that decontamination procedures maintain minimum FE above 95% for N95s and similar respirators. However, it was hypothesized that the limited range of test particle sizes may not include the most penetrating particle size (MPPS) for all respirators, especially after decontamination by moist heat incubation (MHI). Materials and Methods: A custom-designed apparatus was used to measure size-specific FE for respirators across particle size bins between aerodynamic diameter of 0.07 and 1.97 μm using an electrical low-pressure impactor. FEs were measured for two N95 respirator models before and after 10 cycles of MHI. In addition, pressure drop through the respirator materials and scanning electron microscope (SEM) images of respirator layers were obtained before and after MHI. Results: For Kimtech™ brand N95 respirators, FE was not reduced at any size after MHI. For Safe Life brand N95s, FE was below 95% before MHI and decreased significantly after MHI. The MPPS for this respirator was outside the range defined in NIOSH test protocol, and increased after MHI. There was no appreciable change to the pressure drop through the two respirator models after MHI, nor was any deterioration in fiber integrity visible in SEM images. Conclusions: Based on the results of the present study and other studies in the literature, MHI can be used to decontaminate respirators without significant decrease in FE. However, potential effects of MHI on FE need to be assessed for each respirator model. The ability to evaluate size-specific FE across a wide range of particle sizes is important in identifying the MPPS and associated FE of respirators before and after MHI.

Development of Electrospun Nanofibrous Filters for Controlling Coronavirus Aerosols

Airborne transmission of SARS-CoV-2 plays a critical role in spreading COVID-19. To protect public health, we designed and fabricated electrospun nanofibrous air filters that hold promise for applications in personal protective equipment (PPE) and the indoor environment. Due to ultrafine nanofibers (∼300 nm), the electrospun air filters had a much smaller pore size in comparison to the surgical mask and cloth masks (a couple of micrometers versus tens to hundreds of micrometers). A coronavirus strain served as a SARS-CoV-2 surrogate and was used to generate aerosols for filtration efficiency tests, which can better represent SARS-CoV-2 in comparison to other agents used for aerosol generation in previous studies. The electrospun air filters showed excellent performance by capturing up to 99.9% of coronavirus aerosols, which outperformed many commercial face masks. In addition, we observed that the same electrospun air filter or face mask removed NaCl aerosols equivalently or less effectively in comparison to the coronavirus aerosols when both aerosols were generated from the same system. Our work paves a new avenue for advancing air filtration by developing electrospun nanofibrous air filters for controlling SARS-CoV-2 airborne transmission.

Enhancement of peripheral seal of medical face masks using a 3-dimensional-printed custom frame

Background

During the COVID-19 pandemic, American Society for Testing and Materials level 3 and level 2 medical face masks (MFMs) have been used for most health care workers and even for the first responders owing to a shortage of N95 respirators. However, the MFMs lack effective peripheral seal, leading to concerns about their adequacy to block aerosol exposure for proper protection. The purpose of this study was to evaluate the peripheral seal of level 3 and level 2 MFMs with a 3-dimensional (3D-) printed custom frame.

Methods

Level 3 and level 2 MFMs were tested on 10 participants with and without a 3D-printed custom frame; the efficiency of mask peripheral seal was determined by means of quantitative fit testing using a PortaCount Fit Tester based on ambient aerosol condensation nuclei counter protocol.

Results

The 3D-printed custom frame significantly improved the peripheral seal of both level 3 and level 2 MFMs compared with the masks alone (P < .001). In addition, both level 3 and level 2 MFMs with the 3D-printed custom frame met the quantitative fit testing standard specified for N95 respirators.

Practical Implications

The 3D-printed custom frame over level 3 and level 2 MFMs can offer enhanced peripheral reduction of aerosols when using collapsible masks. With the shortage of N95 respirators, using the 3D-printed custom frame over a level 3 or level 2 MFM is considered a practical alternative to dental professionals.

Standards for Surgical Respirators and Masks: Relevance for Protecting Healthcare Workers and the Public During Pandemics

National standards for surgical respirators and masks are written and enforced to protect healthcare workers from particles and microorganisms such as Severe Acute Respriatory Syndrome Coronavirus 2 (SARS-CoV-2). In addition to the ability to filter particles (e.g. filtration efficiency, FE), the standards address breathability (e.g. differential pressure), how well the mask seals to a worker’s face (e.g. fit test), the level of protection from a fluid splash, and other factors. Standards used in the USA, European Union (EU), and China were compared with respect to testing methods and certification criteria. Although there are substantial similarities in standards for respirators, such as surgical N95, FFP2, and KN95 filtering facepiece respirators (FFRs), there are differences with respect to who performs that testing and fit-testing requirements that influence certification. There is greater variation in test methods between countries for surgical (USA) or medical (EU and China) masks than for FFRs. Surgical/medical masks can be certified to different levels of protection. The impact of the similarities and differences in testing methods and certification criteria on FFR and mask performance for protecting healthcare workers from SARS-CoV-2 are discussed, as well as the value of a new standard in the EU for testing fabrics for masks used by the public. Health and safety personnel in healthcare settings must understand the differences between standards so that they can select respirators and masks that provide appropriate protection for healthcare workers.

Advanced Research and Development of Face Masks and Respirators Pre and Post the Coronavirus Disease 2019 (COVID-19) Pandemic: A Critical Review

The outbreak of the COVID-19 pandemic, in 2020, has accelerated the need for personal protective equipment (PPE) masks as one of the methods to reduce and/or eliminate transmission of the coronavirus across communities. Despite the availability of different coronavirus vaccines, it is still recommended by the Center of Disease Control and Prevention (CDC), World Health Organization (WHO), and local authorities to apply public safety measures including maintaining social distancing and wearing face masks. This includes individuals who have been fully vaccinated. Remarkable increase in scientific studies, along with manufacturing-related research and development investigations, have been performed in an attempt to provide better PPE solutions during the pandemic. Recent literature has estimated the filtration efficiency (FE) of face masks and respirators shedding the light on specific targeted parameters that investigators can measure, detect, evaluate, and provide reliable data with consistent results. This review showed the variability in testing protocols and FE evaluation methods of different face mask materials and/or brands. In addition to the safety requirements needed to perform aerosol viral filtration tests, one of the main challenges researchers currently face is the inability to simulate or mimic true aerosol filtration scenarios via laboratory experiments, field tests, and in vitro/in vivo investigations. Moreover, the FE through the mask can be influenced by different filtration mechanisms, environmental parameters, filtration material properties, number of layers used, packing density, fiber charge density, fiber diameter, aerosol type and particle size, aerosol face velocity and concentration loadings, and infectious concentrations generated due to different human activities. These parameters are not fully understood and constrain the design, production, efficacy, and efficiency of face masks.

A comparison of performance metrics for cloth masks as source control devices for simulated cough and exhalation aerosols

Universal mask wearing is recommended to help control the spread of COVID-19. Masks reduce the expulsion of aerosols of respiratory fluids into the environment (called source control) and offer some protection to the wearer. Masks are often characterized using filtration efficiency, airflow resistance, and manikin or human fit factors, which are standard metrics used for personal protective devices. However, none of these metrics are direct measurements of how effectively a mask blocks coughed and exhaled aerosols. We studied the source control performance of 15 cloth masks (face masks, neck gaiters, and bandanas), two medical masks, and two N95 filtering facepiece respirators by measuring their ability to block aerosols ≤ 7 μm expelled during simulated coughing and exhalation (called source control collection efficiency). These measurements were compared with filtration efficiencies, airflow resistances, and fit factors measured on manikin headforms and humans. Collection efficiencies for the cloth masks ranged from 17% to 71% for coughing and 35% to 66% for exhalation. Filtration efficiencies for the cloth masks ranged from 1.4% to 98%, while the fit factors were 1.3 to 7.4 on headforms and 1.0 to 4.0 on human subjects. The Spearman's rank correlation coefficients between the source control collection efficiencies and the standard metrics ranged from 0.03 to 0.68 and were significant in all but two cases. However, none of the standard metrics were strongly correlated with source control performance. A better understanding of the relationships between source control collection efficiency, filtration efficiency, airflow resistance, and fit factor is needed.

A Simple Model Setup Using Spray-Drying Principles and Fluorescent Silica Nanoparticles to Evaluate the Efficiency of Facemask Materials in Terms of Virus Particle Retention

Herein, a simple model setup is presented to spray fine liquid droplets containing nanoparticles in an air stream transporting this toward a filter material. The nanoparticles are made of silica and tagged with a fluorescent dye in order to render the trace of the particles easily visible. The silica nanoparticles, in a first approximation, mimic virus (severe acute respiratory syndrome coronavirus 2) particles. The setup is used to evaluate different tissues, nowadays, in times of the coronavirus pandemic, commonly used as facemasks, with regard to their particle retention capability. The setup enables adjusting different "breathing scenarios" by adjusting the gas flow speed and, thereby, to compare the filter performance for these scenarios. The effective penetration of particles can be monitored via fluorescence intensity measurements and is visualized via scanning electron micrographs and photographs under UV light. Ultimately, a strong increase of particle penetration in various mask materials as function of flow speed of the droplets is observed and an ultimate retention is only observed for FFP3 and FFP2 masks.

Face masks against COVID-19: Standards, efficacy, testing and decontamination methods

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the novel coronavirus disease 2019 (COVID-19), has caused a global pandemic on a scale not seen for over a century. Increasing evidence suggests that respiratory droplets and aerosols are likely the most common route of transmission for SARS-CoV-2. Since the virus can be spread by presymptomatic and asymptomatic individuals, universal face masking has been recommended as a straightforward and low-cost strategy to mitigate virus transmission. Numerous governments and public health agencies around the world have advocated for or mandated the wearing of masks in public settings, especially in situations where social distancing is not possible. However, the efficacy of wearing a mask remains controversial. This interdisciplinary review summarizes the current, state-of-the-art understanding of mask usage against COVID-19. It covers three main aspects of mask usage amid the pandemic: quality standards for various face masks and their fundamental filtration mechanisms, empirical methods for quantitatively determining mask integrity and particle filtration efficiency, and decontamination methods that allow for the reuse of traditionally disposable N95 and surgical masks. The focus is given to the fundamental physicochemical and engineering sciences behind each aspect covered in this review, providing novel insights into the current understanding of mask usage to curb COVID-19 spread.

Screening of core filter layer for the development of respiratory mask to combat COVID-19

The severe outbreak of respiratory coronavirus disease 2019 has increased the significant demand of respiratory mask and its use become ubiquitous worldwide to control this unprecedented respiratory pandemic. The performance of a respiratory mask depends on the efficiency of the filter layer which is mostly made of polypropylene melt blown non-woven (PP-MB-NW). So far, very limited characterization data are available for the PPE-MB-NW in terms to achieve desired particulate filtration efficiency (PFE) against 0.3 µm size, which are imperative in order to facilitate the right selection of PP-MB-NW fabric for the development of mask. In present study, eight different kinds of PP-MB-NW fabrics (Sample A-H) of varied structural morphology are chosen. The different PP-MB-NW were characterized for its pore size and distribution by mercury porosimeter and BET surface area analyzer was explored first time to understand the importance of blind pore in PFE. The PP-MB-NW samples were characterized using scanning electron microscopy so as to know the surface morphology. The filtration efficiency, pressure drop and breathing resistance of various PP-MB-NW fabric samples are investigated in single and double layers combination against the particle size of 0.3, 0.5 and 1 µm. The samples which are having low pore dia, high solid fraction volume, and low air permeability has high filtration efficiency (> 90%) against 0.3 µm particle with high pressure drop (16.3-21.3 mm WC) and breathing resistance (1.42-1.92 mbar) when compared to rest of the samples. This study will pave the way for the judicial selection of right kind of filter layer i.e., PP-MB-NW fabric for the development of mask and it will be greatly helpful in manufacturing of mask in this present pandemic with desired PFE indicating considerable promise for defense against respiratory pandemic.