Physiological Burden Associated with the Use of Filtering Facepiece Respirators (N95 Masks) during Pregnancy

Viscoelastic Polyurethane Foams for Use in Seals of Respiratory Protective Devices

A key factor in effective protection against airborne hazards, i.e., biological and nonbiological aerosols, vapors, and gases, is a good face fit of respiratory protective devices (RPDs). Equally important is the comfort of use, which may encourage or discourage users from donning RPDs. The objective of the work was to develop viscoelastic polyurethane foams for use in RPD seals. The obtained foams were characterized using scanning electron microscopy, infrared spectroscopy, thermogravimetry, and differential scanning calorimetry. Measurements also involved gel fraction, apparent density, air permeability, elastic recovery time, compression set, rebound resilience, and sweat uptake. The results were discussed in the context of modifications to the foam formulation: the isocyanate index (I_NCO) in the range of 0.6–0.9 and the blowing agent content in the range of 1.2–3.0 php. FTIR analysis revealed a higher level of urea groups with increasing water content in the formulation. Higher I_NCO and water content levels also led to lower onset temperatures of thermal degradation and higher glass-transition temperatures of the soft phase. A decrease in apparent density and an increase in mean pore sizes of the foams with increasing I_NCO and water content levels was observed. Functional parameters (air permeability, elastic recovery time, compression set, rebound resilience, and sweat uptake) were also found to be satisfactory at lower I_NCO and water content levels.

Respiratory consequences of N95-type Mask usage in pregnant healthcare workers-a controlled clinical study

Background

Outbreaks of emerging infectious diseases have led to guidelines recommending the routine use of N95 respirators for healthcare workers, many of whom are women of childbearing age. The respiratory effects of prolonged respirator use on pregnant women are unclear although there has been no definite evidence of harm from past use.

Methods

We conducted a two-phase controlled clinical study on healthy pregnant women between 27 to 32 weeks gestation. In phase I, energy expenditure corresponding to the workload of routine nursing tasks was determined. In phase II, pulmonary function of 20 subjects was measured whilst at rest and exercising to the predetermined workload while breathing ambient air first, then breathing through N95-mask materials.

Results

Exercising at 3 MET while breathing through N95-mask materials reduced mean tidal volume (TV) by 23.0 % (95 % CI −33.5 % to −10.5 %, p < 0.001) and lowered minute ventilation (VE) by 25.8 % (95 % CI −34.2 % to −15.8 %, p < 0.001), with no significant change in breathing frequency compared to breathing ambient air. Volumes of oxygen consumption (VO₂) and carbon dioxide expired (VCO₂) were also significantly reduced; VO₂ by 13.8 % (95 % CI −24.2 % to −3 %, p = 0.013) and VCO₂ by 17.7 %, (95 % CI −28.1 % to −8.6 %, p = 0.001). Although no changes in the inspired oxygen and carbon dioxide concentrations were demonstrated, breathing through N95-mask materials during low intensity work (3 MET) reduced expired oxygen concentration by 3.2 % (95 % CI: −4.1 % to −2.2 %, p < 0.001), and increased expired carbon dioxide by 8.9 % (95 % CI: 6.9 % to 13.1 %; p <0.001) suggesting an increase in metabolism. There were however no changes in the maternal and fetal heart rates, finger-tip capillary lactate levels and oxygen saturation and rating of perceived exertion at the work intensity investigated.

Conclusions

Breathing through N95 mask materials have been shown to impede gaseous exchange and impose an additional workload on the metabolic system of pregnant healthcare workers, and this needs to be taken into consideration in guidelines for respirator use. The benefits of using N95 mask to prevent serious emerging infectious diseases should be weighed against potential respiratory consequences associated with extended N95 respirator usage.

Trial Registration

The study was registered at clinicaltrials.gov, identifier NCT00265926.

N95 respirator use during advanced pregnancy

BACKGROUND

To determine the physiological and subjective effects of wearing an N95 filtering facepiece respirator (N95 FFR) in advanced stages of pregnancy.

METHODS

Healthy pregnant women (n = 22) and nonpregnant women (n = 22) had physiological and subjective measurements taken with and without wearing an N95 FFR during exercise and postural sedentary activities over a 1-hour period.

RESULTS

There were no differences between the pregnant and nonpregnant women with respect to heart rate, respiratory rate, oxygen saturation, transcutaneous carbon dioxide level, chest wall temperature, aural temperature, and subjective perceptions of exertion and thermal comfort. No significant effect on fetal heart rate was noted.

CONCLUSIONS

Healthy pregnant women wearing an N95 FFR for 1 hour during exercise and sedentary activities did not exhibit any significant differences in measured physiological and subjective responses compared with nonpregnant women.

Respirator impact on work task performance

OBJECTIVE

Respirators are used to maintain work performance and protect against inhaled toxins. The study compared the effects of two commonly used respirator classes--dual cartridge half face mask (HFM) and filtering face piece (N95)--upon work productivity.

METHODS

107 volunteers performed eight simulated work tasks when using the HFM and N95 respirators. Tasks included several body positions, exertion levels, and concentration requirements. Objective measures of accuracy and speed were developed for each task. Scores for each task were based on the subject's rank among all subjects.

RESULTS

All subjects were capable of performing the tasks. There were no statistically significant differences between respirator types in either task performance metric.

CONCLUSIONS

Productivity impact can be measured effectively and should be considered as part of respirator design testing and when selecting the optimal respirator for a worker.

Surgical mask placement over N95 filtering facepiece respirators: physiological effects on healthcare workers

BACKGROUND AND OBJECTIVE

Filtering facepiece respirators ('N95 Masks') may be in short supply during large-scale infectious outbreaks. Suggestions have been made to extend their useful life by using a surgical mask as an outer barrier, but the physiological impact of this added barrier upon the wearer has not been studied.

METHODS

A surgical mask was worn over an N95 filtering facepiece respirator by 10 healthcare workers for 1 h at each of two work rates. Heart rate, respiratory rate, tidal volume, minute volume, oxygen saturation, transcutaneous carbon dioxide levels and respirator dead space gases were monitored and compared with controls (N95 filtering facepiece respirator without a surgical mask). Subjective perceptions of exertion and comfort were assessed by numerical rating scales.

RESULTS

There were no significant differences in physiological variables between those who used surgical masks and controls. Surgical masks decreased dead space oxygen concentrations of the filtering facepiece respirators at the lesser work rate (P = 0.03) and for filtering facepiece respirators with an exhalation valve at the higher work rate (P = 0.003). Respirator dead space oxygen and carbon dioxide levels were not harmonious with Occupational Safety and Health Administration workplace ambient atmosphere standards. Exertion and comfort scores were not significantly impacted by the surgical mask.

CONCLUSIONS

Use of a surgical mask as an outer barrier over N95 filtering facepiece respirators does not significantly impact the physiological burden or perceptions of comfort and exertion by the wearer over that experienced without use of a surgical mask.