Protective Masks Utilizing Nonendangered Components

A systematic review of passing fit testing of the masks and respirators used during the COVID-19 pandemic: Part 1-quantitative fit test procedures

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.

Design considerations for protective mask development: A remote mask usability evaluation

The design of N95 filtering facepiece respirators (FFRs) continues to pose usability concerns for healthcare workers, which have been exacerbated by the COVID-19 pandemic. The aim of this study was to develop a holistic model to guide mask design improvement. Dental students (n = 38) with experience wearing N95 FFRs participated in a randomized wear trial of three alternative protective masks. A mixed methods survey was used to examine usability of individual mask design components, the relationship of facial/head area to mask features, and overall mask design. Survey results indicated MNmask v1 demonstrated higher usability in seal confidence (M = 3.46), while MNmask v2 performed higher in satisfactory fit (M = 3.50). Design components of nose wire and head/neck bands were the most problematic, while conditions of skin irritation and tight/loose fit created an unfavorable wear experience. To consider healthcare workers' needs in improving the usability of protective masks, a model is presented to consider characteristics of fit, comfort, material, and design.