Reliability of N95 respirators for respiratory protection before, during, and after nursing procedures

Suen, Lorna Kwai Ping; Lin, Yong; Ho, Suki S.K.; Fung, Keith Hin Kee; Boost, Maureen; Wu, Cynthia Sau Ting; Au-Yeung, Cypher H.; O'Donoghue, Margaret May

doi:10.1016/j.ajic.2017.03.028

Cited by 27 publications

(26 citation statements)

References 11 publications

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“…Although the fit factors of the nanofibre FFR were higher than the best-fitting 3M FFR before and after the nursing procedures, the average fit factor of both FFRs decreased significantly after completion of the nursing procedures, as measured using QNFT at different body postures. This result is consistent with those from a previous study, which found that adequately sealed N95 FFRs may not provide consistent protection for the wearer whilst performing nursing procedures and that body movements may increase the risk of face seal leakage [15]. Accordingly, the prototype should be further enhanced for an improved respirator fit to guarantee the respiratory protection of users.…”

Section: Discussionsupporting

confidence: 90%

“…The participants were a group of students from a university baccalaureate nursing programme. They had no prior experience in using an N95 FFR in the clinical setting, but had received formal training in performing the nursing procedures tested [15]. This inclusion criterion ensured that prior experience in using an N95 FFR would not be a confounder of the outcome [16].…”

Section: Study Participantsmentioning

confidence: 99%

“…Electrospinning technology has enabled the Nano and Advanced Materials Research Institute of Hong Kong (NAMI), a research and development centre designated by the Innovation and Technology Commission of the Government of Hong Kong Special Administrative Region, to successfully combine meltblown and spunbond fibres with nanofibres with diameters ranging from a few nanometres to a few hundred nanometres, which cannot be obtained via traditional fabrication techniques. However, an experimental study illustrated that body movements during nursing procedures may increase the risk of face seal leakage [15]. Thus, the purpose of the current study was to evaluate the mask fit and usability of traditional N95 and nanofibre N95 FFRs before and after nursing procedures.…”

Section: Introductionmentioning

confidence: 99%

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Comparing mask fit and usability of traditional and nanofibre N95 filtering facepiece respirators before and after nursing procedures

Suen

Guo

et al. 2020

Journal of Hospital Infection

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Keywords:Mask fit Usability Nanofibre technology N95 filtering facepiece respirators Nursing Physical properties S U M M A R YBackground: The reliability of N95 filtering facepiece respirators (FFRs) depends on correct fitting. The perceived usability of FFRs is equally important because discomfort during usage may affect compliance. Body movements during nursing procedures may also increase the risk of face seal leakage. Aim: To evaluate the mask fit and usability of the best-fitting 3M N95 FFR and the nanofibre N95 FFR before and after nursing procedures. The physical properties of these FFRs were also examined. Methods: This experimental study had a one-group multiple comparison design. In total, 104 nursing students participated, and performed nursing procedures for 10 min when wearing the best-fitting 3M FFR and the nanofibre FFR. Mask fit and perceived usability of the FFRs were evaluated. Findings: More participants failed to obtain a fit factor !100 when using the best-fitting 3M FFR than when wearing the nanofibre FFR (33.7% vs 21.2%) after the procedures (P¼0.417). The nanofibre FFR also demonstrated higher usability than the 3M FFRs in terms of facial heat, breathability, facial pressure, speech intelligibility, itchiness, difficulty of maintaining the mask in place, and comfort level (P<0.001). The nanofibre FFR was also lighter, thinner and had slightly higher bacterial filtration efficiency than the 3M FFRs. Conclusion: The nanofibre FFR demonstrated significantly better usability than the 3M FFRs. None of the respirators were able to provide consistent protection for the wearer, as detected by face seal leakage after performing nursing procedures. Further improvement in the prototype design is needed to increase compliance and ensure the respiratory protection of users.

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Section: Discussionsupporting

confidence: 90%

Section: Study Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparing mask fit and usability of traditional and nanofibre N95 filtering facepiece respirators before and after nursing procedures

Suen

Guo

et al. 2020

Journal of Hospital Infection

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“…Compliance is worst in those with higher BMIs 78 . Body movement when performing medical procedures by HCW may increase the risk of seal leakage 99 …”

Section: Discussionmentioning

confidence: 99%

The COVID‐19 pandemic, personal protective equipment and respirator: A narrative review

2020

Int. J. Clin. Pract.

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Introduction The coronavirus disease 2019 pandemic has touched almost every continent. Personal protective equipment (PPE) is the final line of protection of healthcare workers (HCW). There is variation as well as controversy of infection control recommendation with regards to the use of PPE for HCW between institutions. The aim of this narrative review is to of examine and summarise the available evidence to guide recommendation for the safety of HCW. Method A literature search was conducted on the PubMed, MedLine and Embase databases with the keywords “personal protective equipment,” “COVID 19,” “n95,” “health care worker” and “mortality.” Results SARS‐nCoV‐2 is highly contagious. About 3.5%‐20% of HCW has been reported to be infected. The mortality ranges from 0.53% to 1.94%. PPE is part of the measure within a package of prevention and control of pandemic, rather than a replacement of. Respirators are more effective than masks in preventing aerosol transmission to HCWs. Extended use may be considered if guidelines are adhered. Powered air‐purifying respirators if available should be used in high‐risk procedures. Conclusion Transmission of viruses is multimodal and in the setting of a novel pathogen with high case fatality with no proven effective interventions, PPE that affords the best protection should be available to HCWs.

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“…However, the exercises performed during the fit test are not similar to those executed in real-world setting. Suen et al have used a portable aerosol spectrometer to evaluate the performance of N95 respirators during various nursing procedures, including suction and nasogastric tube insertion for 10 min [19]. The average FF decreased significantly from 184.85 to 134.71 after completing the procedures, and the FF fell to <100 in 33% of the participants.…”

Section: Discussionmentioning

confidence: 99%

N95 filtering facepiece respirators do not reliably afford respiratory protection during chest compression: A simulation study

Hwang

Yoon

et al. 2020

The American Journal of Emergency Medicine

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a b s t r a c tBackground: N95 filtering facepiece respirators (N95 respirators) may not provide adequate protection against respiratory infections during chest compression due to inappropriate fitting. Methods: This was a single-center simulation study performed from December 1, 2016, to December 31, 2016. Each participant underwent quantitative fit test (QNFT) of N95 respirators according to the Occupational Safety and Health Administration protocol. Adequacy of respirator fit was represented by the fit factor (FF), which is calculated as the number of ambient particles divided by the number inside the respirator. We divided all participants into the group that passed the overall fit test but failed at least one individual exercise (partially passed group [PPG]) and the group that passed all exercises (all passed group [APG]). Then, the participants performed three sessions of continuous chest compressions, each with a duration of 2 min, while undergoing real-time fit testing. The primary outcome was any failure (FF < 100) of the fit test during the three bouts of chest compression. Results: Forty-four participants passed the QNFT. Overall, 73% (n = 32) of the participants failed at least one of the three sessions of chest compression; the number of participants who failed was significantly higher in the PPG than in the APG (94% vs. 61%; p = 0.02). Approximately 18% (n = 8) of the participants experienced mask fit failures, such as strap slipping. Conclusions: Even if the participants passed the QNFT, the N95 respirator did not provide adequate protection against respiratory infections during chest compression.

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Reliability of N95 respirators for respiratory protection before, during, and after nursing procedures

Cited by 27 publications

References 11 publications

Comparing mask fit and usability of traditional and nanofibre N95 filtering facepiece respirators before and after nursing procedures

Comparing mask fit and usability of traditional and nanofibre N95 filtering facepiece respirators before and after nursing procedures

The COVID‐19 pandemic, personal protective equipment and respirator: A narrative review

N95 filtering facepiece respirators do not reliably afford respiratory protection during chest compression: A simulation study

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