A comparison of facemask and respirator filtration test methods

NIOSH published a Federal Register Notice to explore the possibility of incorporating FDA required filtration tests for surgical masks (SMs) in the 42 CFR Part 84 respirator certification process. There have been no published studies comparing the filtration efficiency test methods used for NIOSH certification of N95 filtering facepiece respirators (N95 FFRs) with those used by the FDA for clearance of SMs. To address this issue, filtration efficiencies of “N95 FFRs” including six N95 FFR models and three surgical N95 FFR models, and three SM models were measured using the NIOSH NaCl aerosol test method, and FDA required particulate filtration efficiency (PFE) and bacterial filtration efficiency (BFE) methods, and viral filtration efficiency (VFE) method. Five samples of each model were tested using each method. Both PFE and BFE tests were done using unneutralized particles as per FDA guidance document. PFE was measured using 0.1 µm size polystyrene latex particles and BFE with ～3.0 µm size particles containing Staphylococcus aureus bacteria. VFE was obtained using ～3.0 µm size particles containing phiX 174 as the challenge virus and Escherichia coli as the host. Results showed that the efficiencies measured by the NIOSH NaCl method for “N95 FFRs” were from 98.15–99.68% compared to 99.74–99.99% for PFE, 99.62–99.9% for BFE, and 99.8–99.9% for VFE methods. Efficiencies by the NIOSH NaCl method were significantly (p = <0.05) lower than the other methods. SMs showed lower efficiencies (54.72–88.40%) than “N95 FFRs” measured by the NIOSH NaCl method, while PFE, BFE, and VFE methods produced no significant difference. The above results show that the NIOSH NaCl method is relatively conservative and is able to identify poorly performing filtration devices. The higher efficiencies obtained using PFE, BFE and VFE methods show that adding these supplemental particle penetration methods will not improve respirator certification.     

Powered air-purifying respirator use in healthcare: Effects on thermal sensations and comfort

Twelve subjects wore an N95 filtering facepiece respirator (N95 FFR), one tight-fitting full facepiece powered air-purifying respirator (PAPR), two loose-fitting PAPRs, and one elastomeric/PAPR hybrid for 1 hr each during treadmill walking at 5.6 km/hr while undergoing physiological and subjective response monitoring. No significant interaction (p ≥ .05) was noted between the five respirators in heart rate, respiratory rate, oxygen saturation, transcutaneous carbon dioxide, and perceptions of breathing effort or discomfort, exertion, facial heat, and overall body heat. Respirator deadspace heat/humidity were significantly greater for the N95 FFR, whereas tympanic forehead skin temperatures were significantly greater for the hybrid PAPR. Temperature of the facial skin covered by the respirator was equivalent for the N95 FFR and hybrid PAPR, and both were significantly higher than for the other three PAPRs. Perception of eye dryness was significantly greater for a tight-fitting full facepiece PAPR than the N95 FFR and hybrid PAPR. At a low-moderate work rate over 1 hr, effects on cardiopulmonary variables, breathing perceptions, and facial and overall body heat perceptions did not differ significantly between the four PAPRs and a N95 FFR, but the tight-fitting, full facepiece PAPR increased perceptions of eye dryness. The two loose-fitting PAPRs and the full facepiece tight-fitting PAPR ameliorated exercise-induced increases in facial temperature, but this did not translate to improved perception of facial heat and overall body heat.     

Thermal burden of N95 filtering facepiece respirators

Increased thermal perceptions that affect comfort are a leading reason for intolerance to wearing respiratory protective equipment. Despite their popularity and use for decades, relatively little is known about the thermal burden imposed by the use of N95 filtering facepiece respirators (FFR) at normal work rates. Twenty healthy subjects exercised at a low-moderate work rate for 1 and 2 h while wearing four models of N95 FFR (two with an exhalation valve) as core and skin temperatures were monitored wirelessly. N95 FFR use resulted in non-significant minimal increases in core temperature and uncovered facial skin (cheek) temperatures. Facial skin temperature under the FFR was significantly increased over baseline values (P < 0.001). Wearing N95 FFR for up to 2 h at a low-moderate work rate does not impose a significant thermal burden on core temperature and uncovered facial skin temperature but significantly increases the temperature of the facial skin that is covered by the FFR. Perceptions of increased body heat when wearing N95 FFR under the test conditions are likely not due to effects on core temperature but may relate more to warming of the facial skin covered by the respirator and warming of the inspired air.     

The effect of simulated air conditions on N95 filtering facepiece respirators performance

The objective of this study was to determine the effect of several simulated air environmental conditions on the particle penetration and the breathing resistance of two N95 filtering facepiece respirator (FFR) models. The particle penetration and breathing resistance of the respirators were evaluated in a test system developed to mimic inhalation and exhalation breathing while relative humidity and temperature were modified. Breathing resistance was measured over 120 min using a calibrated pressure transducer under four different temperature and relative humidity conditions without aerosol loading. Particle penetration was evaluated before and after the breathing resistance test at room conditions using a sodium chloride aerosol measured with a scanning mobility particle sizer. Results demonstrated that increasing relative humidity and lowering external temperature caused significant increases in breathing resistance (p < 0.001). However, these same conditions did not influence the penetration or most penetrating particle size of the tested FFRs. The increase in breathing resistance varied by FFR model suggesting that some FFR media are less influenced by high relative humidity.     

N95 filtering facepiece respirator deadspace temperature and humidity

The objective of this study was to determine the levels of heat and humidity that develop within the deadspace of N95 filtering facepiece respirators (N95 FFR). Seventeen subjects wore two models each of N95 FFR and N95 FFR with an exhalation valve (N95 FFR/EV) while exercising on a treadmill at a low-moderate work rate for 1 and 2 hr in a temperate ambient environment. FFR deadspace temperature and relative humidity were monitored by a wireless sensor housed within the FFR. Each FFR was weighed pre- and post-testing to determine moisture retention. After 1 hr, FFR deadspace temperature and humidity were markedly elevated above ambient levels, and the FFR deadspace mean apparent heat index was 54°C. N95 FFR/EV use resulted in significantly lower deadspace temperatures than N95 FFR (p = 0.01), but FFR deadspace humidity levels were not significantly different (p = 0.32). Compared with the first hour of use, no significant increase in FFR deadspace heat and humidity occurred over the second hour. FFR mean moisture retention was < 0.3 grams over 2 hr. N95 FFR/EV offer a significant advantage in deadspace heat dissipation over N95 FFR at a low-moderate work rate over 1 hr of continuous use but offered no additional benefit in humidity amelioration. Moisture retention in N95 FFR and N95 FFR/EV is minimal after 2 hr of use. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file containing N95 filtering facepiece respirator deadspace mean RH and temperature recordings for 17 subjects treadmill exercising at 5.6 Km/H over 1 hour.].     

Analysis of forces generated by n95 filtering facepiece respirator tethering devices: a pilot study

The restorative forces of elasticized tethering devices on N95 filtering facepiece respirators (N95 FFR), that occur in response to the application of a load (applied force) during donning, create the requisite pressure to effectively seal the respirator against the face and prevent excessive inward migration of harmful elements. Many workers don and doff the same N95 FFR multiple times in the course of a single workday, yet little is known regarding the possible degradation of these restorative loads and, by implication, protection with multiple donnings. This laboratory pilot study evaluated the degradation in loads of tethering devices of three models of N95 FFRs subjected to the strain of five wear periods of 15?min interspersed with 15-min periods without wear. Data indicate that there were load degradations at each donning that differed significantly with the FFR model (p = <0.001), the greatest of which occurred with the first donning. The N95 FFR model with the lowest restorative loads was able to pass fit testing in a previous study, indicating that lower loads, perhaps coupled with FFR model-specific features, are sufficient to provide an adequate face/FFR interface seal. Tethering devices are importantly related to issues of comfort and protection afforded by N95 FFR and additional research is warranted.     

Filter penetration and breathing resistance evaluation of respirators and dust masks

The primary objective of this study was to compare the filter performance of a representative selection of uncertified dust masks relative to the filter performance of a set of NIOSH-approved N95 filtering face-piece respirators (FFRs). Five different models of commercially available dust masks were selected for this study. Filter penetration of new dust masks was evaluated against a sodium chloride aerosol. Breathing resistance (BR) of new dust masks and FFRs was then measured for 120 min while challenging the dust masks and FFRs with Arizona road dust (ARD) at 25°C and 30% relative humidity. Results demonstrated that a wide range of maximum filter penetration was observed among the dust masks tested in this study (3–75% at the most penetrating particle size (p < 0.001). The breathing resistances of the unused FFRs and dust masks did not vary greatly (8–13 mm H₂O) but were significantly different (p < 0.001). After dust loading there was a significant difference between the BR caused by the ARD dust layer on each FFR and dust mask. Microscopic analysis of the external layer of each dust mask and FFR suggests that different collection media in the external layer influences the development of the dust layer and therefore affects the increase in BR differently between the tested models. Two of the dust masks had penetration values < 5% and quality factors (0.26 and 0.33) comparable to those obtained for the two FFRs (0.23 and 0.31). However, the remaining three dust masks, those with penetration > 15%, had quality factors ranging between 0.04–0.15 primarily because their initial BR remained relatively high. These results indicate that some dust masks analysed during this research did not have an expected very low BR to compensate for their high penetration.     

Sensitivity and specificity of the user-seal-check in determining the fit of N95 respirators

N95 respirators are recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to prevent the inhalation of droplets which may transmit respiratory pathogens. The reliability of N95 respirators in preventing transmission depends on their fit to the wearer. Quantitative fit testing (QNFT) is the gold standard used to determine this fit objectively. The manufacturers of the respirators also recommend performing a self-reported user-seal-check to detect for leakage. This study aims to investigate the capability of the user-seal-check in determining the fit of N95 respirators by investigating the sensitivity and specificity of the user-seal-check compared with QNFT. A prospective and cross-sectional research design was used. A total of 204 local Chinese undergraduate nursing students were recruited to test two commonly used respirator models (3M 1860S and 3M 1862). The results of the user-seal-check were compared with the results of the gold standard QNFT using the Condensation Nucleus Counter Fit Tester System. The sensitivity and specificity of the user-seal-check results obtained with the respirators were calculated. The results indicated low sensitivity, accuracy and predictive value of the user-seal-check in determining the fit of the N95 respirators. The user-seal-check was not found to be reliable as a substitute for QNFT. The results also suggested that the user-seal-check may be unreliable for detecting gross leakage. We recommend that QNFT is used to determine the fit of N95 respirators.     

Manikin-based size-resolved penetrations of CE-marked filtering facepiece respirators

The purpose of this manikin-based study was to determine the percentage penetrations of nine CE-marked filtering facepiece respirator models (two samples from each) from filtering classes FFP1, FFP2, and FFP3 and to demonstrate by an independent measurement method the disadvantages and shortcomings of the currently valid European Norm (EN 149:2001) for filtering facepieces. All of the filtering facepieces were evaluated size-selectively in an experimental chamber using charge-neutralized monodisperse ammonium sulfate in 9 sizes ranging from 20–400 nm of count median diameter (CMD) under flowrate of 95 L/min. The results were then compared to the previous study concerning penetrations of 47-mm diameter filters cut from the filtering material of identical filtering facepieces. Although these two experimental methods for measuring penetrations of filtering materials from filtering facepieces are in good agreement (R² = 0.91), the results show within-respirator variations in all three filtering classes (5.5–19.3% for all FFRs in FFP1, 2.8–8.5% in FFP2, and 0.1–2.8% in FFP3). The most penetrating particle size (MPPS) in this study was found to be in the range of 25–65 nm (CMD), which is in agreement with the range of 30–60 nm found in the previous study. Moreover, 7 out of 9 FFR models reached higher penetrations from manikin-based respirator measurements than during measurements of filters from the respective respirators. Furthermore, penetration levels increased up to ～50% when the respirator was not sealed around the face of the manikin, indicating that the real protection level provided by these filtering facepieces may be even lower if the respirator does not fit perfectly. Considering that poor filtration efficiency and poor fit may increase under real work conditions, the particle penetration is even higher than was found in this study. Therefore, the CE-marked respirators examined in this study may not be efficient in providing the expected level of protection for workers exposed to nanoparticles.     

Mental representation of self in relationships indirectly affects young Black women’s engagement in risky sexual behaviors through psychosocial HIV/STI risk factors

Black females are disproportionately affected by human immunodeficiency virus (HIV)/sexually transmitted infections (STIs), though individual-level sexual risk factors do not appear to explain racial/ethnic HIV incidence rate disparities. The current study examined the roles of attachment representations, working models of self and others, with psychosocial risk factors related to population-level sexual network features in association with risky sexual behaviors. A total of 560 Black emerging adult females (M age = 20.58, SD = 1.89) enrolling in a behavioral HIV prevention intervention trial completed the baseline assessment used in the current analyses. A series of multiple mediator models examined indirect effects of working models of self and others on sexual risk engagement through the following psychosocial HIV/STI risk factors: (a) partner communication self-efficacy, (b) fear of condom negotiation, (c) peer norms for risky sexual behavior, (d) partner trust and (e) sex-related alcohol expectancies. Results indicated an indirect effect of working model of self on the following: condom use with boyfriend/main partner through peer norms for risky sex (ab = .08, 95% CI [.02, .17]), any alcohol use prior to sex through peer norms for risky sex (ab = ?.06, 95% CI [?.12, ?.02]) and alcohol use prior to sex through sex-related alcohol expectancies (ab = ?.13, 95% CI [?.21, ?.05]). Findings provided evidence of a direct association between working model of self and each psychosocial HIV/STI risk factor included in the mediation models. Working model of self may help identify Black females at elevated risk for HIV/STI through these psychosocial risk factors.     

A Quantitative Assessment of the Total Inward Leakage of NaCl Aerosol Representing Submicron-Size Bioaerosol Through N95 Filtering Facepiece Respirators and Surgical Masks

Respiratory protection provided by a particulate respirator is a function of particle penetration through filter media and through faceseal leakage. Faceseal leakage largely contributes to the penetration of particles through a respirator and compromises protection. When faceseal leaks arise, filter penetration is assumed to be negligible. The contribution of filter penetration and faceseal leakage to total inward leakage (TIL) of submicron-size bioaerosols is not well studied. To address this issue, TIL values for two N95 filtering facepiece respirator (FFR) models and two surgical mask (SM) models sealed to a manikin were measured at 8 L and 40 L breathing minute volumes with different artificial leak sizes. TIL values for different size (20–800 nm, electrical mobility diameter) NaCl particles representing submicron-size bioaerosols were measured using a scanning mobility particle sizer. Efficiency of filtering devices was assessed by measuring the penetration against NaCl aerosol similar to the method used for NIOSH particulate filter certification. Results showed that the most penetrating particle size (MPPS) was ～45 nm for both N95 FFR models and one of the two SM models, and ～350 nm for the other SM model at sealed condition with no leaks as well as with different leak sizes. TIL values increased with increasing leak sizes and breathing minute volumes. Relatively, higher efficiency N95 and SM models showed lower TIL values. Filter efficiency of FFRs and SMs influenced the TIL at different flow rates and leak sizes. Overall, the data indicate that good fitting higher-efficiency FFRs may offer higher protection against submicron-size bioaerosols.     

Transfer of bacteriophage MS2 and fluorescein from N95 filtering facepiece respirators to hands: Measuring fomite potential

Contact transmission of pathogens from personal protective equipment is a concern within the healthcare industry. During public health emergency outbreaks, resources become constrained and the reuse of personal protective equipment, such as N95 filtering facepiece respirators, may be needed. This study was designed to characterize the transfer of bacteriophage MS2 and fluorescein between filtering facepiece respirators and the wearer's hands during three simulated use scenarios. Filtering facepiece respirators were contaminated with MS2 and fluorescein in droplets or droplet nuclei. Thirteen test subjects performed filtering facepiece respirator use scenarios including improper doffing, proper doffing and reuse, and improper doffing and reuse. Fluorescein and MS2 contamination transfer were quantified. The average MS2 transfer from filtering facepiece respirators to the subjects' hands ranged from 7.6–15.4% and 2.2–2.7% for droplet and droplet nuclei derived contamination, respectively. Handling filtering facepiece respirators contaminated with droplets resulted in higher levels of MS2 transfer compared to droplet nuclei for all use scenarios (p = 0.007). MS2 transfer from droplet contaminated filtering facepiece respirators during improper doffing and reuse was greater than transfer during improper doffing (p = 0.008) and proper doffing and reuse (p = 0.042). Droplet contamination resulted in higher levels of fluorescein transfer compared to droplet nuclei contaminated filtering facepiece respirators for all use scenarios (p = 0.009). Fluorescein transfer was greater for improper doffing and reuse (p = 0.007) from droplet contaminated masks compared to droplet nuclei contaminated filtering facepiece respirators and for improper doffing and reuse when compared improper doffing (p = 0.017) and proper doffing and reuse (p = 0.018) for droplet contaminated filtering facepiece respirators. For droplet nuclei contaminated filtering facepiece respirators, the difference in MS2 and fluorescein transfer did not reach statistical significance when comparing any of the use scenarios. The findings suggest that the results of fluorescein and MS2 transfer were consistent and highly correlated across the conditions of study. The data supports CDC recommendations for using proper doffing techniques and discarding filtering facepiece respirators that are directly contaminated with secretions from a cough or sneeze.     

How Does Breathing Frequency Affect the Performance of an N95 Filtering Facepiece Respirator and a Surgical Mask Against Surrogates of Viral Particles?

Breathing frequency (breaths/min) differs among individuals and levels of physical activity. Particles enter respirators through two principle penetration pathways: faceseal leakage and filter penetration. However, it is unknown how breathing frequency affects the overall performance of N95 filtering facepiece respirators (FFRs) and surgical masks (SMs) against viral particles, as well as other health-relevant submicrometer particles. A FFR and SM were tested on a breathing manikin at four mean inspiratory flows (MIFs) (15, 30, 55, and 85 L/min) and five breathing frequencies (10, 15, 20, 25, and 30 breaths/min). Filter penetration (P_filter) and total inward leakage (TIL) were determined for the tested respiratory protection devices against sodium chloride (NaCl) aerosol particles in the size range of 20 to 500 nm. “Faceseal leakage-to-filter” (FLTF) penetration ratios were calculated. Both MIF and breathing frequency showed significant effects (p < 0.05) on P_filter and TIL. Increasing breathing frequency increased TIL for the N95 FFR whereas no clear trends were observed for the SM. Increasing MIF increased P_filter and decreased TIL resulting in decreasing FLTF ratio. Most of FLTF ratios were >1, suggesting that the faceseal leakage was the primary particle penetration pathway at various breathing frequencies. Breathing frequency is another factor (besides MIF) that can significantly affect the performance of N95 FFRs, with higher breathing frequencies increasing TIL. No consistent trend of increase or decrease of TIL with either MIF or breathing frequency was observed for the tested SM. To potentially extend these findings beyond the manikin/breathing system used, future studies are needed to fully understand the mechanism causing the breathing frequency effect on the performance of respiratory protection devices on human subjects.     

Design and implementation of a sexual health intervention for migrant construction workers situated in Shanghai,China

Background

China’s growing population of internal migrants has exceeded 236 million. Driven by rapid development and urbanization, this extreme population mobility creates opportunities for transmission of HIV and sexually-transmitted infections (STI). Large numbers of rural migrants flock to megacities such as Shanghai in search of employment. Although migrants constitute a key population at heightened risk of acquiring HIV or an STI, there is a lack of easily accessible sexual health services available for them. In response, we designed a short, inexpensive sexual health intervention that sought to improve HIV and STI knowledge, while reducing stigma, risky sexual behaviour, and sexual transmission of HIV and STI among migrant construction workers (MCW) situated in Shanghai, China.

Results

We implemented a three-armed, community-randomized trial spread across three administrative districts of Shanghai. The low-intensity intervention included educational pamphlets. The medium-intensity intervention included pamphlets, posters, and videos. The high-intensity intervention added group and individual counselling sessions. Across 18 construction sites, 1871 MCW were allocated at baseline to receive one intervention condition. Among baseline participants, 1304 workers were retained at 3-months, and 1013 workers were retained at 6-months, representing a total of 579 person-years of follow-up. All workers, regardless of participation, had access to informational materials even if they did not participate in the evaluation. Overall outputs included: 2284 pamphlets distributed, 720 posters displayed, 672 h of video shown, 376 participants accessed group counselling, and 61 participants attended individual counselling sessions. A multivariable analysis of participation found that men (aOR = 2.2; 95 % CI 1.1, 4.1; p = 0.036), workers situated in Huangpu district (aOR = 5.0; 95 % CI 2.6, 9.5; p < 0.001), and those with a middle school education (aOR = 1.9; 95 % CI 1.2, 3.0; p = 0.01) were more likely to have participated in intervention activities.

Conclusion

A brief educational intervention that prioritized ease of delivery to a highly mobile workforce was feasible and easily accessed by participants. Routine implementation of sexual health interventions in workplaces that employ migrant labour have the potential to make important contributions toward improving HIV and STI outcomes among migrant workers in China’s largest cities.

     

Development of an Advanced Respirator Fit-Test Headform

Improved respirator test headforms are needed to measure the fit of N95 filtering facepiece respirators (FFRs) for protection studies against viable airborne particles. A Static (i.e., non-moving, non-speaking) Advanced Headform (StAH) was developed for evaluating the fit of N95 FFRs. The StAH was developed based on the anthropometric dimensions of a digital headform reported by the National Institute for Occupational Safety and Health (NIOSH) and has a silicone polymer skin with defined local tissue thicknesses. Quantitative fit factor evaluations were performed on seven N95 FFR models of various sizes and designs. Donnings were performed with and without a pre-test leak checking method. For each method, four replicate FFR samples of each of the seven models were tested with two donnings per replicate, resulting in a total of 56 tests per donning method. Each fit factor evaluation was comprised of three 86-sec exercises: “Normal Breathing” (NB, 11.2 liters per min (lpm)), “Deep Breathing” (DB, 20.4 lpm), then NB again. A fit factor for each exercise and an overall test fit factor were obtained. Analysis of variance methods were used to identify statistical differences among fit factors (analyzed as logarithms) for different FFR models, exercises, and testing methods. For each FFR model and for each testing method, the NB and DB fit factor data were not significantly different (P > 0.05). Significant differences were seen in the overall exercise fit factor data for the two donning methods among all FFR models (pooled data) and in the overall exercise fit factor data for the two testing methods within certain models. Utilization of the leak checking method improved the rate of obtaining overall exercise fit factors ≥100. The FFR models, which are expected to achieve overall fit factors ≥ 100 on human subjects, achieved overall exercise fit factors ≥ 100 on the StAH. Further research is needed to evaluate the correlation of FFRs fitted on the StAH to FFRs fitted on people.

[Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: a file providing detailed information on the advanced head form design and fabrication process.]     

Objective assessment of increase in breathing resistance of N95 respirators on human subjects

Face masks or respirators are commonly worn by medical professionals and patients for protection against respiratory tract infection and the spread of illnesses, such as severe acute respiratory syndrome and pandemic influenza (H1N1). Breathing discomfort due to increased breathing resistance is known to be a problem with the use of N95 respirators but there is a lack of scientific data to quantify this effect. The purpose of this study was to assess objectively the impact of wearing N95 face masks on breathing resistance. A total of 14 normal adult volunteers (seven males and seven females) were recruited in this study. Nasal airflow resistance during inspiration and expiration was measured using a standard rhinomanometry and nasal spirometry. A modified full face mask was produced in-house in order to measure nasal resistance with the use of N95 (3M 8210) respirators. The results showed a mean increment of 126 and 122% in inspiratory and expiratory flow resistances, respectively, with the use of N95 respirators. There was also an average reduction of 37% in air exchange volume with the use of N95 respirators. This is the first reported study that demonstrates quantitatively and objectively the substantial impairment of nasal airflow in terms of increased breathing resistance with the use of N95 respirators on actual human subjects.     

Simulated workplace protection factors for half-facepiece respiratory protective devices

This study investigates two different methods (random effects model and 5th percentile) for determining the performance of three types of respiratory protective devices (elastomeric N95 respirators, N95 filtering-facepiece respirators, and surgical masks) during a simulated workplace test. This study recalculated the protection level of three types of respiratory protective devices using the random effects model, compared the two methods with each other and the APF of 10 for half-facepiece respirators, and determined the value of each of the fit test protocols in attaining the desired level of simulated workplace protection factor (SWPF). Twenty-five test subjects with varying face sizes tested 15 models of elastomeric N95 respirators, 15 models of N95 filtering-facepiece respirators, and 6 models of surgical masks. Simulated workplace testing was conducted using a TSI PORTACOUNT Plus model 8020 and consisted of a series of seven exercises. Six simulated workplace tests were performed with redonning of the respirator/mask occurring between each test. Each of the six tests produced an SWPF. To determine the level of protection provided by the respiratory protective devices, a 90% lower confidence limit for the simulated workplace protection factor (SWPF(LCL90%)) and the 5th percentile of simulated workplace protection factor were computed. The 5th percentile method values could be up to seven times higher than the SWPF(LCL90%) values. Without fit testing, all half-facepiece N95 respirators had a 5th percentile of 4.6 and an SWPF(LCL90%) value of 2.7. N95 filtering-facepiece respirators as a class had values of 3.3 and 2.0, respectively, whereas N95 elastomeric respirators had values of 7.3 and 4.6, respectively. Surgical masks did not provide any protection, with values of 1.2 and 1.4, respectively. Passing either the Bitrex, saccharin, or Companion fit test resulted in the respirators providing the expected level of protection with 5th percentiles greater than or equal to 10 except when passing the Bitrex test with N95 filtering-facepiece respirators, which resulted in a 5th percentile of only 7.9. No substantial difference was seen between the three fit tests. All of the SWPF(LCL90%) values after passing a fit test were less than 10. The random model method provides a more conservative estimate of the protection provided by a respirator because it takes into account both between- and within-wearer variability.     

Effectiveness of three decontamination treatments against influenza virus applied to filtering facepiece respirators

Filtering facepiece respirators (FFRs) are recommended for use as precautions against airborne pathogenic microorganisms; however, during pandemics demand for FFRs may far exceed availability. Reuse of FFRs following decontamination has been proposed but few reported studies have addressed the feasibility. Concerns regarding biocidal efficacy, respirator performance post decontamination, decontamination cost, and user safety have impeded adoption of reuse measures. This study examined the effectiveness of three energetic decontamination methods [ultraviolet germicidal irradiation (UVGI), microwave-generated steam, and moist heat] on two National Institute for Occupational Safety and Health-certified N95 FFRs (3M models 1860s and 1870) contaminated with H5N1. An aerosol settling chamber was used to apply virus-laden droplets to FFRs in a method designed to simulate respiratory deposition of droplets onto surfaces. When FFRs were examined post decontamination by viral culture, all three decontamination methods were effective, reducing virus load by > 4 log median tissue culture infective dose. Analysis of treated FFRs using a quantitative molecular amplification assay (quantitative real-time polymerase chain reaction) indicated that UVGI decontamination resulted in lower levels of detectable viral RNA than the other two methods. Filter performance was evaluated before and after decontamination using a 1% NaCl aerosol. As all FFRs displayed <5% penetration by 300-nm particles, no profound reduction in filtration performance was caused in the FFRs tested by exposure to virus and subsequent decontamination by the methods used. These findings indicate that, when properly implemented, these methods effectively decontaminate H5N1 on the two FFR models tested and do not drastically affect their filtering function; however, other considerations may influence decisions to reuse FFRs.     

Filtration performance of NIOSH-approved N95 and P100 filtering facepiece respirators against 4 to 30 nanometer-size nanoparticles

This study investigated the filtration performance of NIOSH-approved N95 and P100 filtering facepiece respirators (FFR) against six different monodisperse silver aerosol particles in the range of 4-30 nm diameter. A particle test system was developed and standardized for measuring the penetration of monodisperse silver particles. For respirator testing, five models of N95 and two models of P100 filtering facepiece respirators were challenged with monodisperse silver aerosol particles of 4, 8, 12, 16, 20, and 30 nm at 85 L/min flow rate and percentage penetrations were measured. Consistent with single-fiber filtration theory, N95 and P100 respirators challenged with silver monodisperse particles showed a decrease in percentage penetration with a decrease in particle diameter down to 4 nm. Penetrations less than 1 particle/30 min for 4-8 nm particles for one P100 respirator model, and 4-12 nm particles for the other P100 model, were observed. Experiments were also carried out with larger than 20 nm monodisperse NaCl particles using a TSI 3160 Fractional Efficiency Tester. NaCl aerosol penetration levels of 20 nm and 30 nm (overlapping sizes) particles were compared with silver aerosols of the same sizes by a three-way ANOVA analysis. A significant (p < 0.001) difference between NaCl and silver aerosol penetration levels was obtained after adjusting for particle sizes and manufacturers. A significant (p = 0.001) interaction with manufacturers indicated the difference in NaCl, and silver aerosol penetrations were not the same across manufacturers. The two aerosols had the same effect across 20 nm and 30 nm sizes as shown by the absence of any significant (p = 0.163) interaction with particle sizes. In the case of P100 FFRs, a significant (p < 0.001) difference between NaCl and silver aerosol (20 nm and 30 nm) penetrations was observed for both respirator models tested. The filtration data for 4-30 nm monodisperse particles supports previous studies that indicate NIOSH-approved air-purifying respirators provide expected levels of filtration protection against nanoparticles.     

Comparison of performance of three different types of respiratory protection devices

Respiratory protection is offered to American workers in a variety of ways to guard against potential inhalation hazards. Two of the most common ways are elastomeric N95 respirators and N95 filtering-facepiece respirators. Some in the health care industry feel that surgical masks provide an acceptable level of protection in certain situations against particular hazards. This study compared the performance of these types of respiratory protection during a simulated workplace test that measured both filter penetration and face-seal leakage. A panel of 25 test subjects with varying face sizes tested 15 models of elastomeric N95 respirators, 15 models of N95 filtering-facepiece respirators, and 6 models of surgical masks. Simulated workplace testing was conducted using a TSI PORTACOUNT Plus model 8020, and consisted of a series of seven exercises. Six simulated workplace tests were performed with redonning of the respirator/mask occurring between each test. The results of these tests produced a simulated workplace protection factor (SWPF). The geometric mean (GM) and the 5th percentile values of the SWPFs were computed by category of respiratory protection using the six overall SWPF values. The level of protection provided by each of the three respiratory protection types was compared. The GM and 5th percentile SWPF values without fit testing were used for the comparison, as surgical masks were not intended to be fit tested. The GM values were 36 for elastomeric N95 respirators, 21 for N95 filtering-facepiece respirators, and 3 for surgical masks. An analysis of variance demonstrated a statistically significant difference between all three. Elastomeric N95 respirators had the highest 5th percentile SWPF of 7. N95 filtering-facepiece respirators and surgical masks had 5th percentile SWPFs of 3 and 1, respectively. A Fisher Exact Test revealed that the 5th percentile SWPFs for all three types of respiratory protection were statistically different. In addition, both qualitative (Bitrex and saccharin) and quantitative (N95-Companion) fit testing were performed on the N95 filtering- and elastomeric-facepiece respirators. It was found that passing a fit test generally improves the protection afforded the wearer. Passing the Bitrex fit test resulted in 5th percentile SWPFs of 11.1 and 7.9 for elastomeric and filtering-facepiece respirators, respectively. After passing the saccharin tests, the elastomeric respirators provided a 5th percentile of 11.7, and the filtering-facepiece respirators provided a 5th percentile of 11.0. The 5th percentiles after passing the N95-Companion were 13.0 for the elastomeric respirators and 20.5 for the filtering-facepiece respirators. The data supports fit testing as an essential element of a complete respiratory protection program.