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.     

Impact of three biological decontamination methods on filtering facepiece respirator fit, odor, comfort, and donning ease

The objective of this study was to determine if ultraviolet germicidal irradiation (UVGI), moist heat incubation (MHI), or microwave-generated steam (MGS) decontamination affects the fitting characteristics, odor, comfort, or donning ease of six N95 filtering facepiece respirator (FFR) models. For each model, 10 experienced test subjects qualified for the study by passing a standard OSHA quantitative fit test. Once qualified, each subject performed a series of fit tests to assess respirator fit and completed surveys to evaluate odor, comfort, and donning ease with FFRs that were not decontaminated (controls) and with FFRs of the same model that had been decontaminated. Respirator fit was quantitatively measured using a multidonning protocol with the TSI PORTACOUNT Plus and the N95 Companion accessory (designed to count only particles resulting from face to face-seal leakage). Participants' subjective appraisals of the respirator's odor, comfort, and donning ease were captured using a visual analog scale survey. Wilcoxon signed rank tests compared median values for fit, odor, comfort, and donning ease for each FFR and decontamination method against their respective controls for a given model. Two of the six FFRs demonstrated a statistically significant reduction (p < 0.05) in fit after MHI decontamination. However, for these two FFR models, post-decontamination mean fit factors were still ≥ 100. One of the other FFRs demonstrated a relatively small though statistically significant increase (p < 0.05) in median odor response after MHI decontamination. These data suggest that FFR users with characteristics similar to those in this study population would be unlikely to experience a clinically meaningful reduction in fit, increase in odor, increase in discomfort, or increased difficulty in donning with the six FFRs included in this study after UVGI, MHI, or MGS decontamination. Further research is needed before decontamination of N95 FFRs for purposes of reuse can be recommended.     

Considerations for Recommending Extended Use and Limited Reuse of Filtering Facepiece Respirators in Health Care Settings

Public health organizations, such as the Centers for Disease Control and Prevention (CDC), are increasingly recommending the use of N95 filtering facepiece respirators (FFRs) in health care settings. For infection control purposes, the usual practice is to discard FFRs after close contact with a patient (“single use”). However, in some situations, such as during contact with tuberculosis patients, limited FFR reuse (i.e., repeated donning and doffing of the same FFR by the same person) is practiced. A related practice, extended use, involves wearing the same FFR for multiple patient encounters without doffing. Extended use and limited FFR reuse have been recommended during infectious disease outbreaks and pandemics to conserve FFR supplies. This commentary examines CDC recommendations related to FFR extended use and limited reuse and analyzes available data from the literature to provide a relative estimate of the risks of these practices compared to single use.

Analysis of the available data and the use of disease transmission models indicate that decisions regarding whether FFR extended use or reuse should be recommended should continue to be pathogen- and event-specific. Factors to be included in developing the recommendations are the potential for the pathogen to spread via contact transmission, the potential that the event could result in or is currently causing a FFR shortage, the protection provided by FFR use, human factors, potential for self-inoculation, the potential for secondary exposures, and government policies and regulations. While recent findings largely support the previous recommendations for extended use and limited reuse in certain situations, some new cautions and limitations should be considered before issuing recommendations in the future. In general, extended use of FFRs is preferred over limited FFR reuse. Limited FFR reuse would allow the user a brief respite from extended wear times, but increases the risk of self-inoculation and preliminary data from one study suggest that some FFR models may begin to lose effectiveness after multiple donnings.     

Reaerosolization of MS2 bacteriophage from an N95 filtering facepiece respirator by simulated coughing

The supply of N95 filtering facepiece respirators (FFRs) may not be adequate to match demand during a pandemic outbreak. One possible strategy to maintain supplies in healthcare settings is to extend FFR use for multiple patient encounters; however, contaminated FFRs may serve as a source for the airborne transmission of virus particles. In this study, reaerosolization of virus particles from contaminated FFRs was examined using bacteriophage MS2 as a surrogate for airborne pathogenic viruses. MS2 was applied to FFRs as droplets or droplet nuclei. A simulated cough (370 l min(-1) peak flow) provided reverse airflow through the contaminated FFR. The number and size of the reaerosolized particles were measured using gelatin filters and an Andersen Cascade Impactor (ACI). Two droplet nuclei challenges produced higher percentages of reaerosolized particles (0.21 and 0.08%) than a droplet challenge (<0.0001%). Overall, the ACI-determined size distribution of the reaerosolized particles was larger than the characterized loading virus aerosol. This study demonstrates that only a small percentage of viable MS2 viruses was reaerosolized from FFRs by reverse airflow under the conditions evaluated, suggesting that the risks of exposure due to reaerosolization associated with extended use can be considered negligible for most respiratory viruses. However, risk assessments should be updated as new viruses emerge and better workplace exposure data becomes available.     

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.]     

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.     

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.     

Cross Contamination: Are Hospital Gloves Reservoirs for Nosocomial Infections?

Use of disposable nonsterile gloves in the hospital setting is second only to proper hand washing in reducing contamination during patient contact. Because proper handwashing is not consistently practiced, added emphasis on glove use is warranted. There is a growing body of evidence that glove boxes and dispensers available to healthcare workers are contaminated by daily exposure to environmental organisms. This finding, in conjunction with new and emerging antibiotic-resistant bacteria, poses a threat to patients and healthcare workers alike. A newly designed glove dispenser may reduce contamination of disposable gloves. The authors investigated contamination of nonsterile examination gloves in an Emergency Department setting according to the type of dispenser used to access gloves. A statistically significant difference existed between the number of bacterial colonies and the type of dispenser: the downward-facing glove dispenser had a lower number of bacteria on the gloves. There was no statistically significant difference in the number of gloves contaminated between the two types of glove dispensers. The study demonstrated that contamination of disposable gloves existed. Additional research using a larger sample size would validate a difference in the contamination of disposable gloves using outward or downward glove dispensers.     

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.     

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.     

Performance of conventional and antimicrobial-treated filtering facepiece respirators challenged with biological aerosols

This study evaluated the filtration performance of four commercially available models of National Institute of Occupational Safety and Health (NIOSH)-certified filtering facepiece respirators (FFR) against both biological and inert aerosols at a flow rate of 85 L/min. Conventional N95 and P100 FFRs and two antimicrobial (AM)-treated FFRs (an N95 and a P95, both with iodine-based AM treatments) were tested for both physical penetration (PEN(P)) and viable penetration (PEN(V)) with three different bioaerosols, including MS2 bacteriophage virus, and the spores and vegetative cells of Bacillus atrophaeus bacteria, in addition to inert sodium chloride (NaCl) aerosol. For each FFR model, the PEN(P) measured with NaCl was predictive of its MS2 PEN(P), and it was observed that spores and bacteria aerosols were also filtered similarly to the inert aerosol. For both conventional FFRs, up to a 1-log reduction in PEN(V) in comparison with PEN(P) was observed and attributed to the experimental variability of the test system. For both models of AM-FFRs, no statistically significant differences between PEN(V) and PEN(P) for any of the three different bioaerosol challenges were observed. Thus, no bioaerosol filtration enhancement over the conventional FFRs was detected for either iodine-based AM-FFR. In the absence of any standardized test methods, we recommend that future studies evaluating the filtration performance of AM-treated FFRs incorporate the experimental best practices described herein.     

Internal contamination of gloves: routes and consequences

The effect of internal glove contamination was investigated using N-methyl pyrrolidone (NMP) as a biological marker to assess systemic absorption when wearing internally contaminated gloves, and when not wearing gloves but subjected to the same challenge contaminant. The routes by which the insides of gloves become contaminated were also investigated. The area of dermal contamination was quantified using a fluorescent tracer dye and a surface monitoring fluorimeter. The main routes of internal glove contamination were found to be self-contamination, cuff entry and failed gloves. Wearing internally contaminated gloves led to higher systemic absorption than was gained from the equivalent skin contamination when not wearing gloves. Repeat wetting of fingers with aqueous NMP, when gloves were not worn, gave higher systemic absorption than the equivalent continuous exposure, probably due to the low volatility of NMP leading to increased concentration and longer residence time on the skin.     

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.     

A Novel Algorithm for Determining Contact Area Between a Respirator and a Headform

The contact area, as well as the contact pressure, is created when a respiratory protection device (a respirator or surgical mask) contacts a human face. A computer-based algorithm for determining the contact area between a headform and N95 filtering facepiece respirator (FFR) was proposed. Six N95 FFRs were applied to five sizes of standard headforms (large, medium, small, long/narrow, and short/wide) to simulate respirator donning. After the contact simulation between a headform and an N95 FFR was conducted, a contact area was determined by extracting the intersection surfaces of the headform and the N95 FFR. Using computer-aided design tools, a superimposed contact area and an average contact area, which are non-uniform rational basis spline (NURBS) surfaces, were developed for each headform. Experiments that directly measured dimensions of the contact areas between headform prototypes and N95 FFRs were used to validate the simulation results. Headform sizes influenced all contact area dimensions (P < 0.0001), and N95 FFR sizing systems influenced all contact area dimensions (P < 0.05) except the left and right chin regions. The medium headform produced the largest contact area, while the large and small headforms produced the smallest.     

Impact of a hygiene intervention on virus spread in an office building

Viral illnesses have a significant direct and indirect impact on the workplace that burdens employers with increased healthcare costs, low productivity, and absenteeism. Workers' direct contact with each other and contaminated surfaces contributes to the spread of viruses at work. This study quantifies the impact of an office wellness intervention (OWI) to reduce viral load in the workplace. The OWI includes the use of a spray disinfectant on high-touch surfaces and providing workers with alcohol-based hand sanitizer gel and hand sanitizing wipes along with user instructions. Viral transmission was monitored by applying an MS2 phage tracer to a door handle and the hand of a single volunteer participant. At the same time, a placebo inoculum was applied to the hands of four additional volunteers. The purpose was to evaluate the concentration of viruses on workers' hands and office surfaces before and after the OWI. Results showed that the OWI significantly reduced viable phage concentrations per surface area on participants' hands, shared fomites, and personal fomites (p?=?0.0001) with an 85.4% average reduction. Reduction of virus concentrations on hands and fomites is expected to subsequently minimize the risk of infections from common enteric and respiratory pathogens. The surfaces identified as most contaminated were the refrigerator, drawer handles and sink faucets in the break room, along with pushbar on the main exit of the building, and the soap dispensers in the women's restroom. A comparison of contamination in different locations within the office showed that the break room and women's restrooms were the sites with the highest tracer counts. Results of this study can be used to inform quantitative microbial risk assessment (QMRA) models aimed at defining the relationship between surface contamination, pathogen exposure and the probability of disease that contributes to high healthcare costs, absenteeism, presenteeism, and loss of productivity in the workplace.     

Persistence of Respirator Use Learning

Although retraining and repeat fit-testing are needed for respirator users, the optimal frequency is uncertain. The persistence of proper respirator donning/doffing techniques and changes in quantitative fit factor over 6 months after initial training were measured in this study. Initial training was designed for rapid rollout situations in which direct contact with well-trained occupational health professionals may be infeasible. Subjects (n = 175) were assigned randomly to use either a filtering facepiece N95 (FFR) or dual cartridge half facemask (HFM) respirator. Each was assigned randomly to one of three training methods—printed brochure, video, or computer-based training. Soon after initial training, quantitative fit and measures of proper technique were determined. These measurements were repeated 6 months later. In the six-month followup, subjects were randomized to receive either a brief reminder card or a placebo card. Total performance score, major errors, and quantitative fit all became significantly worse at 6 months. An individual's result soon after training was the most important predictor of performance 6 months later. There was a marginal not statistically significant tendency for those initially trained by video to have better protection 6 months later. The study suggests that persons who use respirators intermittently should be thoroughly retrained and reevaluated periodically.

[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: Additional statistical analyses.     

Development and initial validation of the Respirator Comfort,Wearing Experience,and Function Instrument [R-COMFI]

Filtering face-piece respirators (FFRs) are worn to protect health care personnel from airborne particles; however, clinical studies have demonstrated that FFR adherence is relatively low in some settings, in part, due to discomfort and intolerance. The objective of this study was to develop and initially evaluate the psychometric properties of an instrument designed to measure the comfort and tolerability of FFRs.

Instrument items were developed through literature reviews, focus groups, and several iterations of ranking and refining by experts. Psychometric evaluation of the instrument was conducted using Rasch partial credit model (PCM) analysis. Pivot anchoring was used to specify the threshold defining item difficulty; in our analyses, this was the point that participants moved from possessing none of the trait to some of the trait.

The final instrument was completed by 165 health care personnel from 3 Veterans Health Administration facilities, and data were analyzed using Rasch PCM. Seven items were removed because they: (1) violated the assumption of independence; (2) were mis-fitting; and/or (3) were deemed not relevant. Category function analysis demonstrated that all categories progressed monotonically. Principal components analysis demonstrated the existence of three subscales (Discomfort, General Wearing Experience, and Function). Final reliability analyses showed that the scale had moderate to high person reliability and high item reliability. The final instrument contained 21 items.

Until now, to our knowledge no instrument with evidence supporting its reliability and validity to assess discomfort and tolerance of FFRs among health care personnel has been published. A 21-item psychometrically sound measure of comfort and tolerability of FFRs, Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), was developed. The significance of developing such an instrument is that it will help identify respirators that are likely to have better adherence in practice settings. The R-COMFI may be used within and beyond the VA healthcare system as a psychometrically sound instrument to evaluate the comfort and tolerability of respirators, including developmental prototypes.     

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.].     

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.     

Density and Proximity of Fast Food Restaurants and Body Mass Index Among African Americans

Objectives. The purpose of this study was to address current gaps in the literature by examining the associations of fast food restaurant (FFR) density around the home and FFR proximity to the home, respectively, with body mass index (BMI) among a large sample of African American adults from Houston, Texas.Methods. We used generalized linear models with generalized estimating equations to examine associations of FFR density at 0.5-, 1-, 2-, and 5-mile road network buffers around the home with BMI and associations of the closest FFR to the home with BMI. All models were adjusted for a range of individual-level covariates and neighborhood socioeconomic status. We additionally investigated the moderating effects of household income on these relations. Data were collected from December 2008 to July 2009.Results. FFR density was not associated with BMI in the main analyses. However, FFR density at 0.5, 1, and 2 miles was positively associated with BMI among participants with lower incomes (P ≤ .025). Closer FFR proximity was associated with higher BMI among all participants (P < .001), with stronger associations emerging among those of lower income (P < .013) relative to higher income (P < .014).Conclusions. Additional research with more diverse African American samples is needed, but results supported the potential for the fast food environment to affect BMI among African Americans, particularly among those of lower economic means.Obesity and its associated health conditions are a growing problem in the United States, with obesity prevalence having more than doubled since the 1960s.1 The health care cost of Americans’ growing waistlines is substantial and expected to top $860 billion by 2030.2 Racial/ethnic disparities in obesity are of particular concern for the nation’s health, with African Americans experiencing the highest prevalence of obesity relative to other racial/ethnic groups.1 The National Health and Nutrition Examination Survey from 2009 to 2010 indicated that 38.8% of African American men and 58.5% of African American women were obese compared with 36.2% of non-Hispanic White men and 32.2% of non-Hispanic White women.3 Racial/ethnic disparities have also been cited for body mass index (BMI), with the gap in BMI growth widening between African Americans and Whites in recent decades.4To better understand the factors associated with these trends, researchers and policymakers are paying increased attention to the retail food environment. The growing availability of low-cost, calorie-dense consumables from fast food restaurants (FFRs) is one of the factors implicated in the nation’s rising BMI.5–7 The availability of FFRs may be particularly relevant to the growing racial/ethnic disparities in BMI because several studies support a higher density of FFRs among predominately African American neighborhoods relative to predominately White neighborhoods.8–11 Moreover, at least 1 study reports stronger relations between fast food availability and fast food consumption among non-White versus White populations.12 Thus, African Americans may be more likely to consume fast food if it is available, and it may be more available to them because FFRs tend to be clustered in African American neighborhoods. Not surprisingly, greater fast food consumption is associated with higher BMI.13–15Several studies examined associations between the availability of fast food and BMI. Fast food availability was most commonly conceptualized as the density of FFRs near a person’s home, work, or school environment. Findings about the associations of FFR density with BMI and overweight or obesity status, however, were mixed,5,11 with some studies supporting positive associations,16–19 and others citing null results.14,20 Less commonly, studies conceptualized fast food availability as the proximity of the closest FFR to a person’s home. Studies taking this approach yielded mixed results regarding relations between FFR proximity and fast food consumption,21,22 as well as between FFR proximity and BMI or obesity status.11,23 Unfortunately, most of these studies focused predominately on White populations, and many had methodological limitations (e.g., self-reported BMI) that could have contributed to mixed results.5,11 We found only a single study that focused on an all-African American sample, which yielded null results regarding associations between FFR density and BMI.24 Although this study had several strengths, including a sample of more than 4500 African Americans and investigator-measured BMI, limitations included only 1 conceptualization of FFR availability (FFR density), and the use of Euclidean distances (“as the crow flies”) in density buffer calculation, which may be less realistic than buffers based on road networks (i.e., the only places along which FFRs can be found).5 In addition, we found no previous studies that examined whether associations between FFR availability and BMI were moderated by household income. Because reasons cited for frequent fast food consumption include both accessibility and affordability,6 it might be that relations of FFRs and BMI are stronger among those of lower economic means for whom fast food might be more affordable than other dining options. Therefore, additional research is needed to better understand the relations of fast food availability and BMI among African Americans.The purpose of this study was to address current gaps in the literature by examining the associations of FFR density around the home and FFR proximity to the home, respectively, with BMI among a large sample of African American adults from Houston, Texas. We additionally investigated the moderating effects of household income on these relations.