Particle release from respirators, part I: determination of the effect of particle size, drop height, and load

In late 2001, some U.S. Postal Service workers and a few members of Congress were exposed to anthrax spores. This led to an increased effort to develop employable methods to protect workers from exposure to anthrax. Some investigations focused on selection and use of respirators to protect workers against airborne anthrax. The present study evaluated the potential for several types of half-mask respirators to release deposited particles. Four brands of the most commonly used filtering facepiece respirators (hereafter termed masks) were loaded with 0.59-μm, 1.0-μm, and 1.9-μm polystyrene latex (PSL) microspheres (nominally 0.6, 1.0, and 2.0 μm) and then dropped onto a rigid surface. The load conditions were 10, 20, or 40 million particles, and drop heights were 0.15, 0.76, and 1.37 m. For the average conditions of 0.76 m, 1.15 μm size and 22 million particles loaded, the average particle release was 0.604 particles per 10,000 (95% CI: .552, .662) particles loaded for all of the filtering facepieces tested. The averaging of conditions is a useful tool to provide generalized information and is also useful when making risk estimates. For most filtering facepiece respirators, particle release tended to increase with drop height and particle size, and there appeared to be a slight inverse relationship with particle load. Two brands of reusable elastomeric half-mask respirators with P100 high-efficiency particulate air (HEPA) filter cartridges were also evaluated. Results of these tests were inconclusive. Part II in this issue addresses the release of particles when simulating removal of a filtering facepiece from a wearer's head.     

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 national Covid-19 vaccination Campaign,South Korea

BackgroundWe evaluate the overall effectiveness of the nationwide vaccination campaign using ChAdOx1 nCoV-19, BNT162b2, mRNA-1273, and Ad26.COV2.S vaccines in preventing Covid-19 in South Korea.MethodsThe National Surveillance System with the National Immunization Registry were linked to form a large-linked database for assessment. Age-adjusted incidence of SARS-CoV-2 infection, severe disease, and death by vaccination status are calculated. Weekly vaccine effectiveness was calculated based on incidence rate ratio (IRR) between fully-vaccinated and unvaccinated persons, as: IRR = incidence rate of vaccinated / incidence rate of unvaccinated. We estimate the cumulative SARS-CoV-2 outcome overtime comparing the observed case with predicted cases without vaccination.ResultsAge-adjusted incidence in unvaccinated persons (5.69 per 100,000 person-day) was 2.7 times the rate in fully vaccinated (2.13 per 100,000 person-day) persons, resulting effectiveness against SARS-CoV-2 infection of 63%. Vaccine effectiveness against severe disease and death were 93% and 95%, respectively. Between March and October 2021, estimated Covid-19 related outcomes averted by vaccinations were: 46,508 infections, 3,424 severe diseases, and 718 deaths.ConclusionsWe found significant protection for national Covid-19 vaccination campaign against Covid-19 severe disease, and death in target populations, but there was an unexpected decreased protection against SARS-CoV-2 infection, highlighting the importance of continued surveillance and assessment.     

Respiratory source control using a surgical mask: An in vitro study

Cough etiquette and respiratory hygiene are forms of source control encouraged to prevent the spread of respiratory infection. The use of surgical masks as a means of source control has not been quantified in terms of reducing exposure to others. We designed an in vitro model using various facepieces to assess their contribution to exposure reduction when worn at the infectious source (Source) relative to facepieces worn for primary (Receiver) protection, and the factors that contribute to each. In a chamber with various airflows, radiolabeled aerosols were exhaled via a ventilated soft-face manikin head using tidal breathing and cough (Source). Another manikin, containing a filter, quantified recipient exposure (Receiver). The natural fit surgical mask, fitted (SecureFit) surgical mask and an N95-class filtering facepiece respirator (commonly known as an “N95 respirator”) with and without a Vaseline-seal were tested. With cough, source control (mask or respirator on Source) was statistically superior to mask or unsealed respirator protection on the Receiver (Receiver protection) in all environments. To equal source control during coughing, the N95 respirator must be Vaseline-sealed. During tidal breathing, source control was comparable or superior to mask or respirator protection on the Receiver. Source control via surgical masks may be an important adjunct defense against the spread of respiratory infections. The fit of the mask or respirator, in combination with the airflow patterns in a given setting, are significant contributors to source control efficacy. Future clinical trials should include a surgical mask source control arm to assess the contribution of source control in overall protection against airborne infection.     

Particle release from respirators, part II: determination of the effect of tension applied in simulation of removal

This study evaluated the potential for disposable filtering facepiece respirators (hereafter termed masks) contaminated with 1-μ m particles to release particles as a result of lateral tension applied to the mask. The lateral tension was designed to simulate the removal of a contaminated mask from a user's head. Four brands of filtering facepieces were loaded with approximately 20 million 1.0-μ m polystyrene latex (PSL) microspheres. The respirators were then placed in a test chamber and subjected to lateral tension between 17.8-26.7 N (4-6 lbs) for 1 to 2 sec. The findings suggest that neither mask type nor loading condition affects particle release. This supports our hypothesis that when filtering facepiece respirators are properly removed from the head they will not release a significant number of particles.     

Respiratory protection provided by N95 filtering facepiece respirators against airborne dust and microorganisms in agricultural farms

A new system was used to determine the workplace protection factors (WPF) for dust and bioaerosols in agricultural environments. The field study was performed with a subject wearing an N95 filtering facepiece respirator while performing animal feeding, grain harvesting and unloading, and routine investigation of facilities. As expected, the geometric means (GM) of the WPFs increased with increasing particle size ranging from 21 for 0.7-1 microm particles to 270 for 5-10 microm particles (p < 0.001). The WPF for total culturable fungi (GM = 35) was significantly greater than for total culturable bacteria (GM = 9) (p = 0.01). Among the different microorganism groups, the WPFs of Cladosporium, culturable fungi, and total fungi were significantly correlated with the WPFs of particles of the same sizes. As compared with the WPFs for dust particles, the WPFs for bioaerosols were found more frequently below 10, which is a recommended assigned protection factor (APF) for N95 filtering facepiece respirators. More than 50% of the WPFs for microorganisms (mean aerodynamic diameter < 5 microm) were less than the proposed APF of 10. Even lower WPFs were calculated after correcting for dead space and lung deposition. Thus, the APF of 10 for N95 filtering facepiece respirators seems inadequate against microorganisms (mean aerodynamic size < 5 microm). These results provide useful pilot data to establish guidelines for respiratory protection against airborne dust and microorganisms on agricultural farms. The method is a promising tool for further epidemiological and intervention studies in agricultural and other similar occupational and nonoccupational environments.     

Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector

N95 filtering facepiece respirators are used by healthcare workers when there is a risk of exposure to airborne hazards during aerosol-generating procedures. Respirator fit-testing is required prior to use to ensure that the selected respirator provides an adequate face seal. Two common fit-test methods can be employed: qualitative fit-test (QLFT) or quantitative fit-test (QNFT). Respiratory protection standards deem both fit-tests to be acceptable. However, previous studies have indicated that fit-test results may differ between QLFT and QNFT and that the outcomes may also be influenced by the type of respirator model. The aim of this study was to determine if there is a difference in fit-test outcomes with our suite of respirators, 3M - 1860S, 1860, AND 1870, and whether the model impacts the fit-test results.

Subjects were recruited from residential care facilities. Each participant was assigned a respirator and underwent sequential QLFT and QNFT fit-tests and the results (either pass or fail) were recorded. To ascertain the degree of agreement between the two fit-tests, a Kappa (Κ) statistic was conducted as per the American National Standards Institute (ANSI) respiratory protection standard. The pass-fail rates were stratified by respirator model and a Kappa statistic was calculated for each to determine effect of model on fit-test outcomes.

We had 619 participants and the aggregate Κ statistic for all respirators was 0.63 which is below the suggested ANSI threshold of 0.70. There was no statistically significant difference in results when stratified by respirator model.

QNFT and QLFT produced different fit-test outcomes for the three respirator models examined. The disagreement in outcomes between the two fit-test methods with our suite of N95 filtering facepiece respirators was approximately 12%. Our findings may benefit other healthcare organizations that use these three respirators.     

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.     

Brief Cost Analysis of Surgical Personal Protective Equipment During the COVID-19 Pandemic

ObjectivesThis study aimed to compare the costs incurred and saved from universal use of N95 respirators with surgical masks for operating room providers in the United States during the COVID-19 pandemic.MethodsWe built a decision analytic model to compare direct medical costs of healthcare workers (HCWs) infected with COVID-19 during operating room procedures from expected transmission when using an N95 respirator relative to a surgical mask. We also examined quarantine costs.ResultsResults varied depending upon prevalence and false-negative rates of tests, but if N95 respirators reduce transmission by 2.8%, prevalence is at 1%, and testing yields 20% false negatives, providers should be willing to pay an additional $0.64 per HCW for the additional protection. Under this scenario, approximately 11 COVID-19 cases would be averted among HCWs per day.ConclusionsPotential savings depend on disease prevalence, rate of asymptomatic patients with COVID-19, accuracy of testing, the marginal cost of respirators, and the quarantine period. We provide a range of calculations to show under which conditions N95 respirators are cost saving.     

Respiratory protection and the risk of Mycobacterium tuberculosis infection

Tuberculosis (TB) can be transmitted to susceptible healthcare workers via inhalation of droplet nuclei carrying viable Mycobacterium tuberculosis bacilli. Several types of respiratory protective devices are compared with respect to efficacy against droplet nuclei penetration: surgical masks, disposable dust/mist particulate respirators (PRs), elastomeric halfmask respirators with high-efficiency (HEPA) filters, and powered airpurifying respirators (PAPRs) with elastomeric halfmask facepieces and HEPA filters. It is estimated that these devices permit, respectively, 42%, 5.7%, 2%, and 0.39% penetration of droplet nuclei into the facepiece. More limited data for the disposable HEPA filtering-facepiece respirator suggest that it would allow droplet nuclei penetration of 3% or less, similar to the value estimated for the elastomeric halfmask HEPA filter respirator. Because a respirator wearer's cumulative infection risk depends on the extent of droplet nuclei penetration, the cumulative risk will differ, given use of these different respirators. Hypothetical but realistic “low-exposure” and “high-exposure” scenarios are posed that involve, respectively, a 1.6% and a 6.4% annual risk of infection for healthcare workers. For the low-exposure scenario, the 10-year cumulative risks given no respirators versus surgical masks versus disposable dust/mist PRs versus elastomeric halfmask HEPA filter respirators versus HEPA filter PAPRs are, respectively, 15%, 6.7%, 0.94%, 0.33%, and .064%. For the high-exposure scenario, the 10-year cumulative risks for no respirator use versus use of the same four types of respirators are, respectively, 48%, 24%, 3.7%, 1.3%, and 0.26%. The use of disposable HEPA filtering-facepiece respirator should permit cumulative risks close to those estimated for the elastomeric halfmask HEPA filter respirator. It is concluded that when an infectious TB patient undergoes a procedure that generates respiratory aerosols, and when droplet nuclei source control is inadequate, healthcare workers attending the patient may need to wear highly protective respirators, such as HEPA filter PAPRs.     

In vivo protective performance of N95 respirator and surgical facemask

BACKGROUND: The SARS outbreak in 2003 has spawned a major controversy concerning protective performance facemasks for healthcare workers. This study reports a study on in-vivo protective performance of surgical masks and N95 respirators. METHODS: Typical surgical masks and N95 respirators used in Hong Kong hospitals were tested in comparison with those treated with nano-functional materials (called nano-masks) on various physical properties and in-vivo wear filtration efficiency, as well as usability test in hospitals for surgical masks. RESULTS: Tests on physical properties showed that N95 respirators had significantly lower air permeability and water vapor permeability than surgical masks. The in-vivo filtration tests illustrated that N95 respirators filtered out 97% of potassium chloride (KCl) solution, while surgical masks filtered out 95% of KCl solution. Nano-masks show stronger water repellency and antibacterial activities, but no difference in usability, comparing with normal N95 and surgical masks. CONCLUSIONS: Surgical masks can provide in-vivo filtration protection of 95% filtration efficiency. N95 respirators provide higher in-vivo filtration efficiency of 97% with significant reduction of air permeability and water vapor permeability. Compared to normal surgical masks/respirators, the nano-masks can provide additional protective functions in stopping capillary diffusion and antibacterial activities.     

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.     

Laboratory and field evaluation of a new personal sampling system for assessing the protection provided by the N95 filtering facepiece respirators against particles

OBJECTIVES: We have recently developed a new personal sampling system for the real-time measurement of the protection provided by respirators against airborne dust and micro-organisms. The objective of this study was to evaluate the performance characteristics of the new sampling system in both laboratory and field conditions. METHODS: The measurements were conducted using the N95 filtering facepiece respirators and the newly developed personal sampling system put on a manikin (laboratory study) or donned by a human subject (laboratory and field studies). Two inhalation flow rates (0 and 40 l min(-1)) in conjunction with the sampling flow rate (10 l min(-1)) were tested in the manikin-based experiments to investigate the effects of the leak location (nose, cheek and chin) and the depth of the sampling probe (0, 5, 10 and 15 mm) within the respirator. The effect of human activity on the protection factor was evaluated using a variety of head movements and breathing patterns when a human subject wore the respirator in a room-size laboratory test chamber. The field study was conducted during corn harvesting with a respirator worn by a human subject on a combine. RESULTS: There was no significant difference in the protection factors for different leak locations, or for sampling probe depths, when the inhalation rate was 0 l min(-1). For the inhalation rate of 40 l min(-1), the protection factors for nose leaks were higher than those for chin and cheek leaks. Furthermore, the protection factor was the lowest and showed the least variation when the sampling probe depth was equal to 0 mm (imbedded on the respirator surface). Human subject testing showed that the grimace maneuver decreased the protection factor and changed the original respirator fit. The protection factor during breath holding was lower than that found during inhalation and exhalation. Field results showed greater variation than laboratory results. CONCLUSIONS: The newly designed personal sampling system efficiently detected the changes in protection factors in real time. The sampling flow was least affected by the inhalation flow when the sampling probe was imbedded on the respirator surface. Leak location, breathing patterns and exercises did affect the measurement of the protection factors obtained using an N95 filtering facepiece respirator. This can be attributed to the differences in the in-mask airflow dynamics contributed by the leak, filter material, sampling probe and inhalation. In future studies, it would be beneficial if the laboratory data could be integrated with the field database.     

Early effectiveness of BNT162b2 Covid-19 vaccine in preventing SARS-CoV-2 infection in healthcare personnel in six Israeli hospitals (CoVEHPI)

BackgroundMethodologically rigorous studies on Covid-19 vaccine effectiveness (VE) in preventing SARS-CoV-2 infection are critically needed to inform national and global policy on Covid-19 vaccine use. In Israel, healthcare personnel (HCP) were initially prioritized for Covid-19 vaccination, creating an ideal setting to evaluate early real-world VE in a closely monitored population.MethodsWe conducted a prospective study among HCP in 6 hospitals to estimate the effectiveness of the BNT162b2 mRNA Covid-19 vaccine in preventing SARS-CoV-2 infection. Participants filled out weekly symptom questionnaires, provided weekly nasal specimens, and three serology samples – at enrollment, 30 days and 90 days. We estimated VE against PCR-confirmed SARS-CoV-2 infection using the Cox Proportional Hazards model and against a combined PCR/serology endpoint using Fisher’s exact test.ResultsOf the 1567 HCP enrolled between December 27, 2020 and February 15, 2021, 1250 previously uninfected participants were included in the primary analysis; 998 (79.8%) were vaccinated with their first dose prior to or at enrollment, all with Pfizer BNT162b2 mRNA vaccine. There were four PCR-positive events among vaccinated participants, and nine among unvaccinated participants. Adjusted two-dose VE against any PCR-confirmed infection was 94.5% (95% CI: 82.6%-98.2%); adjusted two-dose VE against a combined endpoint of PCR and seroconversion for a 60-day follow-up period was 94.5% (95% CI: 63.0%-99.0%). Five PCR-positive samples from study participants were sequenced; all were alpha variant.ConclusionsOur prospective VE study of HCP in Israel with rigorous weekly surveillance found very high VE for two doses of Pfizer BNT162b2 mRNA vaccine against SARS-CoV-2 infection in recently vaccinated HCP during a period of predominant alpha variant circulation.FundingClalit Health Services.     

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.     

Workplace protection factors for an N95 filtering facepiece respirator

This study evaluated the workplace performance of an N95 filtering facepiece, air-purifying respirator in a steel foundry. Air samples were collected inside and outside respirators worn by workers who were properly trained and qualitatively fit tested. For most workers, three or four pairs of air samples were collected on each of 2 days. The 49 valid sample sets were analyzed for iron, silicon, and zirconium. Only iron was present in sufficient concentrations to perform workplace protection factor (WPF) calculations. Individual WPF measurements ranged from 5 to 753. The geometric mean of the distribution was 119 with a lower 5th percentile value of 19. Time-weighted average WPFs (WPF(TWA)) were also calculated for each day for each worker as an estimate of the protection an individual might receive with daily respirator use. The WPF(TWA) values ranged from 15 for the worker with the single WPF value of 5, to a high of 684. The distribution of WPF(TWA) had a geometric mean of 120 and a lower 5th percentile of 22. Both data treatments indicate this respirator's performance was consistent with the assigned protection factor of 10 typically used for half facepiece respirators. The respirator provided adequate protection as used in this study. All contaminant concentrations inside the respirator were well below the relevant occupational exposure limits. Data collected also illustrate the dynamic nature of faceseal leakage in the workplace.     

Modified full-face snorkeling mask for thoracic surgery and otolaryngology surgical use: comfort and usability assessment during the COVID-19 pandemic

Background:A worldwide personal protection equipment (PPE) shortage has emerged during COVID-19 pandemic, contributing to the high incidence of SARS-CoV-2 infection among health care providers. To address this lack of PEE, new solutions have been researched. Among those, full-face snorkeling masks demonstrated to be an interesting option. Among surgical specialties otolaryngologists and thoracic surgeons are at high risk of infection, due to the close contact with airway secretions.Objectives:We tested the comfort and usability of a modified full-face snorkeling mask (Ocean Reef Mask Aria QR+) as a protective device for otolaryngologic and thoracic surgeries.Methods:The mask was customized with a 3D-printed adaptor supporting many industrial filter types, including FFP3 and heat and moisture exchangers (HME). We evaluated surgical performances of the mask, both subjectively, with a questionnaire filled in by the surgeons, as well as objectively, monitoring transcutaneous PCO₂ and PO₂ values of surgeons during surgical procedures.Results:The modified full-face snorkeling mask was tested during 9 otolaryngologic and 15 thoracic surgery procedures. The device demonstrated very good overall vision quality with some limitations regarding lateral vision and almost no difficulties in usability. Water condensation into the mask was absent in almost every case. Both PO₂ and PCO₂ parameters remained within normal ranges during every procedure.Discussion:The modified full-face snorkeling mask can be an innovative PPE. In the current COVID-19 pandemic scenario, the worldwide shortage of protective masks and goggles may exploit this ready-to-use and low-cost solution, especially for high-risk surgical procedures.     

Effectiveness of Covishield vaccine in preventing Covid-19 – A test-negative case-control study

IntroductionThis study aimed at assessing the vaccine effectiveness (VE) of Covishield, which is identical to AstraZeneca vaccine, in preventing laboratory-confirmed Covid-19.MethodsUsing test-negative case-control design, information on vaccination status of cases with Covid-19 among healthcare workers in our institution in Puducherry, India, and an equal number of controls matched for age and date of testing, was obtained. The groups were compared using multivariable conditional logistic regression to calculate odds ratios (OR). VE was calculated as 100*(1–adjusted odds ratio)%.ResultsUsing data from 360 case-control pairs, VE of one dose and of two doses, in providing protection against Covid-19 was 49% (95% CI: 17%-68%) and 54% (27%-71%), respectively. Among cases with moderately severe disease that required oxygen therapy, VE following any number of vaccine doses was 95% (44%-100%).ConclusionCovishield vaccine protected significantly against Covid-19, with a higher protection rate against severe forms of disease.     

Nanoparticle penetration through filter media and leakage through face seal interface of N95 filtering facepiece respirators

National Institute for Occupational Safety and Health recommends the use of particulate respirators for protection against nanoparticles (<100 nm size). Protection afforded by a filtering facepiece particulate respirator is a function of the filter efficiency and the leakage through the face-to-facepiece seal. The combination of particle penetration through filter media and particle leakage through face seal and any component interfaces is considered as total inward leakage (TIL). Although the mechanisms and extent of nanoparticle penetration through filter media have been well documented, information concerning nanoparticle leakage through face seal is lacking. A previous study in our laboratory measured filter penetration and TIL for specific size particles. The results showed higher filter penetration and TIL for 50 nm size particles, i.e. the most penetrating particle size (MPPS) than for 8 and 400 nm size particles. To better understand the significance of particle penetration through filter media and through face seal leakage, this study was expanded to measure filter penetration at sealed condition and TIL with artificially introduced leaks for 20-800 nm particles at 8-40 l minute volumes for four N95 models of filtering facepiece respirators (FFRs) using a breathing manikin. Results showed that the MPPS was ~45 nm for all four respirator models. Filter penetration for 45 nm size particles was significantly (P < 0.05) higher than the values for 400 nm size particles. A consistent increase in filter penetrations for 45 and 400 nm size particles was obtained with increasing breathing minute volumes. Artificial leakage of test aerosols (mode size ~75 nm) through increasing size holes near the sealing area of FFRs showed higher TIL values for 45 nm size particles at different minute volumes, indicating that the induced leakage allows the test aerosols, regardless of particle size, inside the FFR, while filter penetration determines the TIL for different size particles. TIL values obtained for 45 nm size particles were significantly (P < 0.05) higher than the values obtained for 400 nm size particles for all four models. Models with relatively small filter penetration values showed lower TIL values than the models with higher filter penetrations at smaller leak sizes indicating the dependence of TIL values on filter penetration. When the electrostatic charge was removed, the FFRs showed a shift in the MPPS to ~150 nm with the same test aerosols (mode size ~75 nm) at different hole sizes and breathing minute volumes, confirming the interaction between filter penetration and face seal leakage processes. The shift in the MPPS from 45 to 150 nm for the charge removed filters indicates that mechanical filters may perform better against nanoparticles than electrostatic filters rated for the same filter efficiency. The results suggest that among the different size particles that enter inside the N95 respirators, relatively high concentration of the MPPS particles in the breathing zone of respirators can be expected in workplaces with high concentration of nanoparticles. Overall, the data obtained in the study suggest that good fitting respirators with lower filter penetration values would provide better protection against nanoparticles.     

Recent MMR vaccination in health care workers and Covid-19: A test negative case-control study

BackgroundIt has been hypothesised that the measles-mumps-rubella (MMR) vaccine may afford cross-protection against SARS-CoV-2 which may contribute to the wide variability in disease severity of Covid-19.MethodsWe employed a test negative case-control study, utilising a recent measles outbreak during which many healthcare workers received the MMR vaccine, to investigate the potential protective effect of MMR against SARS-CoV-2 in 5905 subjects (n = 805 males, n = 5100 females).ResultsThe odds ratio for testing positive for SARS-CoV-2, in recently MMR-vaccinated compared to not recently MMR-vaccinated individuals was 0.91 (95% CI 0.76, 1.09). An interaction analysis showed a significant interaction for sex. After sex-stratification, the odds ratio for testing positive for males was 0.43 (95% CI 0.24, 0.79, P = 0.006), and 1.01 (95% CI 0.83, 1.22, P = 0.92) for females.ConclusionOur results indicate that there may be a protective effect of the MMR vaccine against SARS-CoV-2 in males but not females.