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Concept: Surgical mask


Inexpensive cloth masks are widely used in developing countries to protect from particulate pollution albeit limited data on their efficacy exists. This study examined the efficiency of four types of masks (three types of cloth masks and one type of surgical mask) commonly worn in the developing world. Five monodispersed aerosol sphere size (30, 100, and 500 nm, and 1 and 2.5 μm) and diluted whole diesel exhaust was used to assess facemask performance. Among the three cloth mask types, a cloth mask with an exhaust valve performed best with filtration efficiency of 80-90% for the measured polystyrene latex (PSL) particle sizes. Two styles of commercially available fabric masks were the least effective with a filtration efficiency of 39-65% for PSL particles, and they performed better as the particle size increased. When the cloth masks were tested against lab-generated whole diesel particles, the filtration efficiency for three particle sizes (30, 100, and 500 nm) ranged from 15% to 57%. Standard N95 mask performance was used as a control to compare the results with cloth masks, and our results suggest that cloth masks are only marginally beneficial in protecting individuals from particles<2.5 μm. Compared with cloth masks, disposable surgical masks are more effective in reducing particulate exposure.Journal of Exposure Science and Environmental Epidemiology advance online publication, 17 August 2016; doi:10.1038/jes.2016.42.

Concepts: Developing country, Particulate, Air pollution, Diesel particulate matter, Soot, Mask, Masks, Surgical mask


ABSTRACT 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 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.

Concepts: Sociology, Aerosol, Respirator, Filters, Leak, Masks, Bioaerosol, Surgical mask


Abstract Background: Placing a surgical mask on an infected patient (respiratory source control) may offer a health-care worker (HCW) more protection than donning an N95 respirator (receiver protection). This observation was made in an in vitro study that used hard, nondeformable faces, and the lack of proper N95 fit may have accounted for the observed results. In the present study, we test the effects of fit on respiratory source control protection, using a soft, deformable mannequin head. Methods: Resusci Anne CPR mannequin heads were placed in a chamber allowing 6 air exchanges/hr (14 cubic feet per minute), to simulate an infected patient (source) and an HCW (receiver). The heads were ventilated with a tidal breathing pattern. The source exhaled radioactive aerosols, and a filter was attached to the receiver to quantify inhaled exposure. N95 respirators and surgical masks were tested on both heads. The degree of protection was expressed by calculating the reduction in exposure expressed as a simulated workplace protection factor (sWPF; the ratio of exposure with mask to exposure without mask) compared statistically using confidence intervals. Results: Use of the Resusci Anne heads resulted in improved fit, with higher sWPF than previously reported, for example, for source N95 mask combinations (7,174 vs. 317) as well as receiver (7.53 vs. 1.37). Masks placed on the receiver provided minimal exposure protection (sWPF range 0.99-7.53), except when sealed with Vaseline (sWPF 63.1). Any mask applied to the source mannequin resulted in significant reductions in exposure (sWPF range 214-17,038). Conclusion: Improved fit significantly enhanced the effects of source control protection. A Vaseline-sealed N95 respirator on the receiver offered less protection when compared with any mask on the source. Respiratory source control can offer more protection to HCW and potentially decrease the spread of aerosolized infections.

Concepts: Respiratory physiology, In vitro, Inhalation, Respirator, Mask, Masks, Gas mask, Surgical mask


Surgical smoke generated during electrocautery contains toxins which may cause adverse health effects to operating room (OR) personnel. The objective of this study was to investigate the performance of surgical masks (SMs), which are routinely used in ORs, more efficient N95 surgical mask respirator (SMRs) and N100 filtering facepiece respirator (FFRs), against surgical smoke.

Concepts: Surgery, Respirator, Filters, Mask, Masks, Gas mask, Surgical mask


While influenza transmission is thought to occur primarily by droplet spread, the role of airborne spread remains uncertain. Understanding the beliefs and attitudes of infectious disease physicians regarding influenza transmission and respiratory and barrier protection preferences can provide insights into workplace decisions regarding respiratory protection planning. Physicians participating in the Infectious Diseases Society of America’s Emerging Infections Network were queried in November 2013 to determine beliefs and attitudes on influenza transmission. A subset of physicians involved in their facility’s respiratory protection decision making were queried about respirator and surgical mask choices under various pandemic scenarios; availability of, and challenges associated with, respirators in their facility; and protective strategies during disposable N95 shortages. The majority of 686 respondents (98%) believed influenza transmission occurs frequently or occasionally via droplets; 44% of respondents believed transmission occurs via small particles frequently (12%) or occasionally (32%). Among the subset of respondents involved in respiratory protection planning at their facility, over 90% preferred surgical masks during provision of non-aerosol-generating patient care for seasonal influenza. However, for the same type of care during an influenza pandemic, two-thirds of respondents opted for disposable N95 filtering facepiece respirators. In settings where filtering facepiece (disposable) N95 respirators were in short supply, preferred conservation strategies included extended use and reuse of disposable N95s. Use of reusable (elastomeric facepiece) respirator types was viewed less favorably. While respondents identified droplets as the primary mode of influenza transmission, during a high-severity pandemic scenario there was increased support for devices that reduced aerosol-based transmission. Use of potentially less familiar respirator types may partially relieve shortages of disposable N95s but also may require significant education efforts so that clinicians are aware of the characteristics of alternative personal protective equipment.

Concepts: Infectious disease, Infection, Influenza, Protection, Pandemic, Respirator, Masks, Surgical mask


Surgical N95 filtering facepiece respirators (FFRs), certified by the National Institute for Occupational Safety and Health (NIOSH) as a respirator and cleared by the Food and Drug Administration (FDA) as a surgical mask, are often used to protect from the inhalation of infectious aerosols and from splashes/sprays of body fluids in health care facilities. A shortage of respirators can be expected during a pandemic. The availability of surgical N95 FFRs can potentially be increased by incorporating FDA clearance requirements in the NIOSH respirator approval process.

Concepts: Health care, Medicine, Public health, Blood, Occupational safety and health, Respirator, Masks, Surgical mask


Background: Potentially infected individuals (‘source’) are sometimes encouraged to use face masks to reduce exposure of their infectious aerosols to others (‘receiver’). To improve compliance with Respiratory Source Control via face mask and therefore reduce receiver exposure, a mask should be comfortable and effective. We tested a novel face mask designed to improve breathability and filtration using nanofiber filtration.

Concepts: Mask, Masks, Gas mask, Surgical mask


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 (Pfilter) 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 Pfilter and TIL. Increasing breathing frequency increased TIL for the N95 FFR whereas no clear trends were observed for the SM. Increasing MIF increased Pfilter 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.

Concepts: Affect, Sodium chloride, Sodium, Order theory, Respirator, Filters, Masks, Surgical mask


A previous study in our laboratory measured the ratio of particle concentration outside (Cout)/inside (Cin) of three N95 filtering facepiece respirator (FFR) models with an N95-Companion and other aerosol instruments using a breathing manikin. Results showed that the Companion measured Cin was contributed by particle penetration through face seal leakage and not through filter media suggesting that the Cout/Cin ratio should be similar for different N95 models at any given leak size. To better understand the phenomenon, the current study analyzed the influence of factors, including filter penetration, resistance, and flow rate on the Companion ratios for two N95 FFR (N1 and N2) and one surgical mask (SM1) models using a manikin. Cout/Cin ratios were measured at 10 and 40 L breathing minute volumes with sealed condition and at artificially introduced leaks. Filter efficiency and resistance were measured at 10 and 40 L/min constant flow rates. Results showed that filter efficiency and resistance were higher for N1 than for N2 and SM1. The ratio for N1was also higher than those of N2 and SM1 at sealed condition at both breathing rates. The result can be due to the higher filtration efficiency of N1. With increasing leak sizes, however, the ratios were higher for N2 than for N1 at 10 and 40 L breathing rates. Higher ratios for N2 can be attributed to the lower resistance that allowed higher aerosol flow through the filter media and captured more negatively charged particles to produce lesser Cin or greater Cout/Cin ratio. Ratios obtained for SM1 at different leak sizes were higher than the ratios of N1 at 10 L. SM1 ratios, however, decreased dramatically at 40 L indicating that high flow rate may adversely affect the ratios. Further studies are needed to better understand the influence of filter media characteristics on the Companion measured Cout/Cin ratios.

Concepts: Electric charge, Ratio, The Higher, Filter, Respirator, Filters, Leak, Surgical mask


The objective of this study was to assess how the relative efficiency of N95 respirators and surgical masks might vary with different challenge aerosols, utilizing a standardized manikin head form as a surrogate to human participation. A Collision nebulizer aerosolized B. anthracis Sterne strain endospores and polystyrene latex (PSL) particles to evaluate 11 models of N95 respirators and surgical masks. An automated breathing simulator, calibrated to normal tidal volume and active breathing rate, mimicked human respiration. A manikin head form with N95 respirators or surgical masks, and manikin head form without N95 respirators or surgical masks were placed in the bioaerosol chamber. An AGI-30 sampler filled with phosphate buffered water was fitted behind the mouth of each manikin head form to collect endospore bioaerosol samples. PSL aerosols concentrations were quantified by an ARTI Hand Held Particle Counter. Geometric Mean (GM) relative efficiency of N95 respirators and surgical masks challenged with endospore bioaerosol ranged from 34-65%. In PSL aerosol experiments, GM relative efficiency ranged from 35-64% for 1.3 μm particles. GM filtration efficiency of all N95 and surgical N95 respirators filter media evaluated was ≥99% when challenged with particles ≥0.1 μm. GM filtration efficiency of surgical mask filter media ranged from 70-83% with particles ≥0.1 μm and 74-92% with 1.3 μm PSL particles. Relative efficiencies of N95 respirators and surgical masks challenged with aerosolized B. anthracis endospores and PSL were similar. Relative efficiency was similar between N95 respirators and surgical masks on a manikin head form despite clear differences in filtration efficiency. This study further highlights the importance of face seal leakage in the respiratory protection provided by N95 respirators, and demonstrates it on a human surrogate.

Concepts: Evaluation, Bacillus, Aerosol, Respirator, Bacillus anthracis, Masks, Aerosol spray, Surgical mask