Excellent performance by avoiding microbial contamination (EPBAMC): A new portal and model for safety of respirator masks approved by bacterial contamination field research

Introduction: Over the past decades, billions of people on Earth have used respirator masks to prevent animal-to-human and human-to-human virus transmission. Recent research has shown the low risk of surface transmission of COVID-19, which turned into a pandemic since January 2020. Social distancing and the use of masks indoors are the most important factors in breaking its transmission chain. Material and Methods: However, the use of contaminated respirator masks can cause dangerous microbial and viral diseases. By adding the factor "avoiding microbial contamination”, the proposed model, called "Excellent Performance by Avoiding Microbial Contamination (EPBAMC)”, improves the WHO's three-factor optimal-performance model of the respirator masks. In this study, to evaluate the need to add the factor of "avoiding contamination”, samples of brand-new respirator masks were collected from several countries and their microbial contamination was carefully studied. The research method was such that the research steps were performed with highest accuracy rate and no double infection was created. Results: By culturing in sterilized medium, the bacterial load of the respirator masks was studied and the results were analyzed. By performing different cultures, a variety of pathogenic microorganisms were identified on half of the respirator mask samples. Some brand-new respirator mask samples contained more than one pathogen. A very important issue was that bacteria were found in brand-new respirators distributed by pharmacies that cause nosocomial infections and are resistant to antibiotics. Conclusion: The results of this study made it necessary to review the standards of the production and distribution process and the procedures for controlling and inspecting respirator masks. © 2022, Published by Frontiers in Health Informatics.

Development of Economical and Effective Ultraviolet (UVC) Irradiation Solutions and Equipment for Rapid Decontamination of SARS-CoV-2 on N95 Respirators

N95 disposable respirator masks are of particular importance to the Covid-19 pandemic. The high cost and limited supply of N95 disposable respirators promote research and safe and effective methods of reusing medical masks. The CDC of USA has announced that ultraviolet (UVC) irradiation inactivates SARS-CoV-2, virus, and other microorganisms known to culture on N95, as well as the results affecting mask fit and filterability. In this study, we analyze and evaluate the pathogen inactivation mechanism and the performance of respirators after treatment and perfect the method of ultraviolet irradiation (UVC) to help inactivate of SARS-CoV-2. At the same time, the research team successfully designed, fabricated and tested a semi-automatic system with UVC capacity 0.15 mW/cm2 at 220 nm that inactivated SARS-CoV-2 (3 log reduction) substances analogues of viruses, and other microorganisms grown on N95. The research results aim to commercialize the system technology (1) to inactivate the SARS-CoV-2 virus through the our application of UVC irradiation at the appropriate wavelength and effective dose, and (2) maintain the suitability and N95 filter rate. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Evaluating Filtering Facepiece Respirator Wearing-Comfort of Lebanese Red Cross Healthcare Providers.

Introduction: The COVID-19 pandemic significantly increased the usage of various types of face masks. In addition, it triggered the rapid manufacture of new production lines of masks to cope with the unprecedented demand to overcome worldwide shortages. Such masks, which were previously used mostly by the health care personnel, became a daily necessity to the greater mainstream population. This rapid and sudden increase in their usage and the fact that new masks' innovations are progressively emerging to meet the growing global shortage requires an ongoing analysis on the factors associated with the fit and comfort while using these masks. Methods: This paper presents the first translation and validation of the R-COMFI questionnaire to evaluate the comfort of a newly developed filtering face-piece respirator by the research team at the University of Antwerp. The questionnaire, which consists of 3 sections: Discomfort, General wearing experience, and Function, was translated from English to Arabic and involved 43 participants in the Lebanese Red Cross healthcare field based in Lebanon. Results: The results showed discomfort factors that are mostly related to breathability and sweating caused by mask usage. Additionally, the results revealed that female respondents found the mask significantly less comfortable than male respondents (p-value with the two-tailed test is 0.0319), which confirmed that future validations should consider the concerns of both genders, and validated the R-COMFI translation exercise detailed in this paper. Discussion: The contribution of this paper can be pinned down into three findings. The first finding is related to the discomfort issues. The second finding highlighted a significant difference in comfort experience between females and males. The last finding is the translation validation of the R-COMFI instrument, which confirmed that the questionnaire can be applied among wider geographical locations.

Impact of Wearing on Filtration Performance of Electrostatic Filter Face Masks.

Certified disposable respirators afford important protection from hazardous aerosols but lose performance as they are worn. This study examines the effect of wear time on filtration efficiency. Disposable respirators were worn by CSIRO staff over a period of 4 weeks in early 2020. Participants wore the respirator masks for given times up to eight hours whilst working in laboratory/office environments. At that time COVID-19 precautions required staff to wear surgical (or other) masks and increase use of hand sanitizer from dispenser stations. Results obtained from a test group of ten individuals without health preconditions show an increasing number of masks failing with wear time, while the remainder continue to perform nearly unaffected for up to 8 h. Some masks were found to retain filtration performance better than others, possibly due to the type of challenge they were subjected to by the wearer. However, the rate and extent of decay are expected to differ between environments since there are many contributing factors and properties of the aerosol challenge cannot be controlled in a live trial. Penetration and variability increased during wear; the longer the wear time, the more deleterious to particle removal, particularly after approximately 2 h of wear. This behavior is captured in a descriptive statistical model based on results from a trial with this test group. The effectiveness of the masks in preventing the penetration of KCl particles was determined before and after wearing, with the analysis focusing on the most penetrating particles in a size range of 0.3-0.5 µm diameter where respirator masks are most vulnerable. The basic elements of the study, including the approach to filter testing and sample sanitization, are broadly applicable. Conclusions also have applicability to typical commercially available single-use respirator masks manufactured from melt blown polypropylene as they are reliant on the same physical principles for particle capture and electrostatic enhancement was comparable for the particle size range used for detection.

Effective antiviral coatings for deactivating SARS-CoV-2 virus on N95 respirator masks or filters.

The application of antiviral coatings to masks and respirators is a potential mitigating step toward reducing viral transmission during the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic. The use of appropriate masks, social distancing, and vaccines is the immediate solution for limiting the viral spread and protecting people from this virus. N95 respirator masks are effective in filtering the virus particles, but they cannot kill or deactivate the virus. We report a possible approach to deactivating SARS-CoV-2 by applying an antimicrobial coating (Goldshield 75) to masks and respirators, rendering them suitable for repeated use. Masks coated with Goldshield 75 demonstrated continuous inactivation of the Alpha and Beta variants of the SARS-CoV-2 over a 3-day period and no loss of inactivation when stored at temperatures at 50 °C.

The Effect of Sanitizing Treatments on Respirator Filtration Performance.

The potential for alcoholic vapors emitted by common sanitizing treatments to deteriorate the (electrostatic) filtration performance of disposable respirator masks has been investigated. Reports in the literature and some standard test methods provide a confusing and ambiguous picture concerning the relevance of this effect. Four different types of exposure were investigated in this study to clarify the effect of alcoholic vapor emissions on respirator masks. These included exposure to saturated vapors, use of hand sanitizers, cleaning of table surfaces and sanitization of masks by spraying them with alcohol-containing solutions. Methods employed were designed to be as real-world oriented as possible while remaining reproducible. Filtration performance and deterioration effects on exposure to the different treatments were determined on three different types of certified commercial respirator masks-a P2 and two KN95 masks. This study provides substantial evidence that disposable respirator masks with an accepted performance rating are seriously compromised from an exposure to saturated alcoholic vapors, can tolerate a one-off spray treatment with an alcoholic solution and retain their attested protection under the influence of alcoholic vapors from the use of hand sanitizer or spray sanitizer. Considering the range of vastly different outcomes obtained from the four treatments investigated, it seems prudent to assess in each case the specific effects of alcoholic solution treatments and vapors on respirator masks before use.

A preliminary evaluation of surgical field contamination risk from surgeon's oro-nasopharyngeal commensal organisms while using reusable FFP3 respirator masks and power hoods with relevance to the COVID 19 pandemic - A pilot study.

In early 2019 in the UK, concern about the risk of COVID-19 transmission to surgeons who operate near to the airway led to wide scale adoption of different masks, including valved types used in industry. It was noted early on that although these masks protect clinicians, they may represent a risk to the patient due to unfiltered air being directed towards them during close contact1 and the National Health Service circulated guidance to that effect2. Subsequently, an increased incidence of surgical site infection (SSI) was noticed, postulated to be due to contamination of the surgical field by microbial particles from valved masks or hoods leading to a National Patient Safety Alert3. A study recommended that a surgical mask be placed over the exhaust valves of these mask types4. We reviewed the literature using the key words surgical masks, power hoods, FFP3 masks and surgical site infection. Most studies showed no reduction in the incidence of SSI with surgical masks5, but some showed an increase6. There were no studies comparing bacterial contamination of the surgical site with different types of masks. A pilot study was designed to evaluate if FFP3 respirators and powerhoods allowed bacterial contamination of the surgical field in comparison with standard surgical masks and no masks. The results appeared to confirm our methodology and suggested that reusable valved FFP3 masks are associated with bacterial dissemination. Subsequent examination of these masks identified a potential mechanism for this bacterial contamination. A larger scale study is needed.

Impacts on staff after implementation of a respiratory protection program in a Victorian public hospital.

BACKGROUND: In October 2020, the Royal Melbourne Hospital implemented a Respiratory Protection Program (RPP), which was initiated by the Victorian Government. This study was to evaluate the effectiveness of the program. METHODS: A cohort of 158 employees, who were identified as high risk to respiratory biohazard exposure, were invited to participate in the RPP. We provided a bundle of interventions, which included an online training package, and mandatory quantitative fit testing. The main outcomes included the participants' knowledge and attitude toward respiratory protection equipment (RPE), which were assessed via an online survey. Their donning and doffing skills, and user seal check techniques on four different types of N95 respirators were also assessed by an observer using a pre-determined marking sheet. We compared these outcomes before and after participation in the program. RESULTS: There was a total of 125 participants, all of whom completed the knowledge and attitude assessment, and 69 completed the skill assessment before and after the program. There was a statistically significant improvement in their knowledge scores, donning and doffing skills, and user seal check techniques after participation in the RPP. Participants also reported significant increased level of confidence in their RPE knowledge, training and skills; and workplace safety. CONCLUSION: This initial report of the implementation of a novel RPP in a Victorian major tertiary hospital provides guidance on the benefits to respiratory protection, staff knowledge, skills, confidence and morale that can be acquired from a scalable online training package combined with mandatory quantitative fit testing.

A randomised crossover study to compare the user seal check and quantitative fit test between two types of duckbill N95 particulate respirator masks: The Halyard Fluidshield® N95 and the BSN Medical ProShield® N-95 particulate respirator masks.

N95 particulate respirator masks are currently recommended for all healthcare workers who care for patients with suspected or confirmed coronavirus disease (COVID-19) when performing aerosol-generating procedures. The protection provided by N95 particulate respirator masks is dependent on the filter's efficiency and seal quality. In this prospective randomised crossover study, we conducted the user seal check and the quantitative fit test on two readily available duckbill models of N95 masks, the Halyard Fluidshield® N95 (Halyard, Alpharetta, GA, USA) and the BSN Medical ProShield® N-95 (BSN Medical, Mount Waverley, Victoria) particulate respirator masks. We recruited a total of 96 anaesthetic staff, of whom 26% were of South-East Asian ethnicity. We found that both types of masks provided reasonably high fit test pass rates among our participants and there was no significant difference between the two brands (77% for the Fluidshield and 65% for the ProShield, P = 0.916). Ninety-two percent of the participants could find at least one well-fitted mask among these two types of masks. We also demonstrated that the user seal check had low accuracy and low concordance (kappa coefficient of 0.16 for the Fluidshield and 0.08 for the ProShield) when compared to the quantitative fit test, and hence was not a reliable method to test seal quality.

COVID-19 coronavirus: recommended personal protective equipment for the orthopaedic and trauma surgeon.

PURPOSE: With the COVID-19 crisis, recommendations for personal protective equipment (PPE) are necessary for protection in orthopaedics and traumatology. The primary purpose of this study is to review and present current evidence and recommendations for personal protective equipment and safety recommendations for orthopaedic surgeons and trauma surgeons. METHODS: A systematic review of the available literature was performed using the keyword terms "COVID-19", "Coronavirus", "surgeon", "health-care workers", "protection", "masks", "gloves", "gowns", "helmets", and "aerosol" in several combinations. The following databases were assessed: Pubmed, Cochrane Reviews, Google Scholar. Due to the paucity of available data, it was decided to present it in a narrative manner. In addition, participating doctors were asked to provide their guidelines for PPE in their countries (Austria, Luxembourg, Switzerland, Germany, UK) for consideration in the presented practice recommendations. RESULTS: World Health Organization guidance for respiratory aerosol-generating procedures (AGPs) such as intubation in a COVID19 environment was clear and included the use of an FFP3 (filtering face piece level 3) mask and face protection. However, the recommendation for surgical AGPs, such as the use of high-speed power tools in the operating theatre, was not clear until the UK Public Health England (PHE) guidance of 27 March 2020. This guidance included FFP3 masks and face protection, which UK surgeons quickly adopted. The recommended PPE for orthopaedic surgeons, working in a COVID19 environment, should consist of level 4 surgical gowns, face shields or goggles, double gloves, FFP2-3 or N95-99 respirator masks. An alternative to the mask, face shield and goggles is a powered air-purifying respirator, particularly if the surgeons fail the mask fit test or are required to undertake a long procedure. However, there is a high cost and limited availabilty of these devices at present. Currently available surgical helmets and toga systems may not be the solution due to a permeable top for air intake. During the current COVID-19 crisis, it appeared that telemedicine can be considered as an electronic personal protective equipment by reducing the number of physical contacts and risk contamination. CONCLUSION: Orthopaedic and trauma surgery using power tools, pulsatile lavage and electrocautery are surgical aerosol-generating procedures and all body fluids contain virus particles. Raising awareness of these issues will help avoid occupational transmission of COVID-19 to the surgical team by aerosolization of blood or other body fluids and hence adequate PPE should be available and used during orthopaedic surgery. In addition, efforts have to be made to improve the current evidence in this regard. LEVEL OF EVIDENCE: IV.