Bacteria Filtration Efficiency for Different Types of Protective Face Masks

Emerging infectious diseases that we are witnessing in the modern age are among the leading public health concerns. They most often occur in the form of epidemics or pandemics, and they have not been sufficiently researched. Owing to the current coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization has published various recommendations to prevent the spread of this communicable disease, including a recommendation to wear protective facial masks. Therefore, this study aimed to determine the filtration effectiveness of bacteria, yeasts, and molds on three different commonly and commercially available masks used in children's educational institutions. In addition, the bacterial content of indoor air bioaerosols was identified. The genera Staphylococcus and Micrococcus were dominant in all samples, whereas bacteria of the genera Bacillus, Acinetobacter, and Corynebacterium were identified at a significantly smaller number. Bacterial, yeast, and mold filtering effectiveness increased from the single-layer cloth mask, which proved to be the least effective, to the surgical mask, to the filtering facepiece type 2 (FFP2) mask. Furthermore, surveys are needed to study the effectiveness of protective measures.

Dysphagia rehabilitation in post-COVID patients: Review of the literature

COVID-19 causes acute respiratory failure syndrome (SIRA), leading patients to require intubation in the intensive care unit (ICU). A common complication of this ventilatory support is dysphagia, which has a prevalence of up to 30%.This work aims to describe rehabilitation methods in patients with coronavirus infection based on levels of evidence according to the GRADE System, so a systematic review of the literature was carried out. The selected articles were divided into the following subtopics: diagnosis of dysphagia and rehabilitation in COVID patients. The gold standard for the diagnosis of dysphagia is the videofluoroscopic swallowing study (VFS). Fiberoptic Evaluation of Swallowing Assessment (FEES) has high sensitivity and specificity, although they have the disjunction of an aerosol-generating procedure (AGP);however, in a pandemic situation, the study of choice in the literature is VF. Once the diagnosis is made, it is necessary to initiate rehabilitation as soon as possible, even from hospitalization in patients who have hemodynamic stability to prevent long-term effects and promote normal swallowing even before discharge. In patients with COVID-19 infection dysphagia, the risk-benefit of assessment tools and therapy used for diagnosis should be decided to help to maintain social distancing. It becomes imperative to carry out clinical studies with high levels of evidence that allow us to generate Clinical Practice Guides for the benefit of our patients.Copyright © 2021 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.

Effect of an N95 respirator and a surgical mask-covered N95 on the cardiovascular responses of dentists treating paediatric patients: A crossover clinical trial.

BACKGROUND: The studies on cardiovascular alterations when using an N95 respirator or surgical mask-covered N95 during dental treatments are limited. AIM: To investigate and compare the cardiovascular responses of dentists treating paediatric patients while wearing an N95 respirator or a surgical mask-covered N95. DESIGN: This was a crossover clinical trial in 18 healthy dentists wearing an N95 respirator or surgical mask-covered N95 during the dental treatment of paediatric patients. Oxygen saturation (SpO2 ), heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) were monitored at baseline, intraoperation, and postoperation. The data were analyzed using the generalized estimating equation. RESULTS: The mean SpO2 , HR, SBP, DBP, and MAP significantly changed from baseline up to the end of the procedures after wearing an N95 by 3.1%, 19.3%, 11.5%, 17.7%, and 13.8% and after wearing a surgical mask-covered N95 by 3.0%, 20.2%, 5.3%, 13.9%, and 8.8%, respectively (p < .05). No significant differences in these values were found between groups (p > .05). CONCLUSIONS: N95 respirators and surgical mask-covered N95s significantly impact the cardiovascular responses of dentists treating paediatric patients with no differences between the two types of masks.

The impact and effectiveness of the general public wearing masks to reduce the spread of pandemics in the UK: a multidisciplinary comparison of single-use masks versus reusable face masks.

During the coronavirus (COVID-19) pandemic, the UK government mandated the use of face masks in various public settings and recommended the use of reusable masks to combat shortages of medically graded single-use masks in healthcare. To assist decision-making on the choice of masks for future pandemics, where shortages may not be a contributing factor, the University College London (UCL) Plastic Waste Innovation Hub has carried out a multidisciplinary comparison between single-use and reusable masks based on their anatomy, standalone effectiveness, behavioural considerations, environmental impact and costs. Although current single-use masks have a higher standalone effectiveness against bacteria and viruses, studies show that reusable masks have adequate performance in slowing infection rates of respiratory viruses. Material flow analysis (MFA), life cycle assessment (LCA) and cost comparison show that reusable masks have a lower environmental and economic impact than single-use masks. If every person in the UK uses one single-use mask each day for a year, it will create a total of 124,000 tonnes of waste, 66,000 tonnes of which would be unrecyclable contaminated plastic waste (the masks), with the rest being the recyclable packaging typically used for transportation and distribution of masks. Using reusable masks creates >85% less waste, generates 3.5 times lower impact on climate change and incurs 3.7 times lower costs. Further behavioural research is necessary to understand the extent and current practices of mask use; and how these practices affect mask effectiveness in reducing infection rates. Wearing single-use masks may be preferred over reusable masks due to perceptions of increased hygiene and convenience. Understanding behaviour towards the regular machine-washing of reusable masks for their effective reuse is key to maximise their public health benefits and minimise environmental and economic costs.

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.

Aerosol-Generating Medical Procedures: Controversies in Definition, Risks, and Mitigation Strategies

An aerosol-generating medical procedure (AGMP) is any procedure performed on a patient that can induce the production of aerosols of various sizes, including droplet nuclei. AGMPs have become a subject of increasing interest during the COVID-19 pandemic for two critical reasons. First, AGMP likely increases the risk of transmission from patients infected with respiratory infections to healthcare personnel and other patients in their environment. Second, special risk mitigation strategies, including selection of specific types of personal protective equipment and environmental controls, are necessary to protect staff during the performance of AGMPs. Heightened awareness for AGMPs began during the 2003 severe acute respiratory syndrome (SARS) pandemic, where it was noted that, in outbreaks, many frontline HCWs had increased risk of contracting the virus related to certain procedures performed on the respiratory tract (Tran et al. PLoS One 7:e35797, 2012). Numerous clinical guidelines were published attempting to categorize and classify the risk associated with various AGMP. However, while numerous procedures have been identified as "aerosol generating, " the scientific evidence for the creation of aerosols associated with these procedures, the burden of potential viable microbes within the created aerosols, and the mechanism of transmission to the host have not been well studied (Davies et al. J Infect Prev 10:122-6, 2009). Almost 20 years later, there are still large gaps in knowledge around AGMPs - what defines them, what is the added risk associated with them, and which strategies are most effective at mitigating the risks associated with them. Here, we summarize the current knowledge around AGMPs including the types, risk, and mitigation strategies. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Review of the Effect of Continuous Use and Limited Reuse of N95 Respirators on Respirator Fit.

Background: Coronavirus disease 2019 (COVID-19) has led to severe shortages of filtering facepiece respirators (FFRs). As a result, extended use, limited reuse, and FFR decontamination have been utilized to extend the life of single-use FFRs. Although some studies have raised concerns that reuse could affect the FFR's ability to form a seal, no comprehensive literature review of the effect of extended use or limited reuse on FFR seal exists. Objective: The goal of this review was to assess the effect of extended use and reuse on respirator fit, with and without decontamination. Methods: Searches of PubMed and Medrxiv yielded 24 papers that included assessment of fit after extended use or limited reuse on a human. One additional handpicked paper was added. Results: Studies report a wide variation in the number of donnings and doffings before fit failure between different models of respirators. Additionally, while seal checks lack sufficient sensitivity to reliably detect fit failures, individuals who failed fit testing were often able to pass subsequent tests by re-positioning the respirator. Even with failure, respirators often maintained a substantially higher level of fit than a surgical mask, so they may still provide a level of protection in crisis settings. Conclusion: Based on currently available data, this literature review was unable to establish a consensus regarding the amount of time a respirator can be worn or the number of uses before fit failure will occur. Furthermore, variations in reuses before fit failure between different models of N95 respirators limit the ability to offer a comprehensive recommendation of greater than one reuse or a specific amount of wear time.

Efficacy of Surgical Masks Versus N95 Respirators for the Prevention of COVID-19 in Dental Settings: A Systematic Review.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. (SARS-CoV-2). It spreads mainly through saliva droplets or nasal discharge. Dentists are among the professionals with the greatest risk of contracting and transmitting COVID-19. We compared the efficacy of surgical masks versus N95 respirators in preventing COVID-19 infection in dental settings. PubMed, Scopus, Web of Science, and Cochrane Library databases were searched. Search terms corresponded to a predefined PICOS (patient/population, intervention, comparison, and outcomes) question. The risk of bias was evaluated using AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews-2), ROBIS (Risk of Bias in Systematic Reviews), and Health Evidence tools. A total of 191 articles were screened, and nine of them were further evaluated for eligibility, of which five articles (fulfilled the selection criteria) and were included in this study. Two studies concluded that surgical masks could provide equivalent protection to N95 respirators. Another study found that N95 respirators were superior to surgical masks. The fourth study found that better protection can be achieved when using surgical masks by the aerosol source than when the recipient uses an N95 respirator, while the last study concluded that surgical masks or N95 respirators alone do not provide full protection. Thus, according to this systematic review, N95 respirators provide better protection against COVID-19 infection compared to surgical masks.

A University Collaboration in Creating a Powered Air Purifying Respirator: An Emergency Innovative Response

Purpose of Study In March of 2020, the World Health Organization declared the coronavirus (COVID-19) a global pandemic. As the number of cases increased worldwide, existing hospital infrastructure struggled to keep up with the demand for equipment and supplies.This exposed healthcare workers to contracting the disease. The purpose of this study is to demonstrate an emergency innovation response in overcoming shortages of personal protective equipment within a university hospital setting, with a special focus on powered air purifying respirators (PAPRs). Methods Used The Center for Medical Innovation (CMI)-a center designed to promote research and development of high-impact healthcare products at the University of Utah (UofU)-enlisted university engineers to develop an open source PAPR system made from readily available commercial materials. Parts were selected to meet filtration, airflow, and protection specifications as outlined by industry standards. Commercially available parts consistent with these specifications were assembled into a novel PAPR system which utilized 3D printed pieces on demand to achieve compatibility. Once assembled, each PAPR went through protection testing to demonstrate health worker safety. A fit factor of 200 is the minimum requirement needed as defined by NIOSH. Testing procedures were carried out with industry standard equipment. Summary of Results A human centered design approach was utilized in iterating versions of the product based on repeated fit testing. Failures were addressed in subsequent models. All PAPRs passed fit testing with a score of > 1000. Following the lean processing standard of just in time inventory, materials to fabricate 1000 PAPRs were procured and assembled on demand. PAPRs are now being used by the UofU Hospital as well as other affiliate entities globally and are filling the gap needed for PPE. Approximately 200 units have been donated to Navajo Nations hospitals in the state of Utah and others have been donated to university sister entities in India, Nepal, and Kenya. Conclusions The Center for Medical Innovation at the University of Utah has facilitated a rapid emergency innovative response in filling the PPE needs locally and abroad by creating this open source accessible PAPR system.

Human-Centered Design in Response to a Pandemic: A Health System and Innovation Center Collaboration

Purpose of Study In the spring of 2020, the coronavirus pandemic brought new challenges to healthcare systems as the rising demand for protective equipment led to product and resource inequalities around the globe. The inability to safeguard workers led to increased infection rates and deaths of healthcare professionals worldwide. The purpose of this study is to evaluate the response of an in-house innovation committee to meet the unforeseen needs faced by healthcare systems during an acute medical crisis. Methods Used Housed directly within the University of Utah's health system (U Health), The Center for Medical Innovation (CMI) teamed up with the hospital's administration, BME, COVID task force, and occupational health to create an innovative think-tank to tackle the challenges brought in by the coronavirus pandemic, with the purpose of stratifying clinical needs based upon acuity, frequency, and urgency. While prioritizing equipment needs, CMI used human-centered design to analyze common industry practices, engineer comparable solutions from commercially available materials, test reimagined products against known gold-standards, and create open-source assembly guides that allowed others facing similar shortages to do the same. Summary of Results The close-working relationship between CMI and U Health allowed for the rapid identification, innovation, and engineering of products that met the needs of healthcare workers during the months following the COVID pandemic. Many of these were directly adopted in clinical settings, including aerosol containment tents, powered air-purifying respirators, and self-testing stations. Additionally, CMI identified and engineered 20 additional readily producible, rapid-response products in anticipation of future needs, such as a bubble CPAP, containment boxes, and re-usable PPE. From these, dozens of open source, 'Improvised Personal Protective Equipment' manuals were shared with global partners to address the inequality of medical equipment in lowresource settings. Conclusions The rapid development of easily-producible, lowcost solutions for acute clinical needs-especially those faced by the equipment shortages seen during a pandemic-is improved via the partnership between health systems and a center for medical innovation.

Relationship between acne and the use of mask in doctors during the COVID-19 pandemic.

OBJECTIVE: To identify the characteristics of the use of masks and features of acne lesions and acne-like eruptions, among doctors involved in various clinical settings. MATERIALS AND METHODS: An observational, prospective, cross-sectional study was conducted from June to September 2020. The main tool of the study was a form designed with the Google forms platform, which has 17 items. RESULT(S): The responses of 150 participants from Mexico and Latin America were analyzed: 84 participants (56%) were female. The most frequent academic degree among the participants was Doctor of Medicine. The mask with the highest frequency of use was the N95 mask in 98 participants (65.3%);84% of the participants presented typical acne lesions, nodules were the most frequent lesions, only 24 patients did not present characteristic lesions. The topographic region where these lesions most frequently occurred was the chin region. CONCLUSION(S): The importance of the presence of acne and acne-like lesions in medical doctors who use personal protective equipment during their working hours is demonstrated, in order to issue future recommendations related to skin care during the SARS-CoV-2 pandemic.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Effect of N95 Filtering Facepiece Respirator on Venous Blood Carbon Dioxide Levels and Hemodynamic Changes in Health Care Workers.

Background: N95 filtering facepiece respirators (FFR) are used by health care workers for prevention of airborne infection, and its use has increased manifolds during COVID-19 pandemic. Prolonged use may result in carbon dioxide (CO2) accumulation, affect hemodynamics, and blood gas values. Although arterial blood gas values accurately measure the blood CO2 levels, venous blood gas values also show acceptable correlation. Aim: To evaluate the physiological impact of N95 FFRs on health care workers, including hemodynamic changes and venous blood levels of CO2 during a period of 6 h. Settings and Design: Prospective observational study in a tertiary care hospital. Methods: The study was conducted on 30 health care workers who performed routine duties while wearing N95 FFR. Venous blood gas values (CO2, pH, and bicarbonate) and vitals (respiratory rate, heart rate, blood pressure, and saturation) were noted at baseline, 2 (T2), and 6 h (T6) after wearing the mask. Discomfort level was also measured on a Visual Analogue Scale (VAS) of 1-10. Statistical Analysis: Repeated measures analysis was done using repeated measures ANOVA or Friedman's test. Group comparisons for continuously distributed data were made using independent sample "t" test or Wilcoxon test. Results and Conclusion: Hemodynamic and blood gas values did not change over time. The VAS for discomfort because of respirator use was 1.33 (1.42) at T2 and 2.77 (1.91) at T6. This was a significant increase in discomfort over time (P = 0.001). About 80% of participants experienced discomfort during this period. N95 FFR did not lead to significant alteration in hemodynamics or change in blood gas values after 6 h of continuous usage. However, discomfort significantly increased over time.

Influence of Face Masks on Physiological and Subjective Response during 130 Min of Simulated Light and Medium Physical Manual Work-An Explorative Study.

BACKGROUND: Undesirable side effects from wearing face masks during the ongoing COVID-19 pandemic continue to be discussed and pose a challenge to occupational health and safety when recommending safe application. Only few studies examined the effects of continuously wearing a face mask for more than one hour. Therefore, the influence of wearing a medical mask (MedMask) and a filtering facepiece class II respirator (FFP2) on the physiological and subjective outcomes in the course of 130 min of manual work was exploratively investigated. Physical work load and cardiorespiratory fitness levels were additionally considered as moderating factors. METHODS: Twenty-four healthy subjects (12 females) from three different cardiorespiratory fitness levels each performed 130 min of simulated manual work with light and medium physical workload using either no mask, a MedMask or FFP2. Heart rate, transcutaneous oxygen and carbon dioxide partial pressure (PtcO2, PtcCO2) as well as perceived physical exertion and respiratory effort were assessed continuously at discrete time intervals. Wearing comfort of the masks were additionally rated after the working period. RESULTS: There was no difference in time-dependent changes of physiological outcomes when using either a MedMask or a FFP2 compared to not wearing a mask. A stronger increase over time in perceived respiratory effort occurred when the face masks were worn, being more prominent for FFP2. Physical workload level and cardiorespiratory fitness level were no moderating factors and higher wearing comfort was rated for the MedMask. CONCLUSION: Our results suggest that using face masks during light and medium physical manual work does not induce detrimental side effects. Prolonged wearing episodes appeared to increase respiratory effort, but without affecting human physiology in a clinically relevant way.