Use of Respiratory Protective Equipment during and after Lifting of Public Health Restrictions due to the COVID-19 Pandemic

Introduction: The COVID-19 pandemic has shown the importance of non-specific measures of infectious disease prevention, including the use of respiratory protective equipment. Despite the improvement in the epidemiological situation and gradual lifting of public health restrictions, some people keep wearing face masks. Objective: To analyze the use of respiratory protective equipment in accordance with COVID-19 face mask requirements and after the end of the mask mandate among medical students in Moscow. Materials and methods: The questionnaire-based survey was conducted in two stages in March 2021 and in March–April 2022 among 988 and 830 third year students of the Institute of Clinical Medicine, Sechenov University, respectively, to collect data on socio-demographic characteristics, the practice of wearing face masks in public places, and the incentives to use them. The observational study was carried out in March 2022 among 816 Russian and 96 foreign students by counting those wearing face masks in the classrooms. Results: We established that 97.5 % of the respondents used respiratory protective equipment during the period of restric-tive public health measures. The main reasons for doing that were a mask mandate due to coronavirus and the necessity of personal contacts with other people. The survey showed that masks were most often used in health facilities, supermarkets, pharmacies, subway, and at the university. During the first two weeks after abolishing mandatory wearing of face masks, 18.3 % of all the respondents continued their use, mainly out of concern for other people's health, of whom 9.9 % and 89.6 % were Russian and foreign medical students, respectively. The second survey demonstrated that 7.2 % of the Russian medical students kept wearing masks in some settings later on. In case of yet another increase in the COVID-19 incidence, 97.6 % of the respondents intend to use respiratory protective equipment and 74.7 % of them plan to recommend this preventive measure to their relatives. Study limitations: Due to the fact that only medical university students aged 20 to 23 took part in the research and in view of the short time period that had elapsed since lifting of masking requirements, it is of interest to survey various age and social population groups in a longer-term perspective. Conclusions: Medical students continue using respiratory protective equipment after the restrictions are lifted, mainly to pro-tect others. © Team of authors, 2022.

Use of Micrococcus luteus to assess the quality of protection of respiratory organs using the pneumatic helmet with positive airflow.

In order to effectively protect from dangerous infectious agents, as well as coronavirus, the scientists of I. Horbachevsky Ternopil national medical university (Ukraine) developed a unique prototype of a mobile respiratory protection system with positive airflow - pneumatic helmet. AIM: To evaluate the bacterial permeability of the proposed concept model of the pneumohelmet in full and partial configuration. MATERIALS AND METHODS: With a generating device (compressor inhaler) an aerosol is created from bacterial suspension, which is directed to the inlet of the personal protective respiratory equipment. The outlet is directed at a Petri dish with meat-peptone broth. Evaluation of bacterial contamination is performed by calculating the colony-forming units by multiplying the indicator by the degree of dilution. The study is repeated with a partial configuration of the pneumatic helmet - the presence of only external, only internal filter or not using any filter components. RESULTS: The growth of Micrococcus luteus colonies on the placed nutrient medium when using the proposed conceptual model of the pneumatic helmet in full configuration was not obtained. Removal of the inner filter did not lead to a violation of the effectiveness of antibacterial protection, as bacteria were detected only on the outer side of filter No.2. The use of a conceptual model without filters made it possible to detect colonies of Micrococcus luteus on the medium and components of the device with the calculation of colony forming units in 3- and 4-fold dilutions. During 24 hours of operation, the bacterial load on the surface of the external filter increased significantly. However, no signs of malfunction of the pneumatic helmet were detected. CONCLUSIONS: The given results confirm the ability of the pneumatic helmet to counteract the penetration of bacteria from the environment during 6, 12, 24 hours of continuous operation. The protection was preserved even with partial configuration, which indicates the presence of a margin of reliability of this system.

Biomechanical and Physiological Evaluation of Respiratory Protective Equipment Application.

Purpose: Respiratory protective equipment is widely used in healthcare settings to protect clinicians whilst treating patients with COVID-19. However, their generic designs do not accommodate the variability in face shape across genders and ethnicities. Accordingly, they are regularly overtightened to compensate for a poor fit. The present study aims at investigating the biomechanical and thermal loads during respirator application and the associated changes in local skin physiology at the skin-device interface. Materials and Methods: Sixteen healthy volunteers were recruited and reflected a range of gender, ethnicities and facial anthropometrics. Four single-use respirators were evaluated representing different geometries, size and material interfaces. Participants were asked to wear each respirator in a random order while a series of measurements were recorded, including interface pressure, temperature and relative humidity. Measures of transepidermal water loss and skin hydration were assessed pre- and post-respirator application, and after 20 minutes of recovery. Statistical analysis assessed differences between respirator designs and associations between demographics, interface conditions and parameters of skin health. Results: Results showed a statistically significant negative correlation (p < 0.05) between the alar width and interface pressures at the nasal bridge, for three of the respirator designs. The nasal bridge site also corresponded to the highest pressures for all respirator designs. Temperature and humidity significantly increased (p < 0.05) during each respirator application. Significant increases in transepidermal water loss values (p < 0.05) were observed after the application of the respirators in females, which were most apparent at the nasal bridge. Conclusion: The results revealed that specific facial features affected the distribution of interface pressures and depending on the respirator design and material, changes in skin barrier function were evident. The development of respirator designs that accommodate a diverse range of face shapes and protect the end users from skin damage are required to support the long-term use of these devices.

Anaesthetists' current practice and perceptions of aerosol-generating procedures: a mixed-methods study.

The evidence base surrounding the transmission risk of 'aerosol-generating procedures' has evolved primarily through quantification of aerosol concentrations during clinical practice. Consequently, infection prevention and control guidelines are undergoing continual reassessment. This mixed-methods study aimed to explore the perceptions of practicing anaesthetists regarding aerosol-generating procedures. An online survey was distributed to the Membership Engagement Group of the Royal College of Anaesthetists during November 2021. The survey included five clinical scenarios to identify the personal approach of respondents to precautions, their hospital's policies and the associated impact on healthcare provision. A purposive sample was selected for interviews to explore the reasoning behind their perceptions and behaviours in greater depth. A total of 333 survey responses were analysed quantitatively. Transcripts from 18 interviews were coded and analysed thematically. The sample was broadly representative of the UK anaesthetic workforce. Most respondents and their hospitals were aware of, supported and adhered to UK guidance. However, there were examples of substantial divergence from these guidelines at both individual and hospital level. For example, 40 (12%) requested respiratory protective equipment and 63 (20%) worked in hospitals that required it to be worn whilst performing tracheal intubation in SARS-CoV-2 negative patients. Additionally, 173 (52%) wore respiratory protective equipment whilst inserting supraglottic airway devices. Regarding the use of respiratory protective equipment and fallow times in the operating theatre: 305 (92%) perceived reduced efficiency; 376 (83%) perceived a negative impact on teamworking; 201 (64%) were worried about environmental impact; and 255 (77%) reported significant problems with communication. However, 269 (63%) felt the negative impacts of respiratory protection equipment were appropriately balanced against the risks of SARS-CoV-2 transmission. Attitudes were polarised about the prospect of moving away from using respiratory protective equipment. Participants' perceived risk from COVID-19 correlated with concern regarding stepdown (Spearman's test, R = 0.36, p < 0.001). Attitudes towards aerosol-generating procedures and the need for respiratory protective equipment are evolving and this information can be used to inform strategies to facilitate successful adoption of revised guidelines.

Skin and respiratory ill-health attributed to occupational face mask use.

BACKGROUND: Face mask use in the workplace has become widespread since the onset of the Covid-19 pandemic and has been anecdotally linked to adverse health consequences. AIMS: To examine reports of adverse health consequences of occupational face mask use received by The Health and Occupation Research (THOR) network before and after the pandemic onset. METHODS: THOR databases were searched to identify all cases of ill-health attributed to 'face mask' or similar suspected causative agent between 1 January 2010 and 30 June 2021. RESULTS: Thirty two cases were identified in total, 18 reported by occupational physicians and 14 by dermatologists. Seventy-five per cent of cases were reported after the pandemic onset and 91% cases were in the health and social care sector. 25 of the 35 (71%) diagnoses were dermatological, the most frequent diagnoses being contact dermatitis (14 cases) and folliculitis/acne (6 cases). Of the seven respiratory diagnoses, four were exacerbation of pre-existing asthma. CONCLUSIONS: There is evidence of an abrupt increase in reports of predominantly dermatological ill-health attributed to occupational face mask use since the start of the pandemic. Respiratory presentations have also occurred.

Overview of the Application of Powered Intelligent Air-Purifying Respirator in the Health Field

During the COVID-19 pandemic, more and more health-care workers around the world use Powered Air-Purifying Respirator (PAPR) personal respiratory protective equipment when treating patients with COVID-19. In order to provide suggestions and references for the implementation and application of existing PAPR protective equipment in the medical and health field, the typical structure of existing PAPR products is classified and summarized, focusing on the PAPR standard documents of China, the United States, the United Kingdom, and Japan. Analysis and summary of key technical requirements in national standards. From academic literature, standard documents, invention patents, product manuals, network literature and product research and other multifaceted information, the research status of Powered Air-Purifying Respirators is reviewed, synthesized and summarized. Finally, the development of international standards, Virus protection test, respiratory response control and comfort are prospected. And the deficiencies of the current PAPR products and the directions that need to be studied by relevant technical personnel in the future are pointed out. © 2021 IEEE

Respiratory Protective Equipment Reconsiderations in the Age of SARS-CoV-2

The use of respiratory protective equipment (RPE) has been recognized as an effective measure to mitigate droplet and airborne transmission of SARS-CoV-2. Although there are various types of RPE available, different RPEs serve different purposes and offer various levels of protection against aerosols. Additionally, recent evidence highlights the role of good fit in ensuring the effectiveness of RPEs. Some modified procedures can enhance the effectiveness of surgical masks by improving fit. In the age of SARS-CoV-2, there is an urgent need for knowledge about RPEs. The correct selection and use of RPEs are of pivotal importance for breaking the transmission chain of SARS-CoV-2.

Respiratory Protective Equipment and Facial Hair in Light of COVID-19: Legal and Ethical Dilemmas

Facial hair inhibits the functionality of certain respiratory protective equipment, yet employers have a duty of care to provide protection for their employees against communicable respiratory diseases such as COVID-19. Could individuals be forced to remove their facial hair? How can staff with facial hair be protected from COVID-19? These issues present legal and ethical dilemmas for employers and employees alike regarding the provision and use of respiratory and personal protective equipment under health and safety considerations. This is a law review examining various UK statutory instruments and case law surrounding the use of facial hair and the use of respiratory protection. Facial hair is a hazard when considering respiratory protective equipment provision and use. Unless there is an absolute need requiring the removal of facial hair for any reason, individuals have the right to grow facial hair as they see fit. It is arguable though what an "absolute need" may be, as numerous proportional and reasonable adjustments can be made to accommodate facial hair that can mitigate the risks associated with respiratory diseases.

Changes in skin characteristics after using respiratory protective equipment (medical masks and respirators) in the COVID-19 pandemic among healthcare workers.

BACKGROUND: The coronavirus disease-2019 (COVID-19) outbreak has presented unique dermatologic challenges due to respiratory protective equipment (RPE)-related skin conditions. OBJECTIVE: To objectively evaluate the effects of RPE including medical masks and respirators on the skin barrier by measuring various physiological properties of the skin. METHODS: A cross-sectional study was designed. Twenty healthy healthcare workers were included in this study. Skin parameters including skin hydration, transepidermal water loss (TEWL), erythema, sebum secretion, pH, and skin temperature were measured in the RPE-covered and RPE-uncovered areas of the face 4 and 8 hours after wearing RPE and 14 hours after not wearing RPE. RESULTS: Skin hydration, TEWL, erythema, pH, and skin temperature increased in the RPE-covered areas after wearing RPE for 4 and 8 hours. By contrast, in the RPE-uncovered areas, skin hydration decreased and TEWL, erythema, and pH showed minimal changes over time. Based on the repeated-measure analysis, the changes in skin physiological properties over time were significantly different between RPE-covered and RPE-uncovered areas. CONCLUSION: We observed that skin physiological characteristics change with the prolonged use of RPE such as medical masks and respirators. These changes may lead to various adverse skin reactions after long-term use.

Comparative Performance Testing of Respirator versus Surgical Mask Using a Water Droplet Spray Model.

BACKGROUND: During the SARS-CoV-2 pandemic, there was shortage of the standard respiratory protective equipment (RPE). The aim of this study was to develop a procedure to test the performance of alternative RPEs used in the care of COVID-19 patients. METHODS: A laboratory-based test was developed to compare RPEs by total inward leakage (TIL). We used a crossflow nebulizer to produce a jet spray of 1-100 µm water droplets with a fluorescent marker. The RPEs were placed on a dummy head and sprayed at distances of 30 and 60 cm. The outcome was determined as the recovery of the fluorescent marker on a membrane filter placed on the mouth of the dummy head. RESULTS: At 30 cm, a type IIR surgical mask gave a 17.7% lower TIL compared with an FFP2 respirator. At 60 cm, this difference was similar, with a 21.7% lower TIL for the surgical mask compared to the respirator. When adding a face shield, the TIL at 30 cm was further reduced by 9.5% for the respirator and 16.6% in the case of the surgical mask. CONCLUSIONS: A safe, fast and very sensitive test method was developed to assess the effectiveness of RPE by comparison under controlled conditions.

[Masks as personal protective equipment in the COVID-19 pandemic: How, when and which should be used]. / Mascarillas como equipo de protección individual durante la pandemia de COVID-19: cómo, cuándo y cuáles deben utilizarse.

BACKGROUND AND OBJECTIVE: In the COVID-19 pandemic, the demand of masks has been increased by health professionals and the general population. In this context, it is necessary to summarize the features and indications of the different types of masks. MATERIAL AND METHODS: To consult and to compile the different recommendations disseminated by prestigious institutions such as the World Health Organization, the European Center for Disease Prevention, the Center for Evidence-Based Medicine, or the Ministry of Health of the Government of Spain has been reviewed. RESULTS: The institutions consulted recommend reserving FFP respirators for healthcare workers, especially when carrying out aerosol-generating procedures (AGPs) (minimum FFP2 protection) and consider some reutilization systems during times of scarcity. The use of surgical masks is recommended to professionals who do not perform AGPs and to the symptomatic population but exist variations in its indications intended for the general healthy population. CONCLUSION: In the context of shortage of personal protective equipment due to the COVID-19 pandemic, a prioritization and rationalization of the use of each type of mask should be established according to the user and the activity performed.

What face mask for what use in the context of COVID-19 pandemic? The French guidelines.

In the context of the COVID-19 pandemic, wearing a face mask has become usual and ubiquitous, in both hospitals and community. However, the general public is consuming surgical or filtering face piece (FFP) masks irrespective of their specificity, leading to global supply shortage for the most exposed persons, which are healthcare workers. This underlines the urgent need to clarify the indications of the different categories of mask, in order to rationalize their use. The study herein specifies the French position for the rational use of respiratory protective equipment for healthcare workers.

Surgical Mask-the Saviour: from its Invention to the COVID-19 Era.

The earliest available evidence attributes the discovery of droplets as a mode of transmission of disease to Carl Flügge, a German bacteriologist, a contemporary of Emil Kocher, in 1897. This finding was instrumental in the development of the gauze mask introduced by Johann von Mikulicz Radecki in the same year. A surgical mask has become an indispensable tool in the armamentarium to fight the COVID 19 pandemic. Surgical masks which were once limited to the confines of healthcare setups are now donned by the members of the general public. It has become imperative that a healthcare worker selects the right kind of respiratory protective equipment to protect himself and his patients. The surgical mask has become essential, in a way, for survival.