Type Of Respiratory Protection Research Articles

The use of the respiratory protective devices by the population during the COVID-19 pandemic

Introduction. Wearing a face mask is an important measure against spread of infection during the COVID-19 pandemic. The purpose of the study was to analyze various aspects of the face masks use by the population during the pandemic. The questioner was used. Results. Almost all respondents (96.4%) wore respiratory protective devices during the pandemic; 91.4% respondents worn face masks visiting grocery stores, pharmacies and medical organizations; 64.0% - visiting non-food trade facilities; 76.9% - travelling by surface transport, and 76.1% - being on the subway. Different types of face masks were used, 93.3% of respondents used disposable medical mask, 25.4% - reusable cloth masks. However, only 44.8% of respondents indicated that their protective equipment was made of non-woven material; 26.1% did not know how many layers their protective equipment contained; about a third of respondents (20.1% - 30.21%) were not able to assess the effectiveness of different types of respiratory protection. A third of the respondents (33.6%) wore a disposable medical mask for 2 hours, 35.2% - more than 2 hours in one day, 28.0% - for several days. Conclusions. Most of the respondents wore the face mask. Disposable medical masks were most commonly used. Requirements for the duration of wearing of face masks were met by about third of the respondents, for the handling - half of the respondents. Spontaneous choice of face mask by respondents confirms the importance of the development of hygiene guideline for choosing the most effective respiratory protection.

O novo normal da Odontologia: revisão das recomendações para retomada da assistência odontológica durante a pandemia da COVID-19

Objetivo: este artigo tem como objetivos identificar as recomendações para a retomada dos atendimentos odontológicos eletivos após surto epidêmico da COVID-19 e identificar os consensos e controvérsias entre as sugestões encontradas nos documentos. Material e Métodos: foi realizada uma pesquisa documental comparativa sobre as recomendações para o retorno do atendimento odontológico eletivo após o surto epidêmico da COVID-19. Secundariamente, foi realizada uma revisão da literatura a partir de busca nas bases: Portal Regional da Biblioteca Virtual em Saúde (BVS), que incorpora Lilacs, SciELO, MEDLINE, a partir da estratégia de busca (“COVID-19” AND “dentistry”). Resultados: foram analisados documentos oficiais do Ministério da Saúde ou de órgãos correspondentes e de entidades de classe de onze diferentes países do mundo e encontrados seis artigos que abordavam as recomendações para o retorno aos atendimentos eletivos. Conclusão: há um consenso quanto aos requisitos para as instalações do consultório, à indicação de realização de triagem antes do agendamento e atendimento e quanto aos cuidados recomendados durante o atendimento. Não há consenso quanto ao uso de bochechos antissépticos prévios ao procedimento, ao uso sistemático de testes rápidos antes do atendimento, ao tipo de proteção respiratória que deve ser utilizada pela equipe odontológica e ao tempo mínimo de pausa antes da realização da higienização da sala de trabalho quando são realizados procedimentos geradores de aerossol.

Short Communication: Health Interventions in Volcanic Eruptions—Community Wearability Assessment of Respiratory Protection against Volcanic Ash from Mt Sinabung, Indonesia

Inhalation of ash can be of great concern for affected communities, during and after volcanic eruptions. Governmental and humanitarian agencies recommend and distribute a variety of respiratory protection (RP), commonly surgical masks but, also, industry-certified N95-style masks. However, there is currently no evidence on how wearable they are within affected populations or how protective wearers perceive them being against volcanic ash (which will influence the likelihood of uptake of recommended interventions). Volunteers living near Mt. Sinabung, Sumatra, Indonesia, participated in a field wearability study, which included a high-efficiency mask certified to industry standards (N95-equiv.); a standard, pleated surgical mask (Surgical); a Basic flat-fold mask (Flat-fold), and the surgical mask plus a scarf tied over the top (Surgical Plus) to improve fit. These types of RP had all performed well during earlier laboratory filtration efficiency tests. The N95-equiv. mask had performed significantly better than the other RP in the subsequent total inward leakage volunteer trials, whilst the Flat-fold and Surgical masks performed poorly, letting in a third of PM2.5 particles (data published elsewhere). Thirty volunteers wore each mask for a 15-min walk before being asked to rate the comfort, breathability and perceived protection and fit of each. After wearing all of the masks, volunteers compared and identified their preferred type of protection. The feedback received from the volunteers suggested that the Surgical Plus and N95-equiv. masks were rated as being significantly hotter and more humid than other masks. The Flat-fold was rated to have better breathability than the other masks. The N95-equiv. mask was ranked as providing the best level of effectiveness of the four masks tested. Ultimately, when asked which type of mask they would choose to wear during ashfall, 33% selected the Flat-fold mask due to its comfort and simplicity, with the Surgical Plus being the least likely to be chosen of the four tested. The study findings are of benefit to agencies who need to make informed decisions on the procurement and distribution of RP for use by those affected in future eruptions and the provision of advice to communities on their usage.

Examining the policies and guidelines around the use of masks and respirators by healthcare workers in China, Pakistan and Vietnam.

There is an ongoing debate regarding the type of respiratory protection that should be recommended for use for healthcare workers. A cross-sectional survey was conducted in three countries: China, Pakistan and Vietnam. In China and Pakistan, the infection control guidelines were developed to be in line with the recommendations from the World Health Organization (WHO) and the Centers for Disease Control and Prevention, while in the Vietnamese guidelines the recommendations correspond with the WHO suggestions only. The guidelines from all three countries document the need for training and fit testing; however there is no system to monitor the training and fit testing programs. Across the three countries, there was some inconsistency with regard to the types of products (i.e. masks vs. respirators) recommended for influenza, severe acute respiratory syndrome (SARS) and tuberculosis. Available evidence should be examined and a comprehensive policy should be developed on the use of masks and respirators. The policy should address critical areas such as regulation, training, fit testing and reuse.

Guidance on the use of respiratory and facial protection equipment

Infectious micro-organisms may be transmitted by a variety of routes, and some may be spread by more than one route. Respiratory and facial protection is required for those organisms that are usually transmitted via the droplet/airborne route, or when airborne particles have been artificially created, such as during ‘aerosol-generating procedures’. A range of personal protective equipment that provides different degrees of facial and respiratory protection is available. It is apparent from the recent experiences with severe acute respiratory syndrome and pandemic (H1N1) 2009 influenza that healthcare workers may have difficulty in choosing the correct type of facial and respiratory protection in any given clinical situation. To address this issue, the Scientific Development Committee of the Healthcare Infection Society established a short-life working group to develop guidance. The guidance is based upon a review of the literature, which is published separately, and expert consensus.

Infektionsprävention bei Tuberkulose - Empfehlungen des DZK

The epidemiological situation of tuberculosis (TB) in Germany has improved considerably during the past few years. However, those in unprotected contact with infectious tuberculosis patients frequently and/or over longer periods of time and/or intensively continue to have a higher risk for TB infection. Rapid diagnosis, prompt initiation of effective treatment, and adequate infection control measures are of particular importance to prevent infection. The present recommendations depict the essentials of infection control as well as specific measures in the hospital (isolation, criteria for its duration and technical requirements, types of respiratory protection, disinfection measures, waste disposal). The specific requirements for outpatients (medical practice), at home, for ambulance services, and in congregate settings, including prisons, are also addressed. Compared with the previous recommendations the pattern of respiratory protection measures has been simplified. As a rule, hospital staff and those visiting infectious tuberculosis patients are advised to wear respiratory protection that satisfies the criteria of FFP2-masks (DIN EN 149), while patients should wear mouth-nose protectors (surgical masks) in the presence of others and outside the isolation room. A detailed depiction of criteria for isolation and its duration in smear positive and only culturally confirmed pulmonary tuberculosis has been added.

Infektionsprävention bei Tuberkulose - Empfehlungen des DZK

The epidemiological situation of tuberculosis (TB) in Germany has improved considerably during the past few years. However, those in unprotected contact with infectious tuberculosis patients frequently and/or over longer periods of time and/or intensively continue to have a higher risk for TB infection. Rapid diagnosis, prompt initiation of effective treatment, and adequate infection control measures are of particular importance to prevent infection. The present recommendations depict the essentials of infection control as well as specific measures in the hospital (isolation, criteria for its duration and technical requirements, types of respiratory protection, disinfection measures, waste disposal). The specific requirements for outpatients (medical practice), at home, for ambulance services, and in congregate settings, including prisons, are also addressed. Compared with the previous recommendations the pattern of respiratory protection measures has been simplified. As a rule, hospital staff and those visiting infectious tuberculosis patients are advised to wear respiratory protection that satisfies the criteria of FFP2-masks (DIN EN 149), while patients should wear mouth-nose protectors (surgical masks) in the presence of others and outside the isolation room. A detailed depiction of criteria for isolation and its duration in smear positive and only culturally confirmed pulmonary tuberculosis has been added.

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.

Workplace Protection of Air-Fed Visors Used in Paint Spraying Operations

Air-fed visors are commonly used for protection against exposure to airborne isocyanates during paint spraying. Protection levels for this class of equipment are theoretically adequate, yet isocyanate sensitization in this occupation still occurs. The work reported here set out to establish the level of respiratory protection that is achieved during real paint spraying activities when air-fed visors are used. The work also examined the effects of reduced air supply flow rates on this type of respiratory protection. The workplace study highlighted common problems that occur when attempting to measure protection factors, and process and interpret the collected data. Many of the environments included in this study did not exhibit challenge concentrations high enough to reliably measure the workplace protection factor of this class of device. When detection limits are taken into consideration, the remaining field data suggest that an assigned protection factor in the region of 40 may be appropriate. When well maintained and used in accordance with the manufacturer's instructions, air-fed visors are capable of providing a good level of respiratory protection. The protection given by air-fed visors is strongly dependent on the air flow supplied to them. Laboratory measurements demonstrate that protection falls as the air supply falls. This is a gradual process and does not suddenly occur at any particular air supply flow. Observations made during the field tests indicate that there may be other activities associated with the spraying process that need to be taken into consideration when looking for sources of respiratory sensitization.

Respiratory Symptoms and Physiologic Assessment of Ironworkers at the World Trade Center Disaster Site

To characterize respiratory abnormalities in a convenience sample of ironworkers exposed at the World Trade Center (WTC) disaster site for varying lengths of time between September 11, 2001, and February 8, 2002. Cross-sectional study. The Mount Sinai Medical Center, a large tertiary hospital. Ninety-six ironworkers engaged in rescue and recovery with exposure onset between September 11, 2001, and September 15, 2001, who responded to an invitation to undergo respiratory evaluation. Medical and exposure history, physical examination, spirometry, forced oscillation (FO), and chest radiographs. The relationships of prevalence of respiratory symptoms and presence of obstructive physiology to smoking, exposure on September 11, duration of exposure, and type of respiratory protection were examined using univariate and linear and logistic regression analyses. Seventy-four of 96 workers (77%) had one or more respiratory symptoms (similar in smokers [49 of 63 subjects, 78%] and nonsmokers [25 of 33 subjects, 76%]). Cough was the most common symptom (62 of 96 subjects, 65%), and was associated with exposure on September 11. Chest examination and radiograph findings were abnormal in 10 subjects (10%) and 19 subjects (20%), respectively. FO revealed dysfunction in 34 of 64 subjects tested (53%), while spirometry suggested obstruction in only 11 subjects (17%). Lack of a respirator with canister was a risk factor for large airway dysfunction, and cigarette smoking was a risk factor for small airway dysfunction. No other relationships reached statistical significance. Respiratory symptoms occurred in the majority of ironworkers at the WTC disaster site and were not attributable to smoking. Exposure on September 11 was associated with a greater prevalence of cough. Objective evidence of lung disease was less common. Spirometry underestimated the prevalence of lung function abnormalities in comparison to FO. Continuing evaluation of symptoms, chest radiographs, and airway dysfunction should determine whether long-term clinical sequelae will exist.

Hazardous materials preparedness in the emergency department

Introduction. This study was conducted to examine the preparedness of emergency departments (EDs) to safely receive, decontaminate, and treat chemically contaminated patients.Methods. The safety officers of all 58 acute-care hospitals in the five-county Philadelphia metropolitan region were surveyed by mail, with a repeat mailing to nonresponders followed by telephone contact. The 16 survey questions addressed the ability of EDs to safely decontaminate and treat chemically contaminated patients.Results. Thirty-eight of 58 hospitals (66%) returned usable surveys. Of these, 24 (63%) have a written plan for decontamination and treatment of chemically contaminated patients in the ED, and 19 (50%) have a hospital-wide disaster plan that includes contingencies for decontamination and treatment of one or more chemically contaminated patients. Thirteen hospitals (34%) conducted a drill of either of these plans in 1994. Twenty (53%) EDs have a specific treatment area for chemically contaminated patients. A stock of supplies for protecting the ED from secondary contamination is maintained by 16 (42%). While 24 (63%) store personal protective equipment, most of these involve only gowns, gloves, and surgical masks; only 13 provide any type of respiratory protection. Nine respondents were certain that patients brought in by local EMS would have been adequately decontaminated in the field, eight stated that they believed or felt decontamination would be adequate, and 12 were concerned that field decontamination might not be adequate. Eighteen hospitals (47%) reported treating one or more chemically contaminated patients in 1994. The authors believe the return rate reflects reluctance to commit hospital policies to paper. This was confirmed during telephone follow-up of nonrespondents when, for example, one safety officer discussed hazardous materials (hazmat) principles for 40 minutes, but refused to complete the survey.Conclusions. Hospital hazmat preparedness in this area varies tremendously. A significant proportion of hospitals lack a written plan and equipment to allow the ED to safely and effectively handle the chemically contaminated patient. There is reluctance to discuss this topic.

A survey of tuberculosis control programs in seventeen Minnesota hospitals: Implications for policy development

Background: Generation of proposed policies directed at interrupting the transmission of Mycobacterium tuberculosis resulted in a need for data establishing health care worker (HCW) tuberculosis (TB) transmission risk and control programs that were in place before 1992. Methods: A voluntary sample of 18 Minnesota health care facilities was surveyed retrospectively for the years 1989 to 1991. The survey was designed to establish the frequency of positive tuberculin skin test (TST) results, the rate of positive results during routine screening, the incidence of positive TST results identified through exposure follow-up, the type of respiratory protection (mask) used, and ventilation patterns of TB isolation rooms. The TST testing program, including name of product used, method of application, and reading/documentation behaviors, was requested. Results: Data were analyzed from 17 hospitals (one long-term facility was deleted). Three hospitals screened all HCWs annually; the remaining hospitals screened HCWs at varying intervals. Forty-eight positive TST results were identified in routine screening. The rate per 10,000 HCWs screened was 5.8 in 1989; 15.9 in 1990; and 14.8 in 1991. An upward trend was noted in positive TST results only in metropolitan teaching/public hospitals. Intercomparisons of TST screening data demonstrated that employees located in Greater Minnesota were more likely to have positive TST results than employees at facilities in the metropolitan area. Hospitals in Greater Minnesota were more likely than metropolitan area hospitals to use tuberculin skin test material. HCWs screened with tuberculin purified protein derivative were more likely to have positive test results than HCWs screened with tuberculin purified protein derivative. Unisolated patients with communicable TB accounted for 445 patient days of probable risk of exposure for HCWs, without demonstration of a trend by calendar year. There were a total of 33 exposure events. Ten of 1031 HCWs screened after an exposure event were declared to be TST positive, for an overall conversion rate of 9.7 per 1000 employees screened. All hospitals used surgical masks for respiratory protection. Seventy-six percent of the hospitals had isolation rooms with negative ventilation; 12% reported isolation rooms with neutral pressure. Conclusion: The practice in Minnesota hospitals surveyed was reasonably consistent with the critical elements defined in the 1990 CDC guidelines for an effective TB control program. The rate of positive TST results was low, with programs in place before 1992. Unified TST programs permitting evaluation of programs are endorsed. Respiratory protection should be protective, not excessive. Engineering controls of isolation rooms should be ensured. Policy development should be driven by the prevalence and incidence of disease in the HCW's place of employment.