Fit evaluation of NIOSH approved N95 filtering facepiece respirators with various skin protectants: A pilot study.

Widespread disease outbreaks can result in prolonged wear times of National Institute for Occupational Safety and Health Approved N95 filtering facepiece respirators by healthcare personnel. Prolonged wear times of these devices can cause the development of various adverse facial skin conditions. Healthcare personnel have been reported to apply "skin protectants" to the face to reduce the pressure and friction of respirators. Because tight-fitting respirators rely on a good face seal to protect the wearer, it is important to understand if the fit is affected when skin protectants are used. This laboratory pilot study included 10 volunteers who performed quantitative fit tests to evaluate respirator fit while wearing skin protectants. Three N95 filtering facepiece respirator models and three skin protectants were evaluated. Three replicate fit tests were performed for each combination of subject, skin protectant (including a control condition of no protectant), and respirator model. Fit Factor (FF) was affected differently by the combination of the protectant type and respirator model. The main effects of the protectant type and respirator model were both significant (p < 0.001); additionally, their interaction was significant (p = 0.02), indicating FF is affected by the combined effects of the protectant type and respirator model. Compared to the control condition, using a bandage-type or surgical tape skin protectant decreased the odds of passing the fit test. Using a barrier cream skin protectant also decreased the odds of passing the fit test across all models compared to the control condition; however, the probability of passing a fit test was not statistically significantly different from the control condition (p = 0.174). These results imply that all three skin protectants reduced mean fit factors for all N95 filtering facepiece respirator models tested. The bandage-type and surgical tape skin protectants both reduced fit factors and passing rates to a greater degree than the barrier cream. Respirator users should follow respirator manufacturers' guidance on the use of skin protectants. If a skin protectant is to be worn with a tight-fitting respirator, the fit of the respirator should be evaluated with the skin protectant applied before use in the workplace.

Assessing the Fit of N95 Filtering Facepiece Respirators Fitted with an Ear Loop Strap System: A Pilot Study.

Throughout the COVID-19 pandemic, hundreds of millions of people worldwide have become new users of respiratory protective devices. Facemasks and KN95 respirators utilizing an ear loop straps system (ELSS) have recently become popular among occupational and non-occupational populations. Part of this popularity is due to the ease of wearability as compared with traditional devices utilizing two headbands, one worn over the head and the other behind the neck-a universal strap system used in NIOSH-certified N95 filtering facepiece respirators (FFRs). Some users convert the two-strap configuration to an adjustable ELSS. The first objective of this pilot study was to quantitatively characterize how such a conversion impacts the respirator fit. Additionally, a novel faceseal (NFS) technology, which has been previously demonstrated to enhance the fit of N95 FFRs, was deployed to modify the ELSS-converted N95 FFRs. The second objective of this study was to quantify the fit improvement that results from adding the NFS to the ELSS. The study was conducted by performing the Occupational Safety and Health Administration (OSHA)-approved quantitative fit testing (QNFT) on 16 human subjects featuring different facial shapes and dimensions. Three models of cup-shaped N95 FFRs were tested in three versions: the standard version with manufacturer's strap system, the ELSS-converted, and the ELSS-converted version modified by adding the NFS. QNFT demonstrated that the fit of an N95 FFR featuring the traditional/standard headbands strap system is negatively impacted when this system is converted to an ELSS. The fit of an ELSS-converted respirator can be significantly improved by the addition of the NFS. We found that the FFR model and the strap system version are significant factors affecting the QNFT-determined respirator fit factor (FF), as well as the OSHA QNFT pass rate (FF ≥100). The findings suggest that the current NFS, if further improved, has a potential for developing a 'universally fitting' ELSS-equipped N95 FFR that can be used by the general public, the vast majority of whom do not have access to OSHA fit requirements.

Technical note: Impact of face covering on aerosol transport patterns during coughing and sneezing.

COVID-19 is spread via different routes, including virus-laden airborne particles generated by human respiratory activities. In addition to large droplets, coughing and sneezing produce a lot of small aerosol particles. While face coverings are believed to reduce the aerosol transmission, information about their outward effectiveness is limited. Here, we determined the aerosol concentration patterns around a coughing and sneezing manikin and established spatial zones representing specific elevations of the aerosol concentration relative to the background. Real-time measurements of sub-micrometer aerosol particles were performed in the vicinity of the manikin. The tests were carried out without any face covering and with three different types of face covers: a safety faceshield, low-efficiency facemask and high-efficiency surgical mask. With no face covering, the simulated coughing and sneezing created a powerful forward-propagating fine aerosol flow. At 6 ft forward from the manikin head, the aerosol concentration was still 20-fold above the background. Adding a face covering reconfigured the forward-directed aerosol transmission pattern. The tested face coverings were found capable of mitigating the risk of coronavirus transmission; their effectiveness is dependent on the protective device. The outward leakage associated with a specific face covering was shown to be a major determinant of the exposure level for a person standing or seating next to or behind the coughing or sneezing "spreader" in a bus/train/aircraft/auditorium setting. Along with reports recently published in the literature, the study findings help assess the infectious dose and ultimately health risk for persons located within a 6-ft radius around the "spreader."

Evaluation of AccuFIT 9000: A Novel Apparatus for Quantitative Fit Testing of Particulate Respirators.

Various strategies developed for protecting frontline workers and the general public from the novel coronavirus, SARS-CoV-2, largely rely on respiratory protective devices (RPDs), especially considering recent evidence about the aerosol transmission route of COVID-19. Performance of an RPD primarily depends on how well the protective device fits the wearer. Therefore, quantitative fit testing of particulate respirators is crucial for achieving the intended protection level. Millions of fit tests are conducted every year using a US OSHA-accepted standard protocol involving a PortaCount® (TSI Inc., Shoreview, MN, USA) which measures a respirator fit factor. Recently, several alternative fit testing instruments have been developed and introduced to the market. Among them is an AccuFIT 9000 (Kanomax-Japan Inc., Suita-city, Osaka, Japan), which, like the PortaCount®, utilizes the condensation particle counting principle, but features an advanced saturation chamber design allowing for a longer residence time and greater flow stability. It is also claimed to have a more cost-efficient assembly than its predecessors. In this study, the novel AccuFIT apparatus was extensively evaluated against the PortaCount® (the reference instrument) using the traditional standard fit testing protocol and following the American National Standards Institute (ANSI) standard (Z88.10-2010 Annex A2). The evaluation was performed with three types of respirators, N95 filtering facepiece respirator (FFR), P100 FFR, and half-mask elastomeric facepiece, of different models and manufacturers donned on 25 subjects. The comparative testing and analysis showed that the AccuFIT 9000 is capable of identifying an inadequate fit of the tested respirators with a sensitivity 0.95 and specificity of 0.97, which meets the ANSI requirement of ≥0.95. The other ANSI requirements/recommendations were also met. It was concluded that the novel fit testing apparatus demonstrated an acceptable performance and, thus, can be successfully deployed for the quantitative respirator fit testing.

New respirator performance monitor (RePM) for powered air-purifying respirators.

Powered air-purifying respirators (PAPRs) that offer protection from particulates are deployed in different workplace environments. Usage of PAPRs by healthcare workers is rapidly increasing; these respirators are often considered the best option in healthcare settings, particularly during public health emergency situations, such as outbreaks of pandemic diseases. At the same time, lack of user training and certain vigorous work activities may lead to a decrease in a respirator's performance. There is a critical need for real-time performance monitoring of respiratory protective devices, including PAPRs. In this effort, a new robust and low-cost real-time performance monitor (RePM) capable of evaluating the protection offered by a PAPR against aerosol particles at a workplace was developed. The new device was evaluated on a manikin and on human subjects against a pair of condensation nuclei counters (P-Trak) used as the reference protection measurement system. The outcome was expressed as a manikin-based protection factor (mPF) and a Simulated Workplace Protection Factor (SWPF) determined while testing on subjects. For the manikin-based testing, the data points collected by the two methods were plotted against each other; a near-perfect correlation was observed with a correlation coefficient of 0.997. This high correlation is particularly remarkable since RePM and condensation particle counter (CPC) measure in different particle size ranges. The data variability increased with increasing mPF. The evaluation on human subjects demonstrated that RePM prototype provided an excellent Sensitivity (96.3% measured on human subjects at a response time of 60 sec) and a Specificity of 100%. The device is believed to be the first of its kind to quantitatively monitor PAPR performance while the wearer is working; it is small, lightweight, and does not interfere with job functions.

Estimated dermal exposure to nebulized pharmaceuticals for a simulated home healthcare worker scenario.

The duties of home healthcare workers are extensive. One important task that is frequently performed by home healthcare workers is administration of nebulized medications, which may lead to significant dermal exposure. In this simulation study conducted in an aerosol exposure chamber, we administered a surrogate of nebulizer-delivered medications (dispersed sodium chloride, NaCl) to a patient mannequin. We measured the amount of NaCl deposited on the exposed surface of the home healthcare worker mannequin, which represented the exposed skin of a home healthcare worker. Factors such as distance and position of the home healthcare worker, room airflow rate and patient's inspiratory rate were varied to determine their effects on dermal exposure. There was a 2.78% reduction in dermal deposition for every centimeter the home healthcare worker moved away from the patient. Increasing the room's air exchange rate by one air change per hour increased dermal deposition by about 2.93%, possibly due to a decrease in near field particle settling. For every 10-degrees of arc the home healthcare worker is positioned from the left side of the patient toward the right and thus moving into the ventilation airflow direction, dermal deposition increased by about 4.61%. An increase in the patient's inspiratory rate from 15-30 L/min resulted in an average of 14.06% reduction in dermal deposition for the home healthcare worker, reflecting a relative increase in the aerosol fraction inhaled by the patient. The findings of this study elucidate the interactions among factors that contribute to dermal exposure to aerosolized pharmaceuticals administered by home healthcare workers. The results presented in this paper will help develop recommendations on mitigating the health risks related to dermal exposure of home healthcare workers.

Predicting Indoor Concentrations of Black Carbon in Residential Environments.

Black carbon (BC) is a descriptive term that refers to light-absorbing particulate matter (PM) produced by incomplete combustion and is often used as a surrogate for traffic-related air pollution. Exposure to BC has been linked to adverse health effects. Penetration of ambient BC is typically the primary source of indoor BC in the developed world. Other sources of indoor BC include biomass and kerosene stoves, lit candles, and charring food during cooking. Home characteristics can influence the levels of indoor BC. As people spend most of their time indoors, human exposure to BC can be associated to a large extent with indoor environments. At the same time, due to the cost of environmental monitoring, it is often not feasible to directly measure BC inside multiple individual homes in large-scale population-based studies. Thus, a predictive model for indoor BC is needed to support risk assessment in public health. In this study, home characteristics and occupant activities that potentially modify indoor levels of BC were documented in 23 homes, and indoor and outdoor BC concentrations were measured twice. The homes were located in the Cincinnati-Kentucky-Indiana tristate region and measurements occurred from September 2015 through August 2017. A linear mixed-effect model was developed to predict BC concentration in residential environments. The measured outdoor BC concentrations and the documented home characteristics were utilized as predictors of indoor BC concentrations. After the model was developed, a leave-one-out cross-validation algorithm was deployed to assess the predictive accuracy of the output. The following home characteristics and occupant activities significantly modified the concentration of indoor BC: outdoor BC, lit candles and electrostatic or high efficiency particulate air (HEPA) filters in heating, ventilation and air conditioning (HVAC) systems. Predicted indoor BC concentrations explained 78% of the variability in the measured indoor BC concentrations. The data show that outdoor BC combined with home characteristics can be used to predict indoor BC levels with reasonable accuracy.

Inactivation of bacterial and fungal spores by UV irradiation and gaseous iodine treatment applied to air handling filters.

Exposure to viable bacterial and fungal spores re-aerosolized from air handling filters may create a major health risk. Assessing and controlling this exposure have been of interest to the bio-defense and indoor air quality communities. Methods are being developed for inactivating stress-resistant viable microorganisms collected on ventilation filters. Here we investigated the inactivation of spores of Bacillus thuringiensis var. kurstaki (Btk), a recognized simulant for B. antracis, and Aspergillus fumigatus, a common opportunistic pathogen used as an indicator for indoor air quality. The viability change was measured on filters treated with ultraviolet (UV) irradiation and gaseous iodine. The spores were collected on high-efficiency particulate air (HEPA) and non-HEPA filters, both flattened for testing purposes to represent "surface" filters. A mixed cellulose ester (MCE) membrane filter was also tested as a reference. Additionally, a commercial HEPA unit with a deep-bed (non-flattened) filter was tested. Combined treatments of Btk spores with UV and iodine on MCE filter produced a synergistic inactivation effect. No similar synergy was observed for A. fumigatus. For spores collected on an MCE filter, the inactivation effect was about an order of magnitude greater for Btk compared to A. fumigatus. The filter type was found to be an important factor affecting the inactivation of Btk spores while it was not as influential for A. fumigatus. Overall, the combined effect of UV irradiation and gaseous iodine on viable bacterial and fungal spores collected on flat filters was found to be potent. The benefit of either simultaneous or sequential treatment was much lower for Btk spores embedded inside the deep-bed (non-flattened) HEPA filter, but for A. fumigatus the inactivation on flattened and non-flattened HEPA filters was comparable. For both species, applying UV first and gaseous iodine second produced significantly higher inactivation than when applying them simultaneously or in an opposite sequence.

Effectiveness of a portable air cleaner in removing aerosol particles in homes close to highways.

Outdoor traffic-related airborne particles can infiltrate a building and adversely affect the indoor air quality. Limited information is available on the effectiveness of high efficiency particulate air (HEPA) filtration of traffic-related particles. Here, we investigated the effectiveness of portable HEPA air cleaners in reducing indoor concentrations of traffic-related and other aerosols, including black carbon (BC), PM2.5 , ultraviolet absorbing particulate matter (UVPM) (a marker of tobacco smoke), and fungal spores. This intervention study consisted of a placebo-controlled cross-over design, in which a HEPA cleaner and a placebo "dummy" were placed in homes for 4-weeks each, with 48-hour air sampling conducted prior to and during the end of each treatment period. The concentrations measured for BC, PM2.5 , UVPM, and fungal spores were significantly reduced following HEPA filtration, but not following the dummy period. The indoor fraction of BC/PM2.5 was significantly reduced due to the HEPA cleaner, indicating that black carbon was particularly impacted by HEPA filtration. This study demonstrates that HEPA air purification can result in a significant reduction of traffic-related and other aerosols in diverse residential settings.

Performance of a novel real-time respirator seal integrity monitor on firefighters: Simulated workplace pilot study.

Millions of workers, including firefighters, use respiratory protective device. The key aspect in assuring the intended protection level of a respirator is its fit. However, even if the respirator originally fits well, the faceseal may be breached during its use. Until now, there have been no practically viable, inexpensive means to monitor the performance of a respirator during actual use. A novel Respirator Seal Integrity Monitor (ReSIM) was developed and recently evaluated on manikins by our team. The objective of this study was to evaluate the ReSIM effectiveness on respirator-wearing firefighters exposed to aerosols while performing simulated routine operational activities. Initially, 15 subjects were recruited for the study. Following a preliminary investigation that resulted in modifications in the ReSIM prototype and testing protocol, a subset of nine firefighters was chosen for a full-scale evaluation. The testing was conducted in a 24.3-m3 exposure chamber using NaCl as the challenge aerosol. Controlled faceseal leaks were established by opening a solenoid valve for 10, 15, or 20 sec. Leaks were also established as the tested firefighter slightly repositioned the respirator on his/her face. During the testing, the ReSIM measured particles inside a full-face elastomeric respirator with a 72.7% leak detection sensitivity (probability of correct leak identification) and an 84.2% specificity (probability of correct identification of the intervals which are absent of any leak). After adjusting for false negatives and persistent false positives, sensitivity and specificity increased to 83.6% and 92.2%, respectively. The factors causing minor limitations in leak detection sensitivity and specificity can be attributed to variability among subjects, moisture's effect on the particle sensor, and some in-mask sampling bias. In conclusion, the ReSIM can promptly detect the breach in a respirator faceseal with high sensitivity and specificity. Due to its capability to alert the wearer of possible overexposure to hazardous aerosols, the ReSIM concept has a remarkable potential to be applied in various working environments, where respirators are used.

Laboratory Evaluation of a Novel Real-Time Respirator Seal Integrity Monitor.

Background: A low-cost real-time Respirator Seal Integrity Monitor (ReSIM) was recently developed to monitor a respirator's actual performance at a workplace. The objective of this study was to evaluate the capability of the new ReSIM prototype in manikin-based laboratory experiments to rapidly detect induced leakage of a half-mask elastomeric respirator. Methods: Two phases of testing were conducted in this study. First, the accuracy of ReSIM measuring an aerosol concentration was assessed by comparing the outputs of ReSIM against a reference optical aerosol spectrometer (OAS) in a flow-through set-up. Second, the capability to detect a leak was tested using a manikin-based set-up to simulate leaks into a functional respirator. Results: The regression curve of ReSIM versus OAS had an R2 of 0.936, indicating its high accuracy within the targeted particle size range of 0.5-2 µm. The ReSIM provided a leak detection sensitivity (probability of correctly identifying intervals with the true leak) of 98.4% when challenged with a combustion aerosol, compared to 71.8% when challenged with a NaCl aerosol. Its specificity (probability of identifying intervals without a leak) was 99.8% after adjusting for persistent false positives for both types of challenge aerosol. Conclusion: The ReSIM prototype not only can estimate the particle concentration with high accuracy but also can rapidly detect respirator faceseal leakage in real time with sufficient sensitivity and specificity. In addition, it can trigger an alarm when the faceseal integrity is compromised.

Surgical Smoke Simulation Study: Physical Characterization and Respiratory Protection.

Exposure of operating room (OR) personnel to surgical smoke, a unique aerosol generated from the common use of electrocautery during surgical procedures, is an increasing health risk concern. The main objective of this simulation study was to characterize the surgical smoke exposure in terms of the particle number concentration and size distribution in a human breathing zone. Additionally, the performance of respiratory protective devices designed for ORs was examined using two commercially available N95 facepiece filtering respirators (FFRs) as well as the same FFRs modified with new faceseal technology. The tests were conducted in an OR-simulating exposure chamber with the surgical smoke generated by electrocautery equipment applied to animal tissue and measured in the breathing zone with four aerosol spectrometers. The simulated workplace protection factor of each tested respirator was determined for ten subjects by measuring the total aerosol concentrations inside and outside of a respirator. The peak of the particle size distribution was in a range of 60-150 nm. The concentration of particles generated during the simulated surgical procedure significantly exceeded the background concentration under all tested air exchange conditions. The data suggest that wearing N95 filtering facepiece respirators significantly decreased the human exposure to surgical smoke. The new faceseal technology provided significantly higher respiratory protection than the commercial N95 FFRs.

Performance of two respiratory protective devices used by home-attending health care workers (a pilot study).

OBJECTIVES: This pilot study aimed at determining the Workplace Protection Factor (WPF) for respiratory protective devices widely used by health care workers to reduce exposure to potentially hazardous aerosols when attending patients in their homes. Two devices were tested, an N95 filtering facepiece respirator (FFR) and a surgical mask (SM). METHODS: Three home-attending health care workers were recruited, medically cleared and fit tested. At the workplace, the aerosol concentrations outside (Cout) and inside (Cin) of the tested respiratory protective device worn by a subject were measured using two simultaneously operating P-Trak condensation particle counters within the particle size range of approximately 20-1,000 nm. Real-time and integrated (time-weighted average, TWA) values of WPF = Cout/Cin were determined. RESULTS: This pilot study demonstrated that the WPF of the tested N95 FFR consistently exceeded that of the SM. The WPFTWA(C) values calculated for the entire test time (based on the TWA aerosol concentration values) ranged from 29 to 40 and 2 to 9, respectively. In all cases, the N95 FFR provided protection above the Occupational Safety and Health Administration's (OSHA) assigned protection factor of 10, whereas the SM often offered little or essentially no protection against the measured sub-micrometer aerosol particles. For both devices, the protection level was found to depend on activity. For example, the WPFTWA(C) for one subject wearing the N95 FFR was 56 during normal activity but fell almost 70% during tracheal suctioning. It is explicable considering that different procedures implemented by health care workers in homes generate particles of different sizes and require different body movements; both factors are anticipated to affect the WPF. CONCLUSIONS: Wearing an N95-certified respirator helps significantly reduce the aerosol inhalation exposure of home-attending health care workers. An SM offers much lower protection. The WPF depends on several factors, including, but not limited to, the health care worker's activity and/or body movements; the WPF varies from one worker to another.

Evaluation of personal inhalable aerosol samplers with different filters for use during anthrax responses.

Risk of inhalation exposure to viable Bacillus anthracis (B. anthracis) spores has primarily been assessed using short-term, stationary sampling methods which may not accurately characterize the concentration of inhalable-sized spores reaching a person's breathing zone. While a variety of aerosol sampling methods have been utilized during previous anthrax responses, no consensus has yet been established for personal air sampling. The goal of this study was to determine the best sampler-filter combination(s) for the collection and extraction of B. anthracis spores. The study was designed to (1) evaluate the performance of four filter types (one mixed cellulose ester, MCE (pore size = 3 µm), two polytetrafluoroethylene, PTFE (1 and 3 µm), and one polycarbonate, PC (3 µm)); and (2) evaluate the best performing filters in two commercially available inhalable aerosol samplers (IOM and Button). Bacillus thuringiensis kurstaki [Bt(k)], a simulant for B. anthracis, served as the aerosol challenge. The filters were assessed based on criteria such as ability to maintain low pressure drop over an extended sampling period, filter integrity under various environmental conditions, spore collection and extraction efficiencies, ease of loading and unloading the filters into the samplers, cost, and availability. Three of the four tested collection filters-except MCE-were found suitable for efficient collection and recovery of Bt(k) spores sampled from dry and humid as well as dusty and clean air environments for up to 8 hr. The PC (3 µm) filter was identified as the best performing filter in this study. The PTFE (3 µm) demonstrated a comparable performance, but it is more expensive. Slightly higher concentrations were measured with the IOM inhalable sampler which is the preferred sampler's performance criterion when detecting a highly pathogenic agent with no established "safe" inhalation exposure level. Additional studies are needed to address the effects of environmental conditions and spore concentration. The data obtained in this investigation are crucial for future efforts on the development and optimization of a method for assessing inhalation exposure to B. anthracis.

Performance of N95 FFRs Against Combustion and NaCl Aerosols in Dry and Moderately Humid Air: Manikin-based Study.

OBJECTIVES: The first objective of this study was to evaluate the penetration of particles generated from combustion of plastic through National Institute for Occupational Safety and Health (NIOSH)-certified N95 filtering facepiece respirators (FFRs) using a manikin-based protocol and compare the data to the penetration of NaCl particles. The second objective was to investigate the effect of relative humidity (RH) on the filtration performance of N95 FFRs. METHODS: Two NIOSH-certified N95 FFRs (A and B) were fully sealed on a manikin headform and challenged with particles generated by combustion of plastic and NaCl particles. The tests were performed using two cyclic flows [with mean inspiratory flow (MIF) rates = 30 and 85 l min(-1), representing human breathing under low and moderate workload conditions] and two RH levels (≈20 and ≈80%, representing dry and moderately humid air). The total and size-specific particle concentrations inside (C in) and outside (C out) of the respirators were measured with a condensation particle counter and an aerosol size spectrometer. The penetration values (C in/C out) were calculated after each test. RESULTS: The challenge aerosol, RH, MIF rate, and respirator type had significant (P < 0.05) effects on the performance of the manikin-sealed FFR. Its efficiency significantly decreased when the FFR was tested with plastic combustion particles compared to NaCl aerosols. For example, at RH ≈80% and MIF = 85 l min(-1), as much as 7.03 and 8.61% of combustion particles penetrated N95 respirators A and B, respectively. The plastic combustion particles and gaseous compounds generated by combustion likely degraded the electric charges on fibers, which increased the particle penetration. Increasing breathing flow rate or humidity increased the penetration (reduced the respirator efficiency) for all tested aerosols. The effect of particle size on the penetration varied depending on the challenge aerosol and respirator type. It was observed that the peak of the size distribution of combustion particles almost coincided with their most penetrating particle size, which was not the case for NaCl particles. This finding was utilized for the data interpretation. CONCLUSIONS: N95 FFRs have lower filter efficiency when challenged with contaminant particles generated by combustion, particularly when used under high humidity conditions compared to NaCl particles.

Performance of Facepiece Respirators and Surgical Masks Against Surgical Smoke: Simulated Workplace Protection Factor Study.

OBJECTIVE: 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. METHODS: Ten subjects were recruited to perform surgical dissections on animal tissue in a simulated OR chamber, using a standard electrocautery device, generating surgical smoke. Six respiratory protective devices (RPDs) were tested: two SMs, two SMRs, and two N100 FFRs [including a newly developed faceseal (FS) prototype]. Fit testing was conducted before the experiment. Each subject was then exposed to the surgical smoke while wearing an RPD under the tests. Concentrations inside (C in) and outside (C out) of the RPD were measured by a particle size spectrometer. The simulated workplace protection factor (SWPF) was determined by the ratio of C out and C in for each RPD-wearing subject. RESULTS: For the SMs, the geometric means of SWPFtotal (based on the total aerosol concentration) were 1.49 and 1.76, indicating minimal protection. The SWPFtotal values of the SMRs and N100 FFRs were significantly higher than those of the SMs: for the two SMRs, the SWPFtotal were 208 and 263; for the two N100s, the SWPFtotal values were 1,089 and 2,199. No significant difference was observed between either the two SMs or the two SMRs. The SWPFtotal for the novel FS prototype N100 FFR was significantly higher than the conventional N100 FFR. The correlation between SWPFtotal and fit factor (FF) determined for two N95 SMRs was not significant. CONCLUSIONS: SMs do not provide measurable protection against surgical smoke. SMRs offer considerably improved protection versus SMs, while the N100 FFRs showed significant improvement over the SMRs. The FS prototype offered a higher level of protection than the standard N100 FFR, due to a tighter seal. While we acknowledge that conventional N100 FFRs (equipped with exhalation valves) are not practical for human OR use, the results obtained with the FS prototype demonstrate the potential of the new FS technology for implementation on various types of respirators.

Culturability of Bacillus spores on aerosol collection filters exposed to airborne combustion products of Al, Mg, and B·Ti.

Destruction of bioweapon facilities due to explosion or fire could aerosolize highly pathogenic microorganisms. The post-event air quality assessment is conducted through air sampling. A bioaerosol sample (often collected on a filter for further culture-based analysis) also contains combustion products, which may influence the microbial culturability and, thus, impact the outcome. We have examined the interaction between spores deposited on collection filters using two simulants of Bacillus anthracis [B. thuringiensis (Bt) and B. atrophaeus (referred to as BG)] and incoming combustion products of Al as well as Mg and B·Ti (common ingredient of metalized explosives). Spores extracted from Teflon, polycarbonate, mixed cellulose ester (MCE), and gelatin filters (most common filter media for bioaerosol sampling), which were exposed to combustion products during a short-term sampling, were analyzed by cultivation. Surprisingly, we observed that aluminum combustion products enhanced the culturability of Bt (but not BG) spores on Teflon filters increasing the culturable count by more than an order of magnitude. Testing polycarbonate and MCE filter materials also revealed a moderate increase of culturability although gelatin did not. No effect was observed with either of the two species interacting on either filter media with products originated by combustion of Mg and B·Ti. Sample contamination, spore agglomeration, effect of a filter material on the spore survival, changes in the spore wall ultrastructure and germination, as well as other factors were explored to interpret the findings. The study raises a question about the reliability of certain filter materials for collecting airborne bio-threat agents in combustion environments.

Performance of an improperly sized and stretched-out loose-fitting powered air-purifying respirator: Manikin-based study.

The objective of this study was to investigate the protection level offered by a Powered Air-Purifying Respirator (PAPR) equipped with an improperly sized or stretched-out loose-fitting facepiece using constant and cyclic flow conditions. Improperly sized PAPR facepieces of two models as well as a stretched-out facepiece were tested. These facepieces were examined in two versions: with and without exhaust holes. Loose-fitting facepieces (size "large") were donned on a small manikin headform and challenged with sodium chloride (NaCl) aerosol particles in an exposure chamber. Four cyclic flows with mean inspiratory flows (MIFs) of 30, 55, 85, and 135 L/min were applied using an electromechanical Breathing Recording and Simulation System (BRSS). The manikin Fit Factor (mFF) was determined as the ratio of aerosol concentrations outside (Cout) to inside (Cin) of the facepiece, measured with a P-Trak condensation particle counter (CPC). Results showed that the mFF decreased exponentially with increasing MIF. The mFF values of the stretched-out facepiece were significantly lower than those obtained for the undamaged ones. Facepiece type and MIF were found to significantly affect the performance of the loose-fitting PAPR. The effect of the exhaust holes was less pronounced and depended on the facepiece type. It was concluded that an improperly sized facepiece might potentially offer relatively low protection (mFF < 250) at high to strenuous workloads. The testing was also performed at a constant inhalation flow to explore the mechanism of the particle-facepiece interaction. Results obtained with cyclic flow pattern were consistent with the data generated when testing the loose-fitting PAPR under constant flow conditions. The time-weighted average values of mFF calculated from the measurements conducted under the constant flow regime were capable of predicting the protection under cyclic flow regime. The findings suggest that program administrators need to equip employees with properly sized facepieces and remove stretched-out ones from workplace. Manufacturers should emphasize the importance of proper sizing with their user instructions.

Penetration of Combustion Aerosol Particles Through Filters of NIOSH-Certified Filtering Facepiece Respirators (FFRs).

Filtering facepiece respirators (FFRs) are commonly worn by first responders, first receivers, and other exposed groups to protect against exposure to airborne particles, including those originated by combustion. Most of these FFRs are NIOSH-certified (e.g., N95-type) based on the performance testing of their filters against charge-equilibrated aerosol challenges, e.g., NaCl. However, it has not been examined if the filtration data obtained with the NaCl-challenged FFR filters adequately represent the protection against real aerosol hazards such as combustion particles. A filter sample of N95 FFR mounted on a specially designed holder was challenged with NaCl particles and three combustion aerosols generated in a test chamber by burning wood, paper, and plastic. The concentrations upstream (Cup) and downstream (Cdown) of the filter were measured with a TSI P-Trak condensation particle counter and a Grimm Nanocheck particle spectrometer. Penetration was determined as (Cdown/Cup) ×100%. Four test conditions were chosen to represent inhalation flows of 15, 30, 55, and 85 L/min. Results showed that the penetration values of combustion particles were significantly higher than those of the "model" NaCl particles (p < 0.05), raising a concern about applicability of the N95 filters performance obtained with the NaCl aerosol challenge to protection against combustion particles. Aerosol type, inhalation flow rate and particle size were significant (p < 0.05) factors affecting the performance of the N95 FFR filter. In contrast to N95 filters, the penetration of combustion particles through R95 and P95 FFR filters (were tested in addition to N95) were not significantly higher than that obtained with NaCl particles. The findings were attributed to several effects, including the degradation of an N95 filter due to hydrophobic organic components generated into the air by combustion. Their interaction with fibers is anticipated to be similar to those involving "oily" particles. The findings of this study suggest that the efficiency of N95 respirator filters obtained with the NaCl aerosol challenge may not accurately predict (and rather overestimate) the filter efficiency against combustion particles.

Protection of firefighters against combustion aerosol particles: simulated workplace protection factor of a half-mask respirator (pilot study).

The present pilot study investigated the penetration of ultrafine particles originated by combustion of different materials into elastomeric half-mask respirators equipped with two P100 filters. We determined the Simulated Workplace Protection Factor (SWPF) for 11 firefighters wearing elastomeric half-mask respirators and performing activities simulating those conducted during fire overhaul operations. The tests were performed in a controlled laboratory setting. A newly-developed battery-operated Portable Aerosol Mobility Spectrometer (PAMS) was used to measure size-resolved aerosol particle concentrations outside (C(out)) and inside (Cin) of an air-purifying respirator donned on a firefighter, and the SWPF was calculated as C(out)/C(in). Based on the total aerosol concentration, the "total" SWPF ranged from 4,222 (minimum) to 35,534 (maximum) with values falling primarily in a range from 11,171 (25 percentile) to 26,604 (75 percentile) and a median value being ≈15,000. This is consistent with the recently reported fit factor (FF) data base.((1)) The size-resolved SWPF data revealed a dependency on the particle size. It was concluded that a portable device such as PAMS can be used on firefighters during overhaul operations (as well as on other workers wearing elastomeric half-mask respirators) to monitor the aerosol concentrations in real time and ultimately help prevent overexposure.