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      Protocol of a prospective comprehensive evaluation of an elastic band beard cover for filtering facepiece respirators in healthcare

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          Abstract

          Individuals who are unable to be clean shaven for religious, medical or cultural reasons are unable to wear a filtering facepiece respirator (FFR), as the respirator cannot provide adequate protection against aerosol-transmissible diseases. There is currently a paucity of validated techniques to ensure the safe inclusion of bearded healthcare workers in the pandemic workforce. We propose to undertake a healthcare-based multi-modal evaluation study on the elastic band beard cover for FFR technique, examining the quantitative fit test (QNFT) results, usability and skill level of participants with repeated assessments over time. This is a prospective study conducted through the Respiratory Protection Program at the Royal Melbourne Hospital. Healthcare workers are invited to participate if they require respiratory protection and cannot shave for religious, cultural or medical reasons. An online education package on the use of respiratory protective equipment and the elastic band beard cover for FFR technique is provided. This is followed by a face-to-face session, where the participant will receive: one-on-one training; undergo a skill assessment on their donning, doffing and user seal check techniques; complete QNFTs and a usability survey. Participants will be invited to repeat the assessment within 3 months of the first session and at 12 months. This study involves multimodal and repeated assessments of an elastic band beard cover for FFRs. The findings of this study will provide information on: whether this simple technique can provide safe, consistent and effective respiratory protection; whether it will interfere with occupational activities; and whether it is comfortable and tolerable for the duration of wear. This is of significant importance to the health workforce around the world, who cannot shave but require access to respiratory protective equipment during the COVID-19 pandemic.

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          Practical Statistics for Medical Research

          DG ALTMAN, DG Altman, D. ALTMAN … (1991)
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            A close shave? Performance of P2/N95 respirators in health care workers with facial hair: results of the BEARDS (Adequate Respiratory DefenceS) study

            Indy Sandaradura, Emma Goeman, Giulietta Pontivivo … (2020)
            P2/N95 filtering face piece respirators (FFRs) protect healthcare workers (HCWs) from airborne infections. This study assessed the impact of facial hair on quantitative respirator fit in 105 male HCWs, of whom 38 were clean shaven, and assessed the prevalence of male facial hair at the study facility. Only 34 (32%) male HCWs overall achieved an adequate FFR fit, including 47% of clean-shaven men. No full-bearded HCWs achieved a fit. Adequate respirator fit decreased significantly with increasing facial hair (P<0.01 for trend). Facial hair was present on 49% of male employees. This study supports quantitative fit testing prior to P2/N95 respirator use.
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              Assessing the effect of beard hair lengths on face masks used as personal protective equipment during the COVID-19 pandemic

              Steven Prince, Hao Chen, Haiyan Tong … (2021)
              Background Globally, a large percentage of men keep a beard at least occasionally. Workplace regulations prohibit beards with N95 respirators, but there is little information on the effect of beards with face masks worn by the public for protection against SARS-CoV-2. Methods and findings We examined the fitted filtration efficiency (FFE) of five commonly worn protective face masks as a function of beard length following the US Occupational Safety and Health Administration Quantitative Fit Test: N95 (respirator), KF94 and KN95, surgical/procedure, and cloth masks. A comparison using N95 respirators was carried out in shaven and bearded men. A detailed examination was conducted for beard lengths between 0 and 10 mm (0.5 mm increments). The effect of an exercise band covering the beard on FFE was also tested. Although N95 respirators showed considerable variability among bearded men, they had the highest FFE for beard lengths up to 10 mm. KF94 and KN95 masks lost up to 40% of their FFE. Procedure and cotton masks had poor performance even on bare skin (10–30% FFE) that did not change appreciably with beard length. Marked performance improvements were observed with an exercise band worn over the beard. Conclusions Though variable, N95 respirators offer the best respiratory protection for bearded men. While KF94 and KN95 FFE is compromised considerably by increasing beard length, they proved better options than procedure and cotton face masks. A simple exercise band improves FFE for face masks commonly used by bearded men during the COVID-19 pandemic.
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                Author and article information

                Contributors
                Daryl Lindsay Williams:
                ORCID: https://orcid.org/0000-0002-6987-5804
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Benjamin Kave: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: ResourcesRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Charles Bodas:
                ORCID: https://orcid.org/0000-0002-6533-7646
                Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – review & editing
                Fiona Begg: Role: ConceptualizationRole: Data curationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – review & editing
                Megan Roberts: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – review & editing
                Irene Ng:
                ORCID: https://orcid.org/0000-0002-6632-5604
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Binson V A: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 31 January 2023
                Publication date Collection: 2023
                Volume: 18
                Issue: 1
                Electronic Location Identifier: e0281152
                Affiliations
                [1 ] Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Australia
                [2 ] Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
                [3 ] Respiratory Protection Program, Royal Melbourne Hospital, Parkville, Australia
                Saintgits College of Engineering, INDIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-6987-5804
                https://orcid.org/0000-0002-6533-7646
                https://orcid.org/0000-0002-6632-5604
                Article
                Publisher ID: PONE-D-22-13621
                DOI: 10.1371/journal.pone.0281152
                PMC ID: 9888701
                PubMed ID: 36719896
                SO-VID: 122cb4ee-f298-4f4d-8fab-dbe92c072f40
                Copyright © © 2023 Williams et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 17 May 2022
                Date accepted : 8 November 2022
                Page count
                Figures: 1, Tables: 0, Pages: 10
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100003747, Department of Health, State Government of Victoria;
                Award Recipient :
                ORCID: https://orcid.org/0000-0002-6987-5804
                This study is supported by the Australian Victorian State Government, who provides funding for the implementation of the Respiratory Protection Program, and ongoing education, training, evaluation and research in relation to respiratory protection equipment. The funder has no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Study Protocol
                Subject: Biology and Life Sciences
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Respirators
                Subject: Engineering and Technology
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Respirators
                Subject: Medicine and Health Sciences
                Subject: Medical Devices and Equipment
                Subject: Respirators
                Subject: People and Places
                Subject: Population Groupings
                Subject: Professions
                Subject: Medical Personnel
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Head
                Subject: Face
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Head
                Subject: Face
                Subject: Engineering and Technology
                Subject: Equipment
                Subject: Safety Equipment
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Subject: Safety
                Subject: Safety Equipment
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Head
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Head
                Subject: Social Sciences
                Subject: Anthropology
                Subject: Cultural Anthropology
                Subject: Religion
                Subject: Social Sciences
                Subject: Sociology
                Subject: Religion
                Subject: Social Sciences
                Subject: Sociology
                Subject: Culture
                Subject: Social Sciences
                Subject: Economics
                Subject: Labor Economics
                Subject: Employment
                Custom metadata
                Data Availability No datasets were generated or analysed in this study protocol. All the individual de-identified data that support the findings of this proposed study will be available upon request from the corresponding author. Data will be available immediately following publication of the result findings until five years after publication.

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                Data availability:
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