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      A Quantitative Assessment of the Total Inward Leakage of NaCl Aerosol Representing Submicron-Size Bioaerosol Through N95 Filtering Facepiece Respirators and Surgical Masks

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          Abstract

          Respiratory protection provided by a particulate respirator is a function of particle penetration through filter media and through faceseal leakage. Faceseal leakage largely contributes to the penetration of particles through a respirator and compromises protection. When faceseal leaks arise, filter penetration is assumed to be negligible. The contribution of filter penetration and faceseal leakage to total inward leakage (TIL) of submicron-size bioaerosols is not well studied. To address this issue, TIL values for two N95 filtering facepiece respirator (FFR) models and two surgical mask (SM) models sealed to a manikin were measured at 8 L and 40 L breathing minute volumes with different artificial leak sizes. TIL values for different size (20–800 nm, electrical mobility diameter) NaCl particles representing submicron-size bioaerosols were measured using a scanning mobility particle sizer. Efficiency of filtering devices was assessed by measuring the penetration against NaCl aerosol similar to the method used for NIOSH particulate filter certification. Results showed that the most penetrating particle size (MPPS) was ∼45 nm for both N95 FFR models and one of the two SM models, and ∼350 nm for the other SM model at sealed condition with no leaks as well as with different leak sizes. TIL values increased with increasing leak sizes and breathing minute volumes. Relatively, higher efficiency N95 and SM models showed lower TIL values. Filter efficiency of FFRs and SMs influenced the TIL at different flow rates and leak sizes. Overall, the data indicate that good fitting higher-efficiency FFRs may offer higher protection against submicron-size bioaerosols.

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          Most cited references28

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          Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial.

          Data about the effectiveness of the surgical mask compared with the N95 respirator for protecting health care workers against influenza are sparse. Given the likelihood that N95 respirators will be in short supply during a pandemic and not available in many countries, knowing the effectiveness of the surgical mask is of public health importance. To compare the surgical mask with the N95 respirator in protecting health care workers against influenza. Noninferiority randomized controlled trial of 446 nurses in emergency departments, medical units, and pediatric units in 8 tertiary care Ontario hospitals. Assignment to either a fit-tested N95 respirator or a surgical mask when providing care to patients with febrile respiratory illness during the 2008-2009 influenza season. The primary outcome was laboratory-confirmed influenza measured by polymerase chain reaction or a 4-fold rise in hemagglutinin titers. Effectiveness of the surgical mask was assessed as noninferiority of the surgical mask compared with the N95 respirator. The criterion for noninferiority was met if the lower limit of the 95% confidence interval (CI) for the reduction in incidence (N95 respirator minus surgical group) was greater than -9%. Between September 23, 2008, and December 8, 2008, 478 nurses were assessed for eligibility and 446 nurses were enrolled and randomly assigned the intervention; 225 were allocated to receive surgical masks and 221 to N95 respirators. Influenza infection occurred in 50 nurses (23.6%) in the surgical mask group and in 48 (22.9%) in the N95 respirator group (absolute risk difference, -0.73%; 95% CI, -8.8% to 7.3%; P = .86), the lower confidence limit being inside the noninferiority limit of -9%. Among nurses in Ontario tertiary care hospitals, use of a surgical mask compared with an N95 respirator resulted in noninferior rates of laboratory-confirmed influenza. clinicaltrials.gov Identifier: NCT00756574
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            Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS)

            Summary We did a case-control study in five Hong Kong hospitals, with 241 non-infected and 13 infected staff with documented exposures to 11 index patients with severe acute respiratory syndrome (SARS) during patient care. All participants were surveyed about use of mask, gloves, gowns, and hand-washing, as recommended under droplets and contact precautions when caring for index patients with SARS. 69 staff who reported use of all four measures were not infected, whereas all infected staff had omitted at least one measure (p=0·0224). Fewer staff who wore masks (p=0·0001), gowns (p=0·006), and washed their hands (p=0·047) became infected compared with those who didn't, but stepwise logistic regression was significant only for masks (p=0·011). Practice of droplets precaution and contact precaution is adequate in significantly reducing the risk of infection after exposures to patients with SARS. The protective role of the mask suggests that in hospitals, infection is transmitted by droplets.
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              Performance of N95 respirators: filtration efficiency for airborne microbial and inert particles.

              In 1995 the National Institute for Occupational Safety and Health issued new regulations for nonpowered particulate respirators (42 CFR Part 84). A new filter certification system also was created. Among the new particulate respirators that have entered the market, the N95 respirator is the most commonly used in industrial and health care environments. The filtration efficiencies of unloaded N95 particulate respirators have been compared with those of dust/mist (DM) and dust/fume/mist (DFM) respirators certified under the former regulations (30 CFR Part 11). Through laboratory tests with NaCl certification aerosols and measurements with particle-size spectrometers, N95 respirators were found to have higher filtration efficiencies than DM and DFM respirators and noncertified surgical masks. N95 respirators made by different companies were found to have different filtration efficiencies for the most penetrating particle size (0.1 to 0.3 micron), but all were at least 95% efficient at that size for NaCl particles. Above the most penetrating particle size the filtration efficiency increases with size; it reaches approximately 99.5% or higher at about 0.75 micron. Tests with bacteria of size and shape similar to Mycobacterium tuberculosis also showed filtration efficiencies of 99.5% or higher. Experimental data were used to calculate the aerosol mass concentrations inside the respirator when worn in representative work environments. The penetrated mass fractions, in the absence of face leakage, ranged from 0.02% for large particle distributions to 1.8% for submicrometer-size welding fumes. Thus, N95 respirators provide excellent protection against airborne particles when there is a good face seal.
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                Author and article information

                Journal
                J Occup Environ Hyg
                J Occup Environ Hyg
                UOEH
                uoeh20
                Journal of Occupational and Environmental Hygiene
                Taylor & Francis
                1545-9624
                1545-9632
                2014
                09 May 2014
                : 11
                : 6
                : 388-396
                Affiliations
                [1 ]National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , Pittsburgh, Pennsylvania
                [2 ]URS Corporation , Pittsburgh, Pennsylvania
                Author notes
                Address correspondence to: Samy Rengasamy, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory , 626 Cochrans Mill Road, P.O. Box 18070, Pittsburgh, PA, USA. e-mail: rda5@ 123456cdc.gov
                Article
                866715
                10.1080/15459624.2013.866715
                4589201
                24275016
                abdf5288-dc36-42ab-85bc-1d04def03aab
                © Copyright Taylor & Francis Group, LLC

                This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.

                History
                Page count
                Figures: 4, Tables: 2, References: 28, Pages: 9
                Categories
                Original Article

                faceseal leakage,filter penetration,n95 filtering facepiece respirator,nacl aerosol,surgical mask,total inward leakage

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