Masks

Do A Task , Wear A Mask
On , Smile On !

DR. MANOJ GUMBER

• MD,DM

• FORMER PROFESSOR IKDRC

• SENIOR CONSULTANT NEPHROLOGIST AND TRANSPLANTPHYSICIAN APOLLO HOSPITAL INTL LTD , AHMEDABAD

Hon. Consultant –IIM Ahmedabad Hon. Consultant- Sola Civil Ahmedabad

Ph. : 9879511234 Email ID : manojrgumber@gmail.com

OVERVIEW

• Why Still We Need To Take Precautions ?

• Why and which mask to Wear ?

• The different masks, with a difference for different professions

• Which mask a health care professional (HCP) should wear ?

• Does shape of the respirator matter?

• Are homemade mask effective?

• Masketiquette

• Disposalofmasks

AFTER LOCKDOWN
Can we go back to our normal life and do routine activities ?

Corona infection

will continue to be an issue for six months to one year approximately

AFTER LOCKDOWN Can we go back to our NEW normal life and do necessary activities ?

After We Learn To Live & Work

With Corona Around Us !

YOU and ME are all SURROUNDED BY CORONA VIRUS

The Margin Of Error Is Very Narrow

“ All preventive and protective measure should be taken to minimize any kind of risk ”

Why To Wear A Mask ?

Size Of The Virus, Droplet And Aerosol

Aerosol size < 10microns

Size of the virus .06-0.14 micron

How Does It Spread?

• Person to Person through respiratory droplets (most common)

• Person Surface Hands Another Person

• Aerosol transmission:
– Mostly During certain hospital procedures

-Doing forcefulbreathingexercises -Speaking while eating -Guffaw-loud and hearty laugh

Why To Wear A Mask Even After Maintaining Social Distance Of 2 Meters?

Why Health Care Professionals (HCP) Should Be Wary Of Aerosols

Aerosol Generated During :

• Endotracheal Intubation & Extubation

• BIPAP

• Bronchoscopy

• Upper GI scopy

• Loud laugh

• Speaking while eating

• Forceful breathing exercises

The variety of Masks

Respirators

▪ Respirators are tight fitting masks, designed to create a facial seal.

▪ Non-valved respirators provide good two way protection, by filtering both inflow and outflow of air.

▪ These are designed protect the wearer (when worn properly), up to the safety rating of the mask.

▪ Available as disposable, half face or full face.

N95

Types Of Respirators

Disposable N 95
For HCP to use Only & Only HCP should use Only & Only HCP should use

Half Face Full Face

Mask Standards

• American standard-N95 by NIOSH

• Europe uses two different standards. 1)“filtering face piece” (FFP) score
FFP1,FFP2 & FFP3 2 )P1/P2/P3 ratings
• Chinese standard-KN95

Respirator Standard Filter Capacity

• This indicates the removal/filter of x% of all particles that are 0.3 microns in diameter or larger by the masks/respirator

• Higher the %, better the efficacy of the mask

Comparison Of Different Standards

KN95 = N95/FFP2

How Big Is The Corona Virus ?

The corona virus ranges from between 0.06 and 0.14 microns in size

How Big Is The Corona Virus & Can Respirators Filter It?

• N95/FFP2 or better Respirators are with high efficiency at 0.3 micron filter particles and the size of the corona virus is around 0.1 microns

• Two studies mentioned below were done to determine the efficacy against 0.1 micron & 0.007 micron size particles
3M research
• All N95 respirators efficiently filter lower than 0.1 micron size with approximately 94% efficiency or higher
Smartfilters.com research

• • •

The respirators tested could filter down to 0.007 microns (much smaller than Covid-19)

The 3M 8812 respirator (FFP1 rated) was able to filter 96.6% of particles 0.007 microns or larger.

FFP2 or FFP3 would achieve even greater filtration

Are N100/P3 respirators actually better than N95/ FFP2?

• Notnecessarily

• •

It’s important to note that these standards only specify the minimum % of particles that the respirator filters

If a mask is FFP2 rated, it will filter at least 94% of particles that are 0.3 microns in diameter or larger but in practice it will filter somewhere between 94% to 99%

Does Shape Of The Respirator Matter?

Dome-shaped N-95 Duck bill shaped N-95 with head elastics with head elastics

Does Shape Of The Mask Matter?

•

• •

•

In Department of Emergency Medicine, University of California, San Francisco

A qualitative fit test of dome-shaped (3M 1860) and duckbill shaped N-95 was done

Overall, 38.2%of participants failed the fit test

70.6% duckbill shaped masks & 27.5% dome- shaped masks failed the fit test

This study found duckbill N95s had a high failure in facial fitness test rate

KN95 Respirator Vs N95 Respirator

• KN95 respirators are held in place by -ear elastic loops
• N-95 are having head elastic loops & are more comfortable to wear
• Ear elastic loops have a weaker facial seal as compared to head elastic N95 •Weaker facial seal masks can be less protective due to weak facial seal

Valved Vs Non-Valved Respirator

Why HCP Should Not Use Valved Respirators

Valved respirators

• • • •

• • •

• •

Advantages

Easier to exhale air
More comfortable to wear

Less moisture build-up inside the respirator Ideal for things like construction work

Disadvantages

Filter only the inhaled air

Do not filter the wearer’s exhalation

The one-way protection puts others around the wearer at risk, in a situation like covid-19

Health care professionals(hcp) should do not use valved respirators

When HCP wears a valved respirator , put a surgical mask or “cloth face covering” over the valved respirator to (partially) filter the out breath

Surgical Vs Non-Surgical Respirators

Surgical Vs Non-surgical Respirators

• All respirators are designed to help protect the wearer from exposure to airborne particles (e.G. Dust, mist, fumes, fibers, and bio aerosols, such viruses and bacteria)

• 3M 8210 respirator is cleared by the U.S. FDA as a surgical mask against corona

• Surgical masks & respirators are tested on a pass/fail basis at 3 velocities corresponding to the range of human blood pressure (80, 120 & 160 mmhg)
3M1860 can resist penetration of blood against 120mm hg pressure 3M 1870+ can resist penetration of blood against 160mm hg pressure

Are Respirators The Saviors ?

YES

• If they are face fit & worn properly No

• If respirators are not face fit & Worn incorrectly

• Touching the front of the respirator which catches viruses and then transferring that to other objects, which could eventually lead back to your mouth and nose

• Taking unnecessary exposure risks just because you’re wearing a respirator. Don’t let it give you false confidence. The safest thing is maintaining social distance

Do We Need To Change Our Looks?

▪ The presence of facial hair, face seal leakage increases from 20 times to 1000 times.

▪ With beard, mask may not be effective.

Which Are The Reliable Brands?

• 3M, GVS, Moldex etc

• Prior to the pandemic, there was easy access to
established brands( 3M, GVS, Moldex)

• Venus 9473 NIOSH Approved

• Palnek Nose

• Urbangabru N99 mask

• Insflug N95 ISI approved

Triple Layer Surgical Mask

• Surgical masks are loose fitting, covering the nose and mouth

• Masks are NOT designed to protect the wearer

• Designed for one way protection, to capture bodily fluid leaving the wearer

• Example – worn during surgery to prevent coughing, sneezing, etc on the vulnerable patient

• The vast majority of masks do not have a safety rating assigned to them (e.g. NIOSH or EN)

Triple Layer Surgical Mask

•

• • •

Surgical mask a 3 three layer designed , with 2 sheets of “non-woven” fabric sandwiching a “melt- blown” layer in the middle

It’s the melt-blown layer that provides the filtering capability

The melt-blown fabric is made by melting a plastic

A melt-blown material is also used in respirators

Melt –blown material is expensive and hard to come by recent increase in demand

Choosing Triple Layer Surgical Mask

• Select the one tested according to a set of standardized test methods (ASTM F2100, EN 14683, or equivalent)

• Check that the melt-blown layer is present

Triple layered Surgical mask

Respirator

Do Triple Layer Surgical Mask Provide Protection ?

• FFP2/FFP3 or N95/N100 are the gold standards

• Surgical masks are primarily designed to protect vulnerable
patients from medical professionals

• They are designed to protect patients, not to protect the wearer

• Stop the wearer (e.g. surgeon) from spreading their germs when coughing /sneezing/speaking

Can Surgical Masks Filter The Corona Virus ?

Vs Vs

Effectiveness of Triple Layer
Surgical Mask Against Influenza(directly )

& Corona (indirectly)

In a US study ,2862 HCP were split into 2 groups,
Those wearing N95 masks and those wearing surgical masks1

Influenza infection events were in
8.2% in N-95 group 7.2% in surgical mask group

Take Home Message : Both N-95 & Triple layer surgical mask were equally effective

Effectiveness of Surgical Mask: Influenza(directly ) & Corona (indirectly)

446 nurses were divided into two groups
Those wearing N95 masks and those wearing surgical masks

Influenza infection events occurred in 22.9%ofN-95group&23.6%inTriplelayer surgicalmaskgroup

Take home message : Both N-95 & Triple layer surgical mask were equally effective

Triple Layer Surgical Mask Vs N95 Respirator

Surgical masks are able to block 80% of particles down to 0.007 microns Compared to the 3M 8812 respirator which blocks 96% (FFP1 rated)

96.6

Triple Layer Surgical Mask Vs N-95 Respirators

• •

We anticipate surgical masks to be inferior to respirators, the studies suggest they are not as inferior as one might assume

The two studies didn’t find a significant difference between surgical masks and N95 respirators, when protecting wearers against influenza

Surgical masks are approximately comparable to N95 masks when it comes to preventing influenza illness

The size & mode of spread of influenza and corona virus is similar so one can assume surgical masks to be effective against corona virus too

Is Wearing A Mask Helpful ?

WearingasurgicalmaskorN95(FFP2)respiratorisbetter atprotecting against influenza-like illnesses than wearing nothing at all

Home Made Mask Vs Triple Layer Surgical Mask

Surgical mask
Vaccum cleaner bag
Dish towel
Cotton Blend 74

97 95

100 % cotton T- shirt

69 Antimicrobial pillowcase65

Scarf 62 Pillowcase 62

Linen Silk

% Particles captured

Home Made Mask

•

Vacuum cleaner bag material & dish towel offer better protection but there is difficulty in breathing using these materials

“The pillowcase and the 100% cotton t-shirt are the most suitable household materials for home made face mask”

• The level of protection these masks offer
is below that of triple layer surgical masks and respirators

Are Home Made Mask Effective ?

Mask Etiquette

▪

▪ ▪

Wash your hands with alcohol-based hand rub or soap and water before putting on a mask.

Place mask carefully to cover mouth & nose

Tie securely to minimize any gaps between the face & the mask

While in use, avoid touching the mask

Remove the mask by using appropriate technique ( do not touch the front but remove the lace from behind)

Mask Etiquette

▪Onceyouremoveorwheneveryou accidentlytouchaused mask, do sanitize your hands

▪ Replace masks with a new clean, dry mask as soon as they become damp / humid

▪Do not re-use single-use masks
▪ Discard single-use masks after each use and dispose-off

them immediately upon removal

▪ For N95 respirators adequate fit check must be performed after wearing

Disposal Of Triple Surgical & N-95 Masks

▪ Appropriate use & disposal is must to ensure Masks are effective

▪ Avoid any increase in risk of transmission associated with the incorrect use and disposal of masks

▪ Disposal Masks to be disposed off immediately after use For HCP –

Dispose off in the yellow bags

At home –

Masks used by patients / care givers/ close contacts during home care should be disinfected using ordinary bleach solution (5%) or sodium hypochlorite solution (1%) and then you can burn or bury/ dispose off in a plastic lined dustbin

“ Take Home Message ”

▪

▪ ▪ ▪ ▪

Social distancing is the best policy to prevent COVID & you need to continue this even after wearing masks

All other precautions to continue while wearing a mask Mask do offer protection against the spread of COVID
Limit duck bill shaped mask use if alternatives are available

Ill fitted N- 95 may offer protection less than a properly fitted surgical mask or for that matter even home made mask

▪ Patient suffering from covid-19 should wear a triple layered mask.

Videos On How To Use & Reuse Masks

Mask Hindi :