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

c

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

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

c

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

X

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

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

Vs

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)

80

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

87

100 % cotton T- shirt

69 Antimicrobial pillowcase65

Scarf 62 Pillowcase 62

Linen Silk

60

58

% 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 :

Mask English :

PPE Hindi :

                                                                           

ACKNOWLEDGEMENT

Dr. Sheetal Agarwal Dr. Akanksha Gumber Simran Gumber Arushi Gumber

A special thanks to health care workers and officials ,Police department ,Technicians and Nurses

And to ,
Every person who is protecting himself/herself by takingthe necessary precautions

Stay Safe Stay Healthy Stay Strong

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: