Do A Task , Wear A Mask
On , Smile On !
￼ ￼ ￼
DR. MANOJ GUMBER
• 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 : email@example.com
• 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?
Can we go back to our normal life and do routine activities ?
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
• Upper GI scopy
• Loud laugh
• Speaking while eating
• Forceful breathing exercises
￼ ￼ ￼
The variety of Masks
￼ ￼ ￼
▪ 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.
Types Of Respirators
Disposable N 95
For HCP to use Only & Only HCP should use Only & Only HCP should use
￼ ￼ ￼
Half Face Full Face
• 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
• All N95 respirators efficiently filter lower than 0.1 micron size with approximately 94% efficiency or higher
• • •
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?
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
• • • •
• • •
Easier to exhale air
More comfortable to wear
Less moisture build-up inside the respirator Ideal for things like construction work
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 ?
• 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
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 ?
￼ ￼ ￼
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)
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
Vaccum cleaner bag
Cotton Blend 74
100 % cotton T- shirt
69 Antimicrobial pillowcase65
Scarf 62 Pillowcase 62
% 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 ?
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)
▪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 :
￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼ ￼
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