N95 filtering facepiece respirators do not reliably afford respiratory protection during chest compression: A simulation study

Abstract

a b s t r a c tBackground: N95 filtering facepiece respirators (N95 respirators) may not provide adequate protection against respiratory infections during chest compression due to inappropriate fitting. Methods: This was a single-center simulation study performed from December 1, 2016, to December 31, 2016. Each participant underwent quantitative fit test (QNFT) of N95 respirators according to the Occupational Safety and Health Administration protocol. Adequacy of respirator fit was represented by the fit factor (FF), which is calculated as the number of ambient particles divided by the number inside the respirator. We divided all participants into the group that passed the overall fit test but failed at least one individual exercise (partially passed group [PPG]) and the group that passed all exercises (all passed group [APG]). Then, the participants performed three sessions of continuous chest compressions, each with a duration of 2 min, while undergoing real-time fit testing. The primary outcome was any failure (FF < 100) of the fit test during the three bouts of chest compression. Results: Forty-four participants passed the QNFT. Overall, 73% (n = 32) of the participants failed at least one of the three sessions of chest compression; the number of participants who failed was significantly higher in the PPG than in the APG (94% vs. 61%; p = 0.02). Approximately 18% (n = 8) of the participants experienced mask fit failures, such as strap slipping. Conclusions: Even if the participants passed the QNFT, the N95 respirator did not provide adequate protection against respiratory infections during chest compression.

Does a Modified Adhesive Respirator Improve the Face Seal for Health Care Workers Who Previously Failed a Fit Test?: A Pilot Study During the Coronavirus Disease 2019 Pandemic

“…2 Some studies have also suggested that N95 respirators fail to protect HCWs during strenuous activities such as performing chest compressions. 8,9 In line with studies by Lee et al 10 and McMahon et al, 11 women had higher fit failure rates compared with men. We observed a similar pattern with fit testing of standard respirators.…”

Quantitative Fit Tested N95 Respirator-Alternatives Generated With CT Imaging and 3D Printing: A Response to Potential Shortages During the COVID-19 Pandemic

“…Maranhao et al ( 32 ) reported higher probability of fit testing failure with commercial disposable N95 respirators when re-used and sterilized after 4 days of continuous use. Further, activities in close approximation to patients, such as cardiopulmonary resuscitation, reduce efficacy of N95 in those that would otherwise pass fit testing ( 33 ).…”

Rhinologic Practice Special Considerations During COVID‐19: Visit Planning, Personal Protective Equipment, Testing, and Environmental Controls

“…This may be related to facial habitus, duration of procedure, and need for uncommon positioning and movement of the head on the neck during procedures for visualization. 23,24 Additionally, the tight seal needed for N95s with their nonadjustable bands can cause significant facial trauma and respiratory compromise to health care workers over repeated use or after procedures of long duration. 25,26 For standard airborne precautions, N95 masks are appropriate for respiratory protection.…”