Staff perceptions of military chemical–biological–radiological–nuclear (CBRN) air-purifying masks during a simulated clinical task in the context of SARS-CoV-2

Abstract

Air-purifying full-face masks, such as military chemical–biological–radiological–nuclear masks, might offer superior protection against severe acute respiratory syndrome coronavirus 2 compared to disposable polypropylene P2 or N95 masks. In addition, disposable masks are in short supply, while military chemical–biological–radiological–nuclear masks can be disinfected then reused. It is unknown whether such masks might be appropriate for civilians with minimal training in their use. Accordingly, we compared the Australian Defence Force in-service chemical–biological–radiological–nuclear Low Burden Mask (AirBoss Defense, Newmarket, Canada) with polypropylene N95 masks and non-occlusive glasses worn during simulated tasks performed by civilian clinicians in an Australian tertiary referral hospital intensive care unit. After brief training in the use of the Low Burden Mask, participants undertook a simulated cardiac arrest scenario. Previous training with polypropylene N95 masks had been provided. Evaluation of 10 characteristics of each mask type were recorded, and time to mask application was assessed. Thirty-three participants tested the Low Burden Mask, and 28 evaluated polypropylene N95 masks and glasses. The Low Burden Mask was donned more quickly: mean time 7.0 (standard deviation 2.1) versus 18.3 (standard deviation 6.7) seconds; P = 0.0076. The Low Burden Mask was rated significantly higher in eight of the 10 assessed criteria, including ease of donning, comfort (initially and over a prolonged period), fogging, seal, safety while removing, confidence in protection, and overall. Visibility and communication ability were rated equally highly for both systems. We conclude that this air-purifying full-face mask is acceptable to clinicians in a civilian intensive care unit. It enhances staff confidence, reduces waste, and is likely to be a lower logistical burden during a prolonged pandemic. Formal testing of effectiveness is warranted.

Respiratory protection and refractive error: Comment on ‘Staff perceptions of military chemical–biological–radiological–nuclear (CBRN) air-purifying masks during a simulated clinical task in the context of SARS-CoV-2’

“…Respiratory protection and refractive error: Comment on 'Staff perceptions of military chemical-biologicalradiological-nuclear (CBRN) air-purifying masks during a simulated clinical task in the context of SARS-CoV-2' Jan Schumacher 1 and D Alistair H Laidlaw 2 We would like to commend Adamson et al on their very interesting article investigating the feasibility, performance and user experience of a modern military spec full-face air-purifying respirator (APR) in a civilian intensive care unit. 1 The findings in this context are of great importance in understanding the need for safe, efficient and comfortable respiratory protective equipment (RPE) for frontline healthcare workers during this and future pandemics.…”

“…Respiratory protection and refractive error: Comment on 'Staff perceptions of military chemical-biologicalradiological-nuclear (CBRN) air-purifying masks during a simulated clinical task in the context of SARS-CoV-2' Jan Schumacher 1 and D Alistair H Laidlaw 2 We would like to commend Adamson et al on their very interesting article investigating the feasibility, performance and user experience of a modern military spec full-face air-purifying respirator (APR) in a civilian intensive care unit. 1 The findings in this context are of great importance in understanding the need for safe, efficient and comfortable respiratory protective equipment (RPE) for frontline healthcare workers during this and future pandemics. The coronavirus disease 2019 (COVID-19) pandemic found most countries unprepared, with limited RPE resources at hand, and healthcare workers had to improvise with RPE designed for industrial, construction or mining applications.…”

“…2 Our own previous full-face APR studies 3 found equally high comfort levels among medical first responders and receivers. However, like Adamson et al, 1 we were often limited to only enrol healthcare workers who did not require vision correction or who were able to use contact lenses.…”

Respirators and complications of airway management

“…The authors suggest that discomfort caused by wearing a respirator or difficulty in communication might be the explanation; in our personal experience, this seems very unlikely. Interestingly, a simulation study of the Australian Defence Force chemical, biological, radiological and nuclear air‐purifying mask, which is a full‐face elastomeric respirator, sometimes referred to colloquially as a ‘gas mask’, was judged to be preferable to N95 respirators by ICU nursing, medical and allied health staff; the simulation included tracheal intubation of a manikin [ 4 ]. This counterintuitive preference for a full‐face respirator demonstrates the potential complexity of assessing the effect of respirators on provider acceptance and performance.…”

Clinical evidence needed for risks of PPE

“…Manikin and simulation-based studies are not necessarily generalisable in all real-world situations, and clinical data are required. They reference a study conducted by Adamson et al [3] that assessed user comfort, but only compared the use of N95 masks against chemical, biological, radiological and nuclear air-purifying masks, excluding surgical masks from their investigation. In contrast, surgical masks formed the main comparator in our study.…”