Filtration Efficiency of Hospital Face Mask Alternatives Available for Use During the COVID-19 Pandemic
Open accessAbstract
Importance: Procuring respiratory protection for clinicians and other health care workers has become a major challenge of the coronavirus disease 2019 (COVID-19) pandemic and has resulted in nonstandard practices such as the use of expired respirators and various decontamination processes to prolong the useful life of respirators in health care settings. In addition, imported, non-National Institute for Occupational Safety and Health (NIOSH)-approved respirators have been donated or acquired by hospitals as a potential replacement for limited NIOSH-approved N95 respirators. Objective: To assess fitted filtration efficiencies (FFEs) for face mask alternatives used during the COVID-19 pandemic. Design, Setting, and Participants: For this quality-improvement study conducted between April and June 2020, we used the Occupational Safety and Health Administration's Quantitative Fit Testing Protocol for Filtering Facepiece Respirators in a laboratory atmosphere supplemented with sodium chloride particles to assess the FFEs of a variety of respirators worn by a male volunteer and female volunteer. Main Outcomes and Measures: The FFEs of respirators commonly worn by clinicians and other health care workers and available respirator alternatives during the COVID-19 pandemic. Results: Of the 29 different fitted face mask alternatives tested on 1 man and 1 woman, expired N95 respirators with intact elastic straps and respirators subjected to ethylene oxide and hydrogen peroxide sterilization had unchanged FFE (>95%). The performance of N95 respirators in the wrong size had slightly decreased performance (90%-95% FFE). All of the respirators not listed as approved in this evaluation (n = 6) failed to achieve 95% FFE. Neither of the 2 imported respirators authorized for use by the Centers for Disease Control and Prevention that were not NIOSH-approved tested in this study achieved 95% FFE, and the more effective of the 2 functioned at approximately 80% FFE. Surgical and procedural face masks had filtering performance that was lower relative to that of N95 respirators (98.5% overall FFE), with procedural face masks secured with elastic ear loops showing the lowest efficiency (38.1% overall FFE). Conclusions and Relevance: This quality-improvement study evaluating 29 face mask alternatives for use by clinicians interacting with patients during the COVID-19 pandemic found that expired N95 respirators and sterilized, used N95 respirators can be used when new N95 respirators are not available. Other alternatives may provide less effective filtration.
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Sickbert-Bennett et al. evaluated multiple brands of surgical and procedure face masks on one test subject, obtaining mean values of 3.5 and 1.6 respectively.
“Similarly, a recent study by Sickbert-Bennett et al. [84] showed PF results where they evaluated multiple brands of surgical and procedure face masks on one test subject, obtaining mean values of 3.5 and 1.6 respectively.”
From The protective performance of reusable cloth face masks, disposable procedure masks, KN95 masks and N95 respirators: Filtration and total inward leakage (2021) · cites this paper as [84]
The Methods describe testing masks on an adult male volunteer, with an additional female volunteer tested for comparison. Table 1 reports four surgical masks with ties at 71.5% mean fitted filtration efficiency and three ear-loop masks at 38.1%; those percentages imply protection factors of approximately 3.5 and 1.6, respectively. The paper does not report those values as protection factors or establish that the masks were from multiple brands. (LLM, conf=0.84)
Experimental — accuracy not yet measuredInward leakage due to gaps in the fit has been demonstrated to play a critical role in the ability of a mask or respirator to protect against exposure to particulates.
“Inward leakage due to gaps in the fit has been demonstrated to play a critical role in the ability of a mask or respirator to protect against exposure to particulates [4, 59, 82–84].”
From The protective performance of reusable cloth face masks, disposable procedure masks, KN95 masks and N95 respirators: Filtration and total inward leakage (2021) · cites this paper as [84]
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- Authors
- Sickbert-Bennett, E. E., Samet, J. M., Clapp, P. W., Chen, H., Berntsen, J., Zeman, K. L., Tong, H., Weber, D. J., & Bennett, W. D.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Environmental Protection Agency (US)
- Oak Ridge Institute for Science and Education (US)
- TRC, Raleigh, North Carolina
- Corresponding author
- Sickbert-Bennett, Emily E.
- ORCID
- Venue
- JAMA Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2020-12-01
- Volume
- 180
- Issue
- 12
- Pages
- 1607
- ISSN
- 2168-6106 (ISSN-L)
- PMC
- PMC7420816
- OpenAlex
- W3048060588
- Cited by
- 164
- References
- 8
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 15 · 2023: 28 · 2022: 38 · 2021: 61 · 2020: 13
- FWCI
- 19.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- UNC Libraries
- Funders
- U.S. Environmental Protection Agency
- University of North Carolina at Chapel Hill
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Physical Sciences › Engineering › Electrical and Electronic Engineering › Aerosol Filtration and Electrostatic Precipitation
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Safety in Workplaces
- Keywords
- filtration efficiency, N95 respirators, face masks, COVID-19 pandemic, respiratory protection, healthcare workers, ethylene oxide sterilization, hydrogen peroxide sterilization, surgical masks, respirator fit testing, respirator shortage, sodium chloride particles
- MeSH terms
- COVID-19, SARS-CoV-2, N95 Respirators, Disinfectants, Equipment Contamination, Ethylene Oxide, Filtration, Health Personnel, Humans, Hydrogen Peroxide, Masks, Materials Testing, Sterilization, Infection Control, Equipment Reuse, Infectious Disease Transmission, Patient-to-Professional, Equipment Failure Analysis, Quality Improvement
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