Comparing the fit of N95, KN95, surgical, and cloth face masks and assessing the accuracy of fit checking
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Abstract
Introduction: The COVID-19 pandemic has made well-fitting face masks a critical piece of protective equipment for healthcare workers and civilians. While the importance of wearing face masks has been acknowledged, there remains a lack of understanding about the role of good fit in rendering protective equipment useful. In addition, supply chain constraints have caused some organizations to abandon traditional quantitative or/and qualitative fit testing, and instead, have implemented subjective fit checking. Our study seeks to quantitatively evaluate the level of fit offered by various types of masks, and most importantly, assess the accuracy of implementing fit checks by comparing fit check results to quantitative fit testing results. Methods: Seven participants first evaluated N95 and KN95 respirators by performing a fit check. Participants then underwent quantitative fit testing wearing five N95 respirators, a KN95 respirator, a surgical mask, and fabric masks. Results: N95 respirators offered higher degrees of protection than the other categories of masks tested; however, it should be noted that most N95 respirators failed to fit the participants adequately. Fit check responses had poor correlation with quantitative fit factor scores. KN95, surgical, and fabric masks achieved low fit factor scores, with little protective difference recorded between respiratory protection options. In addition, small facial differences were observed to have a significant impact on quantitative fit. Conclusion: Fit is critical to the level of protection offered by respirators. For an N95 respirator to provide the promised protection, it must fit the participant. Performing a fit check via NHS self-assessment guidelines was an unreliable way of determining fit.
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Substantial variation exists within each general mask class, for example between KN95 and N95 respirators or different designs of cloth coverings.
“Substantial variation exists within each of these general classes, however. For example, substantial fit and performance discrepancies have been demonstrated for KN95 vs. N95 respirators, or different designs of cloth coverings [11,12,13,14].”
From Comparative Mask Protection against Inhaling Wildfire Smoke, Allergenic Bioaerosols, and Infectious Particles (2022) · cites this paper as [13]
The Results (‘Protection and fit’; page unavailable) show substantial fit differences between the tested KN95 and some N95 respirators. Although the Methods describe several cloth-covering designs, the Results say their fit factors were similar, not that substantial discrepancies were demonstrated between them. (LLM, conf=0.88)
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- Authors
- O’Kelly, E., Arora, A., Pirog, S., Ward, J., & Clarkson, P. J.
- Affiliations
- University of Cambridge (GB)
- Northwestern University (US)
- Corresponding author
- O’Kelly, Eugenia
- Arora, Anmol
- Pirog, Sophia
- Ward, James
- Clarkson, P. John
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2021-01-22
- Volume
- 16
- Issue
- 1
- Pages
- e0245688
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7822328
- OpenAlex
- W3121645079
- Cited by
- 123
- References
- 8
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 20 · 2023: 25 · 2022: 40 · 2021: 23
- FWCI
- 17.53
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Apollo (cc-by)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Safety in Workplaces
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Keywords
- N95 respirators, surgical masks, cloth masks, quantitative fit testing, fit factor, COVID-19 pandemic, respiratory protection, healthcare workers, facial shape
- MeSH terms
- COVID-19, SARS-CoV-2, N95 Respirators, Adolescent, Adult, Aged, Female, Humans, Male, Masks, Middle Aged, Textiles, Occupational Exposure, Young Adult
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