Masks on the Front Lines
People worldwide are wearing a variety of face masks, including surgical, cloth, face mask shields, N95 respirators, and KN95 masks. Online and in person, we have witnessed the use of other creative face coverings that might not be protective.
Even professional health care workers in the same facilities may wear different face coverings as personal protective equipment (PPE). This may be due to a function of a particular job description or because of supply problems. PPEs also include gloves, paper or cloth gowns that tie in the back, caps, and booties. These protective articles limit the exposure of health care workers and patients to the possibility of infection.
As the coronavirus escalated in the early months of 2020, health care professionals wore N95 and KN95 masks. More often though, they used only the surgical masks when working in shared areas. These common areas include reception desks, gift shops, charting areas, and break rooms.
By late summer, many care providers only wore surgical masks, even during patient care. This was primarily because the N95 and KN95 respirators were in short supply. In response, the Food and Drug Administration (FDA) used the Emergency Use Authorization (EUA) tool to make surgical masks widely available and to provide justification for using them.
Health care providers routinely use PPE to provide a physical barrier against bodily fluids and large or small airborne particles. The level of protection required by a health care worker and a patient or client varies. The factors depend on which face covering will be most effective at preventing the spread of respiratory droplets, airborne particles, and other fluids.
Although authorized for use as PPE in health care settings, until availability of FDA-approved N95 and KN95s meet demand, surgical masks are temporarily the alternative medical solution. According to the FDA, the authorized surgical mask “may be effective” for the duration of the pandemic or until a decision is made to revoke the authorization.
NewRain helps you take care of your staff with the availability of authorized and effective PPE in the most convenient way possible. The long duration of this worldwide flux has challenged us to provide our frontline healthcare workers with safety and confidence.
Opinions and Change
Let’s be honest. Ever since the current coronavirus came to the general public’s awareness, people all over the world have been uneasy, and opinionated.
The confusion around what face mask is best, N95 and KN95, or surgical vs. cloth masks, still spark contests of opinion. You will surely find biased reports, and side-takers who often depend on emotional attachments to beliefs rather than factual research.
Fear of the coronavirus is fueled by several factors, including concerns related to heartbreaking stories of illness and lack of resources. Many people have lost their loved ones to the virus, while others have lost them because of the lack of medical care access. With the ongoing outbreaks and deaths, many are still nervous.
People have been shocked by the disorientation of social distancing and the separation from family members, schools, churches, and community groups. We were all baffled by the hoarding of medical supplies such as hand sanitizer, examination gloves, and alcohol wipes from store shelves.
Amid the confusion and arguments, there rose a widespread feeling that the Chinese government poorly handled the virus’s initial presence, propelling the outbreak quickly into a worldwide pandemic.
The World Health Organization (WHO) advised that if the coronavirus “is spreading in your community,” you can enhance your safety and the safety of others by taking precautions. These provisions include social distancing, wearing face masks, and vigilant hand cleaning among other recommendations.
Some of us are unsure how to comply with the WHOs advice to keep rooms “well-ventilated” in the middle of winter (or summer), “avoid crowds” and “coughing into a bent elbow or tissue” to prevent the spread of small particles from person to person.
Whether in public or healthcare settings, there will always be questions, concerns, and differences of opinion, therefore you need to know the facts—not hearsay.
N95 vs. KN95 Mask Protection
Let’s start with the most effective protection level, where the safety of healthcare workers and patients are vulnerable day in and day out. Both the N95 and KN95 respirator masks filter 95% of airborne particles.
Manufacturer’s layer synthetic material to form the masks and are intended to cover the mouth and nose. They are designed using a seal to prevent the transfer of aerosol particulates between patients and healthcare workers. These masks have high-quality filtering properties that limit the spread of coronavirus on small air particles.
An N95 respirator is a mask that is a subset of N95 Filtering Face-piece Respirators (FFRs), which achieves a facial fit around the nose and mouth and extra-efficient filtration of airborne particles. The masks are tested for fluid resistance, particulate and bacterial filtration efficiency, flammability, and biocompatibility.
Some people claim that since the coronavirus is super tiny, at 0.1-micron diameter, wearing any mask will not protect the wearer or others from exposure. That argument stems from misunderstanding how N95 respirators work. Rigorous testing by the National Institute for Occupational Safety and Health (NIOSH) approves filters that use particles that simulate a 0.3 micron in size. These particles are the most likely to pass through the filter.
When a person with coronavirus talks, coughs, or sneezes, the airborne particles contain water and mucus, which carry most other microscopic critters with them. Proportionately large drops of fluid containing viruses easily become trapped and filtered by the mask’s filtration fibers.
Additionally, and more effectively preventing the passage of these 0.1-micron viruses, electrostatic charges in the fibers attract particles that stick to them. Even the smallest particles continuously vibrate due to Brownian motion and are likely to hit filter fibers and become trapped.
An N95 respirator worn correctly, will filter 95 percent of particles, most of which are larger than 0.3 microns and get stuck in the mesh. Particles smaller than 0.3 microns (including coronavirus) are also snagged by the mask fibers’ electrostatic charges.
The N95 is the only mask approved by the United States National Institute for Occupational Safety and Health (NIOSH). The approval comes from the non-valved design with a tight-fitting face seal. This model provides the highest level of protection and is essential for healthcare workers who work in close contact with patients.
To Valve or Not to Valve
FFP masks with and without valves help workers in many environments, such as painting and construction. They protect wearers from respiratory hazards such as dust and mist. While many FFPs are not approved to filter the coronavirus, the N95 respirators used in healthcare offer workers similar pros and cons.
N95s without valves can cause sweating, irritation, and claustrophobia for some people, and fog up glasses, face shields, and goggles. N95s are still the best protection for patients because they don’t allow the provider’s exhaled air to spread to others.
The valved respirator releases exhaled particles into the environment. In turn your breathing is more comfortable and the mask regulates the flow rate of inhaled and exhaled air. N95s with valves are not recommended for healthcare providers because the masks only protect the worker and not the patient.
It is crucial to wear non-valved N95 respirators when working with patients who are sick with coronavirus. Those at higher risk for contracting and succumbing to severe effects of the illness should also wear these masks.
The Centers for Disease Control and Prevention (CDC) request the general public to avoid using N95 respirators. This specific request is to ensure critical supplies will continue to be available for health care workers and first responders.
The KN95 mask is not approved by NIOSH, which requires a vigorous process to authorize medical equipment. NIOSH also approves other products vital to preventing the spread of coronavirus. ECRI (Emergency Care Research Institute) reported nearly 70 percent of KN95 masks made in China did not meet NIOSH requirements.
Using N95 masks from international labs can put health care workers and patients at risk if the covers are not vetted through specialized PPE testing. Using a machine identical to the one NIOSH uses in its certification process, ECRI offers testing and consultation recommendations. These consults are provided to hospitals and healthcare systems to ensure KN95, N95 masks and other PPE meet industry standards.
It is essential to know where a particular mask is manufactured. Knowing this reduces the risk of purchasing N95 or KN95 respirators that do not meet US standards for filtering efficiency. Even unapproved KN95 covers could still provide better protection against coronavirus than surgical or cloth masks.
N95s vs. Surgical Masks
In the absence of N95 masks due to short supplies, a surgical mask is the next best option. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID), said in February 2021 that it might be best to wear two surgical masks unless healthcare providers have N95s.
The CDC outlines key differences between surgical masks and N95 masks:
- N95 masks must be tested and approved by NIOSH, while the FDA can clear surgical masks for healthcare use.
- N95s limit exposure to small airborne particles and large droplets, while surgical masks are fluid resistant, only protecting against large droplets.
- N95s are fit tested to contour the face and adhere tightly when they are worn properly. Surgical masks fit loosely, with only the ear loops to keep the face-covering in place.
- N95s have a seal check requirement, while surgical masks are not made to seal.
- N95s filter out at least 95 percent of airborne particles, while surgical masks do not protect the wearer at the same level and allow the inhalation of small airborne particles.
- N95 masks have minimal leakage when worn correctly, while surgical masks leak at the outside edges during user inhalation.
Many healthcare experts agree that N95s meet stringent standards. Even KN95s that do not meet requirements for filtering small particles are better protection than surgical or cloth masks.
Cloth masks are prevalent in public, mostly because airflow is better, breathing is more comfortable, and glasses fog up less. They are sold in different shapes, sizes, colors and sometimes even personalized to suit wearers’ personalities.
But how effective are they in preventing the spread of coronavirus?
That depends on the cloth’s level of filtration. Cloth in general offers an elevated level of permeability and the least amount of protection. Some officials declare that a cloth mask is better than no mask at all. Even still, you will not see healthcare professionals wearing them on the job
Dr. Eric Cioe-Pena, Northwell Health’s director of global health in New York, said, “the best mask is the one people are going to wear when out of the home, A KN95 is not better than a surgical mask when you keep taking it off.”
Uncomfortable masks get sweaty and itchy, and many people touch their faces more while using a cover than without. Scratching your nose under your surgical mask, then selecting the ripest produce is a sure way to spread a virus.
Our heroes in the medical field must hold themselves to a different standard. No face-touching during patient care, no matter what itches, drips, or fogs.
For die-hard cloth mask advocates, we suggest some research that might help you determine what is best for your responsibilities. Healthcare workers must abide by CDC and OSHA requirements to protect patients and themselves from spreading the virus. The general public’s guidelines are loose and generous, allowing people to cover their mouths and noses with really anything.
Researchers submitted a study published in Science Advances which they used optical imaging to measure differences in droplet dispersion through various masks during regular speech.
Speaking through cloth masks such as neck gaiters appears to disperse large droplets into smaller droplets. The process enables particles to remain airborne for more extended periods of time. In contrast, larger particles sink faster to a level below transmission. This study suggests that cloth masks may be inefficient at decreasing the spread of coronavirus than no mask at all.
The values for particulate transmission without a mask were slightly lower than the relative. The total droplet counts when speaking through a neck gaiter are three to four times higher than knitted, cotton, and valved N95 masks. The N95 respirator and surgical mask were at zero and close to zero, with relative droplet counts between 0.0 & 1.0.
If you are in alignment with the billboards starring masked people saying, “I am doing it for my __________ (sister, mother, grandpa, neighbor, whoever), there is a logical consensus. Wearing at least a cotton, or polyester cloth mask is better than a neck gaiter, or no mask at all. The most advised masks are still surgical or N95 masks and are especially important for healthcare providers.
If you are interested in protecting yourself, wearing the valved N95 is useful for allowing you to breathe. This is essential to you but it is not so great at protecting those around you. In contrast, the cloth masks such as bandanas, are not much protection at all.
In closing, the surgical mask and the KN95s are more helpful in reducing the spread of coronavirus than cloth masks. As more N95 respirators become available, employers of healthcare workers will be able to re-supply their staff for optimal safety.