LETTER TO EDITOR Year : 2021  |  Volume : 37  |  Issue : 2  |  Page : 312-313

Personal protective equipment for Health care workers donning for COVID-19 areas: Walking a tight rope between safety and comfort!

Anju Gupta1, Nishkarsh Gupta2
1 Department of Anaesthesiology, Pain Medicine and Intensive Care, AIIMS, New Delhi, India
2 Department of Onco.Anesthesiology and Palliative Medicine, DRBRAIRCH, AIIMS, New Delhi, India

Date of Submission12-Jul-2020Date of Decision04-Jan-2021Date of Acceptance03-Apr-2021Date of Web Publication15-Jul-2021

Correspondence Address:
Dr. Nishkarsh Gupta
437 Pocket A, Sarita Vihar, New Delhi - 110 076
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/joacp.JOACP_427_20

How to cite this article:
Gupta A, Gupta N. Personal protective equipment for Health care workers donning for COVID-19 areas: Walking a tight rope between safety and comfort!. J Anaesthesiol Clin Pharmacol 2021;37:312-3
How to cite this URL:
Gupta A, Gupta N. Personal protective equipment for Health care workers donning for COVID-19 areas: Walking a tight rope between safety and comfort!. J Anaesthesiol Clin Pharmacol [serial online] 2021 [cited 2021 Jul 16];37:312-3. Available from: https://www.joacp.org/text.asp?2021/37/2/312/321425
Dear Editor,

Coronavirus disease-2019 (COVID-19) pandemic has infected more than 180 million cases worldwide. The frontline healthcare workers (HCWs) battling the disease need to don into personal protective equipment (PPE) to protect themselves from the infection.[1]

An N95 respirator is a protective mask designed to achieve an efficient filtration (block at least 95% of particles >0.3 μm in size). Its incorrect use could compromise its protective effect and may even increase the risk of infection.[2],[3] This is especially important for anesthesiologists who are frequently involved in aerosol-generating procedures like noninvasive ventilation, tracheal intubation or extubation.

The most important consideration for the effectiveness of a mask is its fit on the HCWs face and its filtration efficacy. A tightly fit mask may lead to discomfort, claustrophobia, pressure on the face and difficulty in breathing.[1] Previous studies have observed that the HCW's compliance with use of N95 mask and the recommended PPE is generally poor because the respirators reduce the maximal physical work capacity by increasing the inspiratory resistance, expiratory resistance, and dead space. COVID areas have limited air conditioning and the non-valved masks may become wet with usage earlier due to inability to dissipate humidity. The resistance offered by the non-valved masks during expiration may lead to headache, inability to concentrate, shortness of breath, dizziness, rise in blood pressure, and fatigue due to accumulation of carbon dioxide.[4] This may increase mask handling and increase the risk of infection to the HCW. In addition, non-valved N95 masks may increase the fogging of goggles and face shield and that makes procedures like intubation difficult for HCW especially with a prolonged donning (6–8 h period usually), in the already cumbersome conditions (PPE and aerosol box).[5]

The valved variety allows unimpeded exhalation through one-way valve. An exhalation valve in the N95 masks may help to dissipate humidity, heat, and carbon dioxide from the dead space and decrease exhalation resistance. However, an infected person wearing a valved mask may spread the virus to others around him.

No previous study has identified the impact of mask type on COVID-19 transmission. A valved N95 mask may be more acceptable for the HCW, but there is a distinct possibility of transmition of the infection to others. This can be minimized by daily screening of the HCWs before coming for duty, maintaining a safe distance from each other and wearing a surgical mask over it.

The stress of working in COVID areas with PPE during the present pandemic has already dented the morale of HCWs. We should ensure comfort of the HCWs along with the safety for others. Based on logical thinking a valved mask should be avoided when working in non-COVID or COVID suspect areas. However, in COVID positive areas where prolonged continuous donning in full PPE is required and risk of infection from HCW to others is negligible, valved mask would offer the best balance of breathing comfort and safety to the provider. Centers for disease control and prevention (CDC) also mentions that valve in N95 masks reduces the exhalation resistance and makes it more comfortable to wear without reducing their efficacy in prevention of infection to the HCWs caring for COVID positive patients.[6]

Further research could give invaluable insights for clarifying the risks and level of safety associated with the use of either type of devices and in framing appropriate policies regarding the appropriate type of PPE in various circumstances. We would urge the manufacturers to deliberate into mask designs with appropriate certification like 'SITARA' and are universally acceptable to all HCWs in tackling the pandemic of COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

  References 
1.Nichol K, Bigelow P, O'Brien-Pallas L, McGeer A, Manno M, Holness DL. The individual, environmental, and organizational factors that influence nurses' use of facial protection to prevent occupational transmission of communicable respiratory illness in acute care hospitals. Am J Infect Control 2008;36:481-7.  
    2.Banach DB, Bielang R, Calfee DP. Factors associated with unprotected exposure to 2009 H1N1 influenza a among healthcare workers during the first wave of the pandemic. Infect Control Hosp Epidemiol 2011;32:293-5.  
    3.Bessesen MT, Savor-Price C, Simberkoff M, Reich NG, Pavia AT, Radonovich LJ. N95 respirators or surgical masks to protect healthcare workers against respiratory infections: Are we there yet? Am J Respir Crit Care Med 2013;187:904-5.  
    4.Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, et al. Headaches associated with personal protective equipment-A cross-sectional study among frontline healthcare workers during COVID-19. Headache 2020;60:864-77.  
    5.Roberge RJ. Are exhalation valves on N95 filtering facepiece respirators beneficial at low-moderate work rates: An overview. J Occup Environ Hyg 2012;9:617-23.  
    6.Centers for disease control and prevention, US. Personal Protective Equipment: Questions and Answers. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html. [Last accessed on 2021 Jan 04].