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Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, multiple guidelines have recommended videolaryngoscope (VL) for tracheal intubation. However, there is no evidence that VL reduces time to tracheal intubation, and this is important for COVID-19 patients with respiratory failure. Methods: To simulate intubation of COVID-19 patients, we randomly assigned 28 elective surgical patients to be intubated with either McGrath™ MAC VL or direct laryngoscope (DL) by specialist anaesthetists who donned 3M™ Jupiter™ powered air-purifying respirators (PAPR) and N95 masks. The primary outcome was time to intubation. Results: The median time to intubation was 61 s (interquartile range [IQR] 37-63 s) and 41.5 s (IQR 37-56 s) in the VL and DL groups, respectively (P = 0.35). The closest mean distance between the anaesthetist and patient during intubation was 21.6 ± 4.8 cm and 17.6 ± 5.3 cm in the VL and DL groups, respectively (P = 0.045). There were no significant differences in the median intubation difficulty scale scores, proportion of successful intubations at the first laryngoscopic attempt and proportion of intubations requiring adjuncts. All the patients underwent successful intubation with no adverse event. Conclusion: There was no significant difference in the time to intubation of elective surgical patients with either McGrath™ VL or DL by specialist anaesthetists who donned PAPR and N95 masks. The distance between the anaesthetist and patient was significantly greater with VL. When resources are limited or disrupted during a pandemic, DL could be a viable alternative to VL for specialist anaesthetists. [ABSTRACT FROM AUTHOR]

This study evaluated the differences in respiratory protection between replaceable particulate respirators (RPRs) and powered air-purifying respirators (PAPRs) based on different wearing methods during exercise tasks. Ten participants wore RPRs and PAPRs alternately in ways comparable to those adopted by workers in actual workplaces. We measured the fit factor of the respiratory protective equipment (RPE) during exercise tasks for each wearing variation. The exercise load was set to 80W using an ergometer. The exercise tasks comprised five actions described in the Japan Industrial Standard T8150 in 2018. We compared the results with experimental data obtained at rest in our previous studies. The fit factor of RPRs during exercise was significantly lower than (p<0.001) and about half that measured at rest, indicating inadequate respiratory protection. On the other hand, the fit factor of PAPRs during exercise tasks was also significantly lower than (p<0.001) and about half that at rest, but respiratory protection was maintained. This suggests that the protection provided by PAPRs is independent of wearing method during exercise. PAPRs may thus be better than RPRs for workers who have to wear RPE inappropriately due to health problems. [ABSTRACT FROM AUTHOR]

Aim: To investigate how personal protective equipment with an attached powered air‐purifying respirator worn by intensive care unit nurses caring for COVID‐19 patients in Korea impacts nursing‐skill performance and psychosocial stress. Design: A cross‐sectional descriptive study was designed using purposive sampling. Review Methods: Online data collection was conducted from 3 March 2021–20 March 2021on 181 nurses who had worked for more than 1 month in COVID‐19 critical care settings wearing personal protective equipment with a powered air‐purifying respirator. A structured questionnaire was used to gather data on sociodemographic characteristics, attitude toward personal protective equipment, nursing‐skill performance wearing personal protective equipment and psychosocial stress. Data Sources: Data was sourced from structured questionnaire responses. Results: Nursing skill performance decreased to 63.4%, compared with normal performance. Subjects' perceptions and attitudes related to PPE scored 3.56 out of 5; 44.7% of subjects reported severe psychosocial stress, which was significantly affected by attitude toward personal protective equipment usage, nursing performance, experience caring for COVID‐19 patients and length of personal protective equipment usage per shift. Conclusion: Greater negative attitude toward usage of personal protective equipment with a powered air‐purifying respirator, results in lower nursing‐skill performance and higher the psychosocial stress of nurses responding to COVID‐19 outbreaks. Implications for the profession and/or patient care: High negative attitude toward PPE and low nursing‐skill performance due to PPE with an attached PAPR results in significant and debilitating psychosocial stress in ICU nurses responding to COVID‐19 outbreaks. To respond effectively to future infectious disease outbreaks and improve nursing performance, minimising the inconvenience and restrictions experienced by nurses wearing personal protective equipment is critical. Reporting Method: We adhered to relevant EQUATOR guidelines to report. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

The UK High-Consequence Infectious Diseases (HCID) Network of high-level isolation units provides care for patients with contact- or airborne-transmissible highly infectious and highly dangerous diseases. In most HCID units, the healthcare workers (HCWs) wear personal protective equipment (PPE) ensembles incorporating a powered air-purifying respirator (PAPR) for head and respiratory protection. Some PAPRs have components worn outside/over other PPE, necessitating decontamination of re-usable elements. Two alternative PAPRs, with all re-usable elements worn under PPE, were trialled in this study. To undertake scenario-based testing of PAPRs and PPE to determine usability, comfort and ability to remove contaminated PPE without personal cross-contamination. Trained healthcare volunteers (N =20) wearing PAPR/PPE ensembles were sprayed with ultraviolet fluorescent markers. They undertook exercises to mimic patient care, and subsequently, after doffing the contaminated PPE following an established protocol, any personal cross-contamination was visualized under ultraviolet light. Participants also completed a questionnaire to gauge how comfortable they found the PPE. The ensembles were tested under extreme 'worst case scenario' conditions, augmented by physical and manual dexterity tests. Participating volunteers considered the exercise to be beneficial in terms of training and PPE evaluation. Data obtained, including feedback from questionnaires and doffing buddy observations, supported evidence-based decisions on the PAPR/PPE ensemble to be adopted by the HCID Network. One cross-contamination event was recorded in the ensemble chosen; this could be attributed to doffing error, and could therefore be eliminated with further practice. [ABSTRACT FROM AUTHOR]

Abstract Background Due to the coronavirus disease 2019 (COVID-19) pandemic, interventions in the upper airways are considered high-risk procedures for otolaryngologists and their colleagues. The purpose of this study was to evaluate limitations in hearing and communication when using a powered air-purifying respirator (PAPR) system to protect against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission and to assess the benefit of a headset. Methods Acoustic properties of the PAPR system were measured using a head and torso simulator. Audiological tests (tone audiometry, Freiburg speech test, Oldenburg sentence test (OLSA)) were performed in normal-hearing subjects (n = 10) to assess hearing with PAPR. The audiological test setup also included simulation of conditions in which the target speaker used either a PAPR, a filtering face piece (FFP) 3 respirator, or a surgical face mask. Results Audiological measurements revealed that sound insulation by the PAPR headtop and noise, generated by the blower-assisted respiratory protection system, resulted in significantly deteriorated hearing thresholds (4.0 ± 7.2 dB hearing level (HL) vs. 49.2 ± 11.0 dB HL, p

Background: The use of personal protective equipment for respiratory infection control during cardiopulmonary resuscitation (CPR) is a physical burden to healthcare providers. The duration for which CPR quality according to recommended guidelines can be maintained under these circumstances is important. We investigated whether a 2-min shift was appropriate for chest compression and determined the duration for which chest compression was maintained in accordance with the recommended guidelines while wearing personal protective equipment.Methods: This prospective crossover simulation study was performed at a single center from September 2020 to October 2020. Five indicators of CPR quality were measured during the first and second sessions of the study period. All participants wore a Level D powered air-purifying respirator (PAPR), and the experiment was conducted using a Resusci Anne manikin, which can measure the quality of chest compressions. Each participant conducted two sessions. In Session 1, the sequence of 2 min of chest compressions, followed by a 2-min rest, was repeated twice; in Session 2, the sequence of 1-min chest compressions followed by a 1-min rest was repeated four times.Results: All 34 participants completed the study. The sufficiently deep compression rate was 65.9 ± 31.1% in the 1-min shift group and 61.5 ± 30.5% in the 2-min shift group. The mean compression depth was 52.8 ± 4.3 mm in the 1-min shift group and 51.0 ± 6.1 mm in the 2-min shift group. These two parameters were significantly different between the two groups. There was no significant difference in the other values related to CPR quality.Conclusions: Our findings indicated that 1 min of chest compressions with a 1-min rest maintained a better quality of CPR while wearing a PAPR. [ABSTRACT FROM AUTHOR]

The aim of the work was to conduct experimental studies aimed at determining the protection factor of the filter respirator with forced air supply by volunteers in different modes of operation and to establish the dependence of the amount of air supplied by the fan from the air purification device to the filter’s resistance. Simulation studies to determine the protective effectiveness of the filter respirator on the testers were performed according to the procedure for determining the penetration coefficient of test aerosol – sodium chloride, as the ratio of the submask concentration of test aerosol to the ambient concentration formed in a special chamber that meets the requirements of DSTU EN 13274. Determination of the amount of air supplied by the air purification unit to the submask space and assessment of the value of positive pressure inside the mask was performed according to the procedure described in DSTU EN 12941: 2004. As a result of simulated laboratory tests to determine the protective effectiveness of filter respirators with forced air supply to the testers, it was found that the average result of the protection factor of the test samples ranged from 99.93 to 99.97, which meets the requirements of DSTU EN 12941: 2004. In addition, it was found that the amount of air treated by the fan of the air purification device for clean filters is 165 and 215 dm3/min for operating modes “Normal” and “Turbo”, while for the polluted filters it is reduced to 131 and 185 dm3/min, respectively. During the study, the compliance of the value of excess pressure in the submask space with the requirements of DSTU EN 12941: 2004, which should not exceed 2.5 mbar, was confirmed. It is also determined that the stability of the technical parameters of the air purification device is maintained in the specified range when charging the “Dinogy Li-Pol 11000mAh 14.8V 4S 25C” brand battery not less than 12 V to ensure the current value of not less than 1.6 A. The practical value of the results lies in determining the duration of protective action of the filter respirator, the choice of filter resistance to establish the scope and modes of operation in the developed personal respiratory protection equipment.

Abstract Background Powered air-purifying respirators are in short supply and can break down with extended use. Replacement parts can become hard to acquire. The aim of this study was to create an innovative quality improvement proof of concept using rapid prototyping. Methods Here we report three cases of 3D printed powered air-purifying respirator parts. 3D printing was performed on all parts using fused deposition modeling with standard polylactic acid, in the same way that presurgical models would be created. Measurements using an electronic caliper as well as CT scans were used to compare an original part to its corresponding 3D printed parts for accuracy. Results Electronic caliper and computed tomography measurements both showed accuracy consistant with current published norms. Conclusions Ultimately, there will be questions surrounding intellectual property, effectiveness and potential long-term safety for these types of 3D printed parts. Future research should look into the addition of specific nanoparticles from the position of cost, efficacy, safety and improved accuracy.

Abstract Background Healthcare workers (HCWs) are at particular risk during pandemics and epidemics of highly virulent diseases with significant morbidity and case fatality rate. These diseases include severe acute respiratory syndrome coronaviruses, SARS-CoV-1 and SARS-CoV-2, Middle Eastern Respiratory Syndrome (MERS), and Ebola. With the current (SARS-CoV-2) global pandemic, it is critical to delineate appropriate contextual respiratory protection for HCWs. The aim of this systematic review was to evaluate the effect of powered air-purifying respirators (PAPRs) as part of respiratory protection versus another device (egN95/FFP2) on HCW infection rates and contamination. Methods Our primary outcomes included HCW infection rates with SARS-CoV-2, SARS-CoV-1, Ebola, or MERS when utilizing PAPR. We included randomized controlled trials, non-randomized controlled trials, and observational studies. We searched the following databases: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers independently screened all citations, full-text articles, and abstracted data. Due to clinical and methodological heterogeneity, we did not conduct a meta-analysis. Where applicable, we constructed evidence profile (EP) tables for each individual outcome. Confidence in cumulative evidence for each outcome was classified according to the GRADE system. Results We identified 689 studies during literature searches. We included 10 full-text studies. A narrative synthesis was provided. Two on-field studies reported no difference in the rates of healthcare workers performing airway procedures during the care of critical patients with SARS-CoV-2. A single simulation trial reported a lower level of cross-contamination of participants using PAPR compared to alternative respiratory protection. There is moderate quality evidence that PAPR use is associated with greater heat tolerance but lower scores for mobility and communication ability. We identified a trend towards greater self-reported wearer comfort with PAPR technology in low-quality observational simulation studies. Conclusion Field observational studies do not indicate a difference in healthcare worker infection utilizing PAPR devices versus other compliant respiratory equipment. Greater heat tolerance accompanied by lower scores of mobility and audibility in PAPR was identified. Further pragmatic studies are needed in order to delineate actual effectiveness and provider satisfaction with PAPR technology. Systematic review registration The protocol for this review was prospectively registered with the International Register of Systematic Reviews identification number CRD42020184724 .

Background: Due to the coronavirus disease 2019 (COVID-19) pandemic, interventions in the upper airways are considered high-risk procedures for otolaryngologists and their colleagues. The purpose of this study was to evaluate limitations in hearing and communication when using a powered air-purifying respirator (PAPR) system to protect against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission and to assess the benefit of a headset. Methods: Acoustic properties of the PAPR system were measured using a head and torso simulator. Audiological tests (tone audiometry, Freiburg speech test, Oldenburg sentence test (OLSA)) were performed in normal-hearing subjects (n = 10) to assess hearing with PAPR. The audiological test setup also included simulation of conditions in which the target speaker used either a PAPR, a filtering face piece (FFP) 3 respirator, or a surgical face mask. Results: Audiological measurements revealed that sound insulation by the PAPR headtop and noise, generated by the blower-assisted respiratory protection system, resulted in significantly deteriorated hearing thresholds (4.0 ± 7.2 dB hearing level (HL) vs. 49.2 ± 11.0 dB HL, p < 0.001) and speech recognition scores in quiet (100.0 ± 0.0% vs. 2.5 ± 4.2%, p < 0.001; OLSA: 20.8 ± 1.8 dB vs. 61.0 ± 3.3 dB SPL, p < 0.001) when compared to hearing without PAPR. Hearing with PAPR was significantly improved when the subjects were equipped with an in-ear headset (p < 0.001). Sound attenuation by FFP3 respirators and surgical face masks had no clinically relevant impact on speech perception. Conclusions: The PAPR system evaluated here can be considered for high-risk procedures in SARS-CoV-2-positive patients, provided that hearing and communication of the surgical team are optimized by the additional use of a headset. [ABSTRACT FROM AUTHOR]

To assist firefighters and other first responders to use their existing equipment for respiration during the COVID-19 pandemic without using single-use, low-supply, masks, this study outlines an open source kit to convert a 3M-manufactured Scott Safety self-contained breathing apparatus (SCBA) into a powered air-purifying particulate respirator (PAPR). The open source PAPR can be fabricated with a low-cost 3-D printer and widely available components for less than $150, replacing commercial conversion kits saving 85% or full-fledged proprietary PAPRs saving over 90%. The parametric designs allow for adaptation to other core components and can be custom fit specifically to fire-fighter equipment, including their suspenders. The open source PAPR has controllable air flow and its design enables breathing even if the fan is disconnected or if the battery dies. The open source PAPR was tested for air flow as a function of battery life and was found to meet NIOSH air flow requirements for 4 h, which is 300% over expected regular use.

This study evaluated the performance of two respirators, a replaceable particulate respirator (RPR) and a powered air-purifying respirator (PAPR), worn according to non-recommended methods. Ten subjects wore either an RPR or PAPR according to the recommended method, or according to a non-recommended method, with a knit cover placed between the facepiece cushion and face, with a towel placed between the facepiece cushion and face, or with the headband on a helmet. The leakage rate of each wearing variation was then measured, according to the procedure for determining the protection factor of respiratory protective equipment, using atmospheric dust as required by JIS T8150. The average leakage rate for the RPR was 1.82-10.92%, whereas that of the PAPR was 0.18-0.42%. The performance of the RPR decreased when worn in methods outside of recommendations; however, there was no significant decrease in the performance of PAPR under any method of wear. Therefore, a PAPR is recommended for work in which a replaceable or disposable particulate respirator fails to provide sufficient protection against hazardous dust substances, or for workers who are unable to use a particulate respirator according to the recommended method owing to the work environment or health conditions. [ABSTRACT FROM AUTHOR]

Background and Objectives: This retrospective study evaluated the clinical impact of enhanced personal protective equipment (PPE) on the clinical outcomes in patients with out-of-hospital cardiac arrest. Moreover, by focusing on the use of a powered air-purifying respirator (PAPR), we investigated the medical personnel’s perceptions of wearing PAPR during cardiopulmonary resuscitation. Materials and Methods: According to the arrival time at the emergency department, the patients were categorized into a conventional PPE group (1 August 2019 to 20 January 2020) and an enhanced PPE group (21 January 2020, to 31 August 2020). The primary outcomes of this analysis were the return of spontaneous circulation (ROSC) rate. Additionally, subjective perception of the medical staff regarding the effect of wearing enhanced PPE during cardiopulmonary resuscitation (CPR) was evaluated by conducting a survey. Results: This study included 130 out-of-hospital cardiac arrest (OHCA) patients, with 73 and 57 patients in the conventional and enhanced PPE groups, respectively. The median time intervals to first intubation and to report the first arterial blood gas analysis results were longer in the enhanced PPE group than in the conventional PPE group (3 min vs. 2 min; p = 0.020 and 8 min vs. 3 min; p < 0.001, respectively). However, there were no significant differences in the ROSC rate (odds ratio (OR) = 0.79, 95% confidence interval (CI): 0.38–1.67; p = 0.542) and 1 month survival (OR 0.38, 95% CI: 0.07–2.10; p = 0.266) between the two groups. In total, 67 emergent department (ED) professionals responded to the questionnaire. Although a significant number of respondents experienced inconveniences with PAPR use, they agreed that PAPR was necessary during the CPR procedure for protection and reduction of infection transmission. Conclusion: The use of enhanced PPE, including PAPR, affected the performance of CPR to some extent but did not alter patient outcomes. PAPR use during the resuscitation of OHCA patients might positively impact the psychological stability of the medical staff.

Background: Powered air-purifying respirators are in short supply and can break down with extended use. Replacement parts can become hard to acquire. The aim of this study was to create an innovative quality improvement proof of concept using rapid prototyping. Methods: Here we report three cases of 3D printed powered air-purifying respirator parts. 3D printing was performed on all parts using fused deposition modeling with standard polylactic acid, in the same way that presurgical models would be created. Measurements using an electronic caliper as well as CT scans were used to compare an original part to its corresponding 3D printed parts for accuracy. Results: Electronic caliper and computed tomography measurements both showed accuracy consistant with current published norms. Conclusions: Ultimately, there will be questions surrounding intellectual property, effectiveness and potential long-term safety for these types of 3D printed parts. Future research should look into the addition of specific nanoparticles from the position of cost, efficacy, safety and improved accuracy. [ABSTRACT FROM AUTHOR]

Background: Healthcare workers (HCWs) are at particular risk during pandemics and epidemics of highly virulent diseases with significant morbidity and case fatality rate. These diseases include severe acute respiratory syndrome coronaviruses, SARS-CoV-1 and SARS-CoV-2, Middle Eastern Respiratory Syndrome (MERS), and Ebola. With the current (SARS-CoV-2) global pandemic, it is critical to delineate appropriate contextual respiratory protection for HCWs. The aim of this systematic review was to evaluate the effect of powered air-purifying respirators (PAPRs) as part of respiratory protection versus another device (egN95/FFP2) on HCW infection rates and contamination. Methods: Our primary outcomes included HCW infection rates with SARS-CoV-2, SARS-CoV-1, Ebola, or MERS when utilizing PAPR. We included randomized controlled trials, non-randomized controlled trials, and observational studies. We searched the following databases: MEDLINE, EMBASE, and Cochrane Library (Cochrane Database of Systematic Reviews and CENTRAL). Two reviewers independently screened all citations, full-text articles, and abstracted data. Due to clinical and methodological heterogeneity, we did not conduct a meta-analysis. Where applicable, we constructed evidence profile (EP) tables for each individual outcome. Confidence in cumulative evidence for each outcome was classified according to the GRADE system. Results: We identified 689 studies during literature searches. We included 10 full-text studies. A narrative synthesis was provided. Two on-field studies reported no difference in the rates of healthcare workers performing airway procedures during the care of critical patients with SARS-CoV-2. A single simulation trial reported a lower level of cross-contamination of participants using PAPR compared to alternative respiratory protection. There is moderate quality evidence that PAPR use is associated with greater heat tolerance but lower scores for mobility and communication ability. We identified a trend towards greater self-reported wearer comfort with PAPR technology in low-quality observational simulation studies. Conclusion: Field observational studies do not indicate a difference in healthcare worker infection utilizing PAPR devices versus other compliant respiratory equipment. Greater heat tolerance accompanied by lower scores of mobility and audibility in PAPR was identified. Further pragmatic studies are needed in order to delineate actual effectiveness and provider satisfaction with PAPR technology. Systematic review registration: The protocol for this review was prospectively registered with the International Register of Systematic Reviews identification number CRD42020184724. [ABSTRACT FROM AUTHOR]

The correct selection and utilization of respiratory personal protective equipment is of the utmost importance in the current COVID-19 pandemic. This is especially true for health care workers exposed to high-risk aerosol-generating procedures, including otolaryngologists, ophthalmologists, neurosurgeons, maxillofacial surgeons, and laparoscopic surgeons. This communication provides a review of approved forms of respiratory protection and compares their characteristics, including surgical masks, N95 respirator, elastomeric respirators, powered air-purifying respirators, and controlled air-purifying respirators. For standard airborne precautions, N95 respirator are appropriate for respiratory protection. However, high-risk aerosol-generating procedures may create aerosolization of high viral loads that represent increased risk to health care workers. In these situations, enhanced respiratory protection with filters certified as 99, 100, or HEPA (high-efficiency particulate air) may be appropriate. [ABSTRACT FROM AUTHOR]

Objectives Infection control policies and guidelines recommend using facemasks and respirators to protect healthcare workers (HCWs) from respiratory infections. Common types of respirators used in healthcare settings are filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). Aims of this study were to examine the current attitudes and practices of HCWs regarding the selection and use of respiratory protection and determine the acceptability of a novel PAPR. Methods In-depth interviews were undertaken with 20 HCWs from a large tertiary hospital in Sydney, Australia. Participants were fit tested with a lightweight tight-fitting half-facepiece PAPR (CleanSpace2™ Power Unit, PAF-0034, by CleanSpace Technology®) using the TSI™ Portacount quantitative fit test method. Results Interview results showed that HCWs had a limited role in the selection and use of facemasks and respirators and had been using the devices provided by the hospital. The majority of subjects had no knowledge of hospital policy for the use of facemasks and respirators, had not been trained on the use of respirators, and had not been fit tested previously. Compliance with the use of facemasks and respirators was perceived as being low and facemasks and respirators were typically used only for short periods of time. All 20 participants were successfully fit tested to the CleanSpace2™ PAPR (overall geometric mean fit factor—6768). According to the exit surveys, CleanSpace2™ PAPRs were easy to don (14/20) and doff (15/20) and comfortable to wear (14/20). Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations. Conclusions HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs. [ABSTRACT FROM AUTHOR]

Inclusion of reusable respirators, such as elastomeric half-face respirators (EHFRs) and powered air-purifying respirators (PAPRs), in hospital respiratory protection inventories may represent 1 solution to the problem of N95 respirator shortages experienced during pandemics. User acceptance of these devices is 1 potential barrier to implementing such a strategy in respiratory protection programs. To assess user attitudes toward various respirators, health care workers enrolled in respiratory protection programs in a medical system using EHFRs, N95s, and PAPRs and completed an online questionnaire that addressed attitudes, beliefs, and respirator preferences under different risk scenarios. Responses were compared between user groups. Of 1,152 participants, 53% currently used N95s, 24% used EHFRs, and 23% used PAPRs. N95 users rated their respirators more favorably compared with EHFR and PAPR users (P <.001) regarding comfort and communication, however, EHFR users rated their respirators much more highly regarding sense of protection (P <.001). For all user groups, reusable respirators were significantly more likely (odds ratios 2.3-7.7) to be preferred over N95 filtering facepiece respirators in higher risk scenarios compared to "usual circumstance" scenarios. Despite somewhat less favorable ratings on comfort and communication, experienced EHFR and PAPR users still prefer reusable respirators over N95s in certain higher risk scenarios. This suggests that reusable respirators are an acceptable alternative to N95 respirators in health care and offer 1 viable solution to prevent pandemic-generated respirator shortages. [ABSTRACT FROM AUTHOR]

This study evaluated the differences in respiratory protection between replaceable particulate respirators (RPRs) and powered air-purifying respirators (PAPRs) based on different wearing methods during exercise tasks. Ten participants wore RPRs and PAPRs alternately in ways comparable to those adopted by workers in actual workplaces. We measured the fit factor of the respiratory protective equipment (RPE) during exercise tasks for each wearing variation. The exercise load was set to 80W using an ergometer. The exercise tasks comprised five actions described in the Japan Industrial Standard T8150 in 2018. We compared the results with experimental data obtained at rest in our previous studies. The fit factor of RPRs during exercise was significantly lower than (p<0.001) and about half that measured at rest, indicating inadequate respiratory protection. On the other hand, the fit factor of PAPRs during exercise tasks was also significantly lower than (p<0.001) and about half that at rest, but respiratory protection was maintained. This suggests that the protection provided by PAPRs is independent of wearing method during exercise. PAPRs may thus be better than RPRs for workers who have to wear RPE inappropriately due to health problems.

Numerous changes have been made to the French labour regulations in recent years relating to the prevention of risks of exposure to asbestos fibres for operators removing asbestos-containing materials. These changes refer to the method used to count fibres, the collective and personal protective devices to be used on these worksites, and the occupational exposure limit value, which was reduced to 10 f.L−1 on 2 July 2015. In this context, this study assessed the level of respiratory protection afforded by supplied-air respirators and powered air-purifying respirators by monitoring exposure for several operators on nine worksites. The levels of dustiness measured in personal samples taken outside masks showed significant evidence of potential exposure during removal of asbestos-containing plaster or sprayed asbestos, and when using abrasive blasting to treat asbestos-containing materials. For these tasks outside concentration regularly exceeds 25000 f.L−1. Measurements inside masks were generally low, under 10 f.L−1, except in some situations involving the removal of asbestos-containing plaster. This partial penetration of fibres inside masks could be due to the high loading linked to this material. The distributions of Workplace Protection Factors obtained for the two types of respiratory protective devices studied were broad, and the fifth percentile values equal to 236 and 104, respectively, for supplied-air respirators and powered air-purifying respirators. This work highlights once again the need to prioritize collective protection when seeking to prevent asbestos-related risks. [ABSTRACT FROM AUTHOR]

Bone-sawing procedures are routinely performed during veterinary and human autopsies and represent an important source for infectious aerosols. Here we investigate the generation of aerosols during bone-sawing procedures using 5 different saws regularly used in veterinary and human pathology. In particular, the electrical bone band saw produced vast amounts of aerosolized particles less than 5 µm in diameter, which spread rapidly throughout the entire autopsy hall, leading to an exposure of all personnel. Other sawing devices tested were a diamond-coated cut grinder, an oscillating saw, a reciprocating saw, and a hand bone saw. Although these saws, especially the handsaw, generated fewer aerosolized particles than the band saw, the level of exposure of the saw operator would still be of concern in cases where infectious material would require sawing. Contamination of the entire autopsy area was successfully prevented by the construction of a separately ventilated sawing cabin inside the existing autopsy room. Saw operators in this cabin, however, were exposed to even higher aerosol concentrations. Protection of saw operators was achieved by using a powered air-purifying respirator. In conclusion, our results demonstrate that all bone-sawing procedures applied in veterinary and human pathology can generate aerosols that are of concern for the health of autopsy personnel. To reduce the risk of aerosol infections from bone-sawing procedures, efficient and properly designed ventilation systems to limit the spread of aerosols and appropriate personal protective equipment against aerosols for exposed personnel should be implemented. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the efficacy of powered air-purifying respirators (PAPRs) worn by the workers, and to investigate the effect of this application on exposure and preclinical effects in terms of workplace measuring and biomarker monitoring in ITO sputter target manufacturing plants and workers, respectively. Fifty-four workers were recruited and investigated from 2010–2012, during which PAPRs were provided to on-site workers in September 2011. Each worker completed questionnaires and provided blood and urine samples for analysis of biomarkers of indium exposure and preclinical effects. Area and personal indium air samples were randomly collected from selected worksites and from participants. The penetration percentage of the respirator (concentration inside respirator divided by concentration outside respirator) was 6.6%. Some biomarkers, such as S-In, SOD, GPx, GST, MDA, and TMOM, reflected the decrease in exposure and showed lower levels, after implementation of PAPRs. This study is the first to investigate the efficacy of PAPRs for reducing indium exposure. The measurement results clearly showed that the implementation of PAPRs reduces levels of indium-related biomarkers. These findings have practical applications for minimizing occupational exposure to indium and for managing the health of workers exposed to indium. [ABSTRACT FROM AUTHOR]