Assessment of inhalation exposure to microplastic particles when disposable masks are repeatedly used

Wearing masks to prevent infectious diseases, especially during the COVID-19 pandemic, is common. However, concerns arise about inhalation exposure to microplastics (MPs) when disposable masks are improperly reused. In this study, we assessed whether disposable masks release inhalable MPs when reused in simulated wearing conditions. All experiments were conducted using a controlled test chamber setup with a constant inspiratory flow. Commercially available medical masks with a three-layer material, composition comprising polypropylene (PP in the outer and middle layers) and polyethylene (PE in the inner layer), were used as the test material. Brand-new masks with and without hand rubbing, as well as reused medical masks, were tested. Physical properties (number, size, and shape) and chemical composition (polymers) were identified using various analytical techniques such as fluorescence staining, fluorescence microscopy, and micro-Fourier Transform Infrared Spectroscopy (μFTIR). Scanning Electron Microscopy (SEM) was used to scrutinize the surface structure of reused masks across different layers, elucidating the mechanism behind the MP generation. The findings revealed that brand-new masks subjected to hand rubbing exhibited a higher cumulative count of MPs, averaging approximately 1.5 times more than those without hand rubbing. Fragments remained the predominant shape across all selected size classes among the released MPs from reused masks, primarily through a physical abrasion mechanism, accounting for >90 % of the total MPs. The numbers of PE particles were higher than PP particles, indicating that the inner layer of the mask contributed more inhalable MPs than the middle and outer layers combined. The released MPs from reused masks reached their peak after 8 h of wearing. This implies that regularly replacing masks serves as a preventive measure and mitigates associated health risks of inhalation exposure to MPs.

Validation of N95 respirator models for pressure drop and particle capture efficiency

Despite efforts to apply administrative and engineering controls to minimize worker exposure to aerosols, filtering facepiece respirators (FFRs) continue to be an important form of personal protective equipment in hard-to-control settings such as healthcare, agriculture, and construction. Optimizing the performance of FFRs can be advanced with the use of mathematical models that incorporate the forces that act on particles during filtration as well as those filter characteristics that influence filter pressure drop. However, a thorough investigation of these forces and characteristics using measurements of currently available FFRs has not been undertaken. Filter characteristics such as fiber diameter and filter depth were measured from samples taken from six currently-available N95 FFRs from three manufacturers. A filtration model was developed that included diffusion, inertial and electrostatic forces to estimate the filtration of an aerosol with a Boltzmann charge distribution. The diameter of the filter fibers was modeled as either a single "effective" diameter or as a lognormal distribution of diameters. Both modeling schemes produced an efficiency curve that simulated efficiency measurements made over a range of particle diameters (0.01 - 0.3 µm) with the use of a scanning mobility particle sizer in the region where efficiency is at a minimum. However, the method using a distribution of fiber diameters produced a better fit for particles > 0.1 µm. The coefficients associated with a simple form of the diffusion equation constituting a power law incorporating the Peclet number were adjusted to enhance model accuracy. Likewise, the fiber charge of the electret fibers was also adjusted to maximize model fit but remained within levels reported by others. A filter pressure drop model was also developed. Results demonstrated the need for a pressure drop model applicable to N95s relative to existing models developed with the use of fibers with larger diameters than those used in current N95 FFRs. A set of N95 FFR characteristics are provided that can be used to develop models of typical N95 FFR filter performance and pressure drop in future studies.

The Problem with 'Suction Only' Methods to Reduce Surgical Smoke Exposure

Surgical staff and patients are frequently exposed to surgical smoke and there is mounting evidence that this may be harmful. Borsetti et al. have devised a novel approach to minimising intraoperative exposure to surgical smoke. Here, I briefly outline my concerns with the 'suction only' approach to addressing this problem. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Managing Quartz Exposure in Apartment Building and Infrastructure Construction Work Tasks

The present report describes exposure to respirable silica and dust in the construction industry, as well as means to manage them. The average exposure in studied work tasks (n = 148) amounted to 64% of the Finnish OEL value of 0.05 mg/m³. While 10% of exposure estimates exceeded the OEL, the 60% percentile was well below 10% of the OEL, as was the median exposure. In other words, exposure was low in more than half of the tasks. Work tasks where exposure was low included construction cleaning, work management, installation of concrete elements, rebar laying, driving work machines equipped with cabin air intake filtration, and landscaping, in addition to some road construction tasks. Excessive exposure (>OEL) was related to not using respiratory protection at all or not using it for long enough after the dusty activity ceased. Excessive exposures were found in sandblasting, dismantling facade elements, diamond drilling, drilling hollow-core slabs, drilling with a drilling rig, priming of explosives, tiling, use of cabinless earthmoving machines, and jackhammering, regardless of whether the hammering took place in an underpressurized compartment or not. Even in these tasks, it was possible to perform the work safely, following good dust prevention measures and, when necessary, using respiratory protection suitable for the job. Furthermore, in all tasks with generally low exposure, one could be significantly exposed through the general air or by making poor choices in terms of dust control.

Evaluation of a self-cleaning portable dust collector for reducing worker exposures to silica at hydraulic-fracturing sites

National Institute for Occupational Safety and Health (NIOSH) researchers continue to study worker exposure to respirable crystalline silica (RCS) and develop interventions to reduce these exposures. Occupational overexposures to RCS continue to cause illness and deaths in many industries and RCS has been identified as a serious exposure risk associated with hydraulic- fracturing operations during oil and gas extraction. In 2016 the Occupational Safety and Health Administration (OSHA) reduced the permissible exposure limit (PEL) to 0.05 milligrams of silica per cubic meter of air, averaged over an 8-hour day. This mandate requires hydraulic-fracturing operations to implement dust controls and safer work methods to protect workers from silica exposures above this PEL by June 23, 2021. At hydraulic-fracturing sites utilizing sand movers, pneumatic transfer of fracking sand is the primary source of aerosolized RCS. Currently, there are limited commercially available engineering controls for the collection of dust emitted from thief hatches on sand movers. The goal of this research is to develop a robust, cost-effective, weather resistant, portable, self-cleaning dust collection system that can be retrofitted onto sand mover thief hatches. A prototype was designed, built, and tested, and it was determined that the system could handle flows in the range of 600 to 1300 cfm with loading/cleaning cycle times of 40 and 5 minutes respectively and demonstrated operating efficiencies of 97-99%. Further development of this NIOSH prototype is being done in collaboration with an industry partner with the goal of developing a commercially viable, cost-effective solution to reduce RCS at hydraulic-fracturing sites around the world.Implications: This research has verified that airborne dust created by pneumatic transfer of fracking sand can be effectively collected using a passive cartridge filter system, and that the filters can be cleaned using blasts of air. Mounting these units to the thief hatches of sand movers will significantly reduce dust emissions from sand movers on hydraulic fracturing sites. Thus, this system offers the Oil and Gas Industry a method to reduce worker exposure to RCS on hydraulic fracturing sites that utilize sand movers. The success of this prototype has led researchers to devise a modified version for collecting dust at conveyor transfer points.

Benefits and limitations of field-based monitoring approaches for respirable dust and crystalline silica applied in a sandstone quarry

With the advent of new sensing technologies and robust field-deployable analyzers, monitoring approaches can now generate valuable hazard information directly in the workplace. This is the case for monitoring respirable dust and respirable crystalline silica concentration levels. Estimating the quartz amount of a respirable dust sample by nondestructive analysis can be carried out using portable Fourier transform infrared spectroscopy (FTIR) units. Real-time respirable dust monitors, combined with small video cameras, allow advanced assessments using the Helmet-CAM methodology. These two field-based monitoring approaches, developed by the National Institute for Occupational Safety and Health (NIOSH), have been trialed in a sandstone quarry. Twenty-six Helmet-CAM sessions were conducted, and forty-one dust samples were collected around the quarry and analyzed on-site during two events. The generated data generated were used to characterize concentration levels for the monitored areas and workers, to identify good practices, and to illustrate activities that could be improved with additional engineered control technologies. Laboratory analysis of the collected samples complemented the field finding and provided an assessment of the performance of the field-based techniques. Only a fraction of the real-time respirable dust monitoring sessions data could be corrected with laboratory analysis. The average correction factor ratio was 5.0. Nevertheless, Helmet-CAM results provided valuable information for each session. The field-based quartz monitoring approach overestimated the concentration by a factor of 1.8, but it successfully assessed the quartz concentration trends in the quarry. The data collected could be used for the determination of a quarry calibration factor for future events. The quartz content in the dust was found to vary from 14% to 100%, and this indicates the need for multiple techniques in the characterization of respirable dust and quartz concentration and exposure. Overall, this study reports the importance of the adoption of field-based monitoring techniques when combined with a proper understanding and knowledge of the capabilities and limitations of each technique.

Elevated exposures to respirable crystalline silica among engineered stone fabrication workers in California, January 2019-February 2020

BACKGROUND

Workers fabricating engineered stone face high risk for exposure to respirable crystalline silica (RCS) and subsequent development of silicosis. In response, the California Division of Occupational Safety and Health (Cal/OSHA) performed targeted enforcement inspections at engineered stone fabrication worksites. We investigated RCS exposures and employer adherence to Cal/OSHA's RCS and respiratory protection standards from these inspections to assess ongoing risk to stone fabrication workers.

METHODS

We extracted employee personal air sampling results from Cal/OSHA inspection files and calculated RCS exposures. Standards require that employers continue monitoring employee RCS exposures and perform medical surveillance when exposures are at or above the action level (AL; 25 μg/m3 ); exposures above the permissible exposure limit (PEL; 50 μg/m3 ) are prohibited. We obtained RCS and respiratory protection standard violation citations from a federal database.

RESULTS

We analyzed RCS exposures for 152 employees at 47 workplaces. Thirty-eight (25%) employees had exposures above the PEL (median = 89.7 μg/m3 ; range = 50.7-670.7 μg/m3 ); 17 (11%) had exposures between the AL and PEL. Twenty-four (51%) workplaces had ≥1 exposure above the PEL; 7 (15%) had ≥1 exposure between the AL and PEL. Thirty-four (72%) workplaces were cited for ≥1 RCS standard violation. Twenty-seven (57%) workplaces were cited for ≥1 respiratory protection standard violation.

CONCLUSIONS

Our investigation demonstrates widespread RCS overexposure among workers and numerous employer Cal/OSHA standard violation citations. More enforcement and educational efforts could improve employer compliance with Cal/OSHA standards and inform employers and employees of the risks for RCS exposure and strategies for reducing exposure.

Case Report: Exposure to Respirable Crystalline Silica and Respiratory Health Among Australian Mine Workers

Occupational exposure to respirable crystalline silica (RCS) is common in a range of industries, including mining, and has been associated with adverse health effects such as silicosis, lung cancer, and non-malignant respiratory diseases. This study used a large population database of 6,563 mine workers from Western Australia who were examined for personal exposure to RCS between 2001 and 2012. A standardized respiratory questionnaire was also administered to collect information related to their respiratory health. Logistic regression analyses were performed to ascertain the association between RCS concentrations and the prevalence of respiratory symptoms among mine workers. The estimated exposure levels of RCS (geometric mean 0.008mg/m3, GSD 4.151) declined over the study period (p < 0.001) and were below the exposure standard of 0.05 mg/m3. Miners exposed to RCS had a significantly higher prevalence of phlegm (p = 0.017) and any respiratory symptom (p = 0.013), even at concentrations within the exposure limit. Miners are susceptible to adverse respiratory health effects at low levels of RCS exposure. More stringent prevention strategies are therefore recommended to protect mine workers from RCS exposures.

Understanding Filtering Facepiece Respirators

How to ensure adequate protection.

Efficacy of Ventilation, HEPA Air Cleaners, Universal Masking, and Physical Distancing for Reducing Exposure to Simulated Exhaled Aerosols in a Meeting Room

There is strong evidence associating the indoor environment with transmission of SARS-CoV-2, the virus that causes COVID-19. SARS-CoV-2 can spread by exposure to droplets and very fine aerosol particles from respiratory fluids that are released by infected persons. Layered mitigation strategies, including but not limited to maintaining physical distancing, adequate ventilation, universal masking, avoiding overcrowding, and vaccination, have shown to be effective in reducing the spread of SARS-CoV-2 within the indoor environment. Here, we examine the effect of mitigation strategies on reducing the risk of exposure to simulated respiratory aerosol particles within a classroom-style meeting room. To quantify exposure of uninfected individuals (Recipients), surrogate respiratory aerosol particles were generated by a breathing simulator with a headform (Source) that mimicked breath exhalations. Recipients, represented by three breathing simulators with manikin headforms, were placed in a meeting room and affixed with optical particle counters to measure 0.3-3 µm aerosol particles. Universal masking of all breathing simulators with a 3-ply cotton mask reduced aerosol exposure by 50% or more compared to scenarios with simulators unmasked. While evaluating the effect of Source placement, Recipients had the highest exposure at 0.9 m in a face-to-face orientation. Ventilation reduced exposure by approximately 5% per unit increase in air change per hour (ACH), irrespective of whether increases in ACH were by the HVAC system or portable HEPA air cleaners. The results demonstrate that mitigation strategies, such as universal masking and increasing ventilation, reduce personal exposure to respiratory aerosols within a meeting room. While universal masking remains a key component of a layered mitigation strategy of exposure reduction, increasing ventilation via system HVAC or portable HEPA air cleaners further reduces exposure.

A smart mask for active defense against airborne pathogens

Face masks are a primary preventive measure against airborne pathogens. Thus, they have become one of the keys to controlling the spread of the COVID-19 virus. Common examples, including N95 masks, surgical masks, and face coverings, are passive devices that minimize the spread of suspended pathogens by inserting an aerosol-filtering barrier between the user's nasal and oral cavities and the environment. However, the filtering process does not adapt to changing pathogen levels or other environmental factors, which reduces its effectiveness in real-world scenarios. This paper addresses the limitations of passive masks by proposing ADAPT, a smart IoT-enabled "active mask". This wearable device contains a real-time closed-loop control system that senses airborne particles of different sizes near the mask by using an on-board particulate matter (PM) sensor. It then intelligently mitigates the threat by using mist spray, generated by a piezoelectric actuator, to load nearby aerosol particles such that they rapidly fall to the ground. The system is controlled by an on-board micro-controller unit that collects sensor data, analyzes it, and activates the mist generator as necessary. A custom smartphone application enables the user to remotely control the device and also receive real-time alerts related to recharging, refilling, and/or decontamination of the mask before reuse. Experimental results on a working prototype confirm that aerosol clouds rapidly fall to the ground when the mask is activated, thus significantly reducing PM counts near the user. Also, usage of the mask significantly increases local relative humidity levels.

The protective performance of reusable cloth face masks, disposable procedure masks, KN95 masks and N95 respirators: Filtration and total inward leakage

Face coverings are a key component of preventive health measure strategies to mitigate the spread of respiratory illnesses. In this study five groups of masks were investigated that are of particular relevance to the SARS-CoV-2 pandemic: re-usable, fabric two-layer and multi-layer masks, disposable procedure/surgical masks, KN95 and N95 filtering facepiece respirators. Experimental work focussed on the particle penetration through mask materials as a function of particle diameter, and the total inward leakage protection performance of the mask system. Geometric mean fabric protection factors varied from 1.78 to 144.5 for the fabric two-layer and KN95 materials, corresponding to overall filtration efficiencies of 43.8% and 99.3% using a flow rate of 17 L/min, equivalent to a breathing expiration rate for a person in a sedentary or standing position conversing with another individual. Geometric mean total inward leakage protection factors for the 2-layer, multi-layer and procedure masks were <2.3, while 6.2 was achieved for the KN95 masks. The highest values were measured for the N95 group at 165.7. Mask performance is dominated by face seal leakage. Despite the additional filtering layers added to cloth masks, and the higher filtration efficiency of the materials used in disposable procedure and KN95 masks, the total inward leakage protection factor was only marginally improved. N95 FFRs were the only mask group investigated that provided not only high filtration efficiency but high total inward leakage protection, and remain the best option to protect individuals from exposure to aerosol in high risk settings. The Mask Quality Factor and total inward leakage performance are very useful to determine the best options for masking. However, it is highly recommended that testing is undertaken on prospective products, or guidance is sought from impartial authorities, to confirm they meet any implied standards.

Implications of Cloth COVID Masks for Size Distribution of Inhaled Plutonium, Respiratory Deposition, and Fecal Bioassay Monitoring

This work considers the implications of cloth masks due to the COVID-19 pandemic on suspected plutonium inhalations and dose assessment. In a plutonium inhalation scenario, the greater filtration efficiency for large particles exhibited by cloth masks can reduce early fecal excretion without a corresponding reduction in dose. For plutonium incidents in which cloth masks are worn, urinary excretion should be the preferred method of inferring dose immediately after the inhalation, and fecal excretion should be considered unreliable for up to 10 days.

Design of optical cavity for air sanification through ultraviolet germicidal irradiation

The transmission of airborne pathogens represents a major threat to worldwide public health. Ultraviolet light irradiation can contribute to the sanification of air to reduce the pathogen transmission. We have designed a compact filter for airborne pathogen inactivation by means of UVC LED sources, whose effective irradiance is enhanced thanks to high reflective surfaces. We used ray-tracing and computational fluid dynamic simulations to model the device and to maximize the performance inside the filter volume. Simulations also show the inhibition of SARS-Cov-2 in the case of high air fluxes. This study demonstrates that current available LED technology is effective for air sanification purposes.

SARS-Cov-2: The Relevance and Prevention of Aerosol Transmission

Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has claimed many victims worldwide due to its high virulence and contagiousness. The person-to-person transmission of SARS-Cov-2 when in close contact is facilitated by respiratory droplets containing the virus particles, and by skin contact with contaminated surfaces. However, the large number of COVID-19 infections cannot be explained only by droplet deposition or contact contamination. It seems very plausible that aerosols are important in transmitting SARS-Cov-2. It has been demonstrated that SARS-CoV-2 remains viable in aerosols for hours, facilitating rapid distribution of the virus over great distances. Aerosols may, therefore, also be responsible for so-called super-spreader events. Indirect evidence points to a correlation between ventilation and the transmission and spread of SARS-Cov-2, supporting ventilation as an important factor in preventing airborne transmission. Further actions to avoid transmission of COVID-19 include social distancing, hygiene measures, and barrier measures, such as face-coverings. Professional masks offer better protection than cloth masks. These protection measures are especially relevant to health care workers, when performing endotracheal intubation, but the risk from non-invasive ventilation and nebulizing treatment seems to be moderate.

Opportunities and challenges in reducing personal inhalation exposure to air pollution among electronic waste recovery workers in Ghana

BACKGROUND

Informal sector electronic waste (e-waste) recovery produces toxic emissions resulting from burning e-waste to recover valuable metals.

OBJECTIVES

To identify high-risk worker groups by measuring relative levels of personal inhalation exposure to particulate matter (PM) of fine (≤2.5 µm) and coarse (2.5-10 µm) fractions (PM2.5 and PM2.5-10, respectively) across work activities among e-waste workers, and to assess how wind conditions modify levels of PM by activity and site location.

METHODS

At the Agbogbloshie e-waste site, 170 partial-shift PM samples and time-activity data were collected from participants (N = 105) enrolled in the GeoHealth cohort study. Personal sampling included continuous measures of size-specific PM from the worker's breathing zone and time-activity derived from wearable cameras. Linear mixed models were used to estimate changes in personal PM2.5 and PM2.5-10 associated with activities and evaluate effect modification by wind conditions.

RESULTS

Mean (±standard deviation) personal PM2.5 and PM2.5-10 concentrations were 80 (±  81) and 123 (± 139) µg m-3 , respectively. The adjusted mean PM2.5 concentration for burning e-waste was 88 µg m-3 , a 28% increase above concentrations during non-recovery activities (such as eating). Transportation-related and burning activities were associated with the highest PM2.5-10 concentrations. Frequent changes in wind direction were associated with higher PM2.5 concentrations when burning, and high wind speeds with higher PM2.5-10 concentrations when dismantling e-waste downwind of the burning zone.

Nontargeted Analysis of Face Masks: Comparison of Manual Curation to Automated GCxGC Processing Tools

Masks constructed of a variety of materials are in widespread use due to the COVID-19 pandemic, and people are exposed to chemicals inherent in the masks through inhalation. This work aims to survey commonly available mask materials to provide an overview of potential exposure. A total of 19 mask materials were analyzed using a nontargeted analysis two-dimensional gas chromatography (GCxGC)-mass spectrometric (MS) workflow. Traditionally, there has been a lack of GCxGC-MS automated high-throughput screening methods, resulting in trade-offs with throughput and thoroughness. This work addresses the gap by introducing new machine learning software tools for high-throughput screening (Floodlight) and subsequent pattern analysis (Searchlight). A recursive workflow for chemical prioritization suitable for both manual curation and machine learning is introduced as a means of controlling the level of effort and equalizing sample loading while retaining key chemical signatures. Manual curation and machine learning were comparable with the mask materials clustering into three groups. The majority of the chemical signatures could be characterized by chemical class in seven categories: organophosphorus, long chain amides, polyethylene terephthalate oligomers, n-alkanes, olefins, branched alkanes and long-chain organic acids, alcohols, and aldehydes. The olefin, branched alkane, and organophosphorus components were primary contributors to clustering, with the other chemical classes having a significant degree of heterogeneity within the three clusters. Machine learning provided a means of rapidly extracting the key signatures of interest in agreement with the more traditional time-consuming and tedious manual curation process. Some identified signatures associated with plastics and flame retardants are potential toxins, warranting future study to understand the mask exposure route and potential health effects.

Experimental Efficacy of the Face Shield and the Mask against Emitted and Potentially Received Particles

There is currently not sufficient evidence to support the effectiveness of face shields for source control. In order to evaluate the comparative barrier performance effect of face masks and face shields, we used an aerosol generator and a particle counter to evaluate the performance of the various devices in comparable situations. We tested different configurations in an experimental setup with manikin heads wearing masks (surgical type I), face shields (22.5 cm high with overhang under the chin of 7 cm and circumference of 35 cm) on an emitter or a receiver manikin head, or both. The manikins were face to face, 25 cm apart, with an intense particle emission (52.5 L/min) for 30 s. The particle counter calculated the total cumulative particles aspirated on a volume of 1.416 L In our experimental conditions, when the receiver alone wore a protection, the face shield was more effective (reduction factor = 54.8%), while reduction was lower with a mask (reduction factor = 21.8%) (p = 0.002). The wearing of a protective device by the emitter alone reduced the level of received particles by 96.8% for both the mask and face shield (p = NS). When both the emitter and receiver manikin heads wore a face shield, the protection allowed for better results in our experimental conditions: 98% reduction for the face shields versus 97.3% for the masks (p = 0.01). Face shields offered an even better barrier effect than the mask against small inhaled particles (<0.3 µm-0.3 to 0.5 µm-0.5 to 1 µm) in all configurations. Therefore, it would be interesting to include face shields as used in our experimental study as part of strategies to reduce transmission within the community setting.

Investigation of the protection efficacy of face shields against aerosol cough droplets

Simple plastic face shields have numerous practical advantages over regular surgical masks. In light of the spreading COVID-19 pandemic, the potential of face shields as a substitution for surgical masks was investigated. In order to determine the efficacy of the protective equipment we used a cough simulator. The protective equipment considered was placed on a manikin head that simulated human breathing. Concentration and size distribution of small particles that reached the manikin respiration pathways during the few tens of seconds following the cough event were monitored. Additionally, water sensitive papers were taped on the tested protective equipment and the manikin face. In the case of frontal exposure, for droplet diameter larger than 3 μm, the shield efficiency in blocking cough droplets was found to be comparable to that of regular surgical masks, with enhanced protection for portions of the face that the mask does not cover. Additionally, for finer particles, down to 0.3 µm diameter, a shield blocked about 10 times more fine particles than the surgical mask. When exposure from the side was considered, the performance of the shield was found to depend dramatically on its geometry. While a narrow shield allowed more droplets and aerosol to penetrate in comparison to a mask under the same configuration, a slightly wider shield significantly improved the performance. The source control potential of shields was also investigated. A shield, and alternatively, a surgical mask, were placed on the cough simulator, while the breathing simulator, situated 60 cm away in the jet direction, remained totally exposed. In both cases, no droplets or particles were found in the vicinity of the breathing simulator. Conducted experiments were limited to short time periods after expiratory events, and do not include longer time ranges associated with exposure to suspended aerosol. Thus, additional evidence regarding the risk posed by floating aerosol is needed to establish practical conclusions regarding actual transmittance reduction potential of face shields and surgical face masks.

Some Immunological Impacts of Face Mask Usage During the COVID-19 Pandemic

&lt;b&gt;Background and Objective:&lt;/b&gt; COVID-19 is a fast-spreading worldwide pandemic caused by SARS-CoV-2. The World Health Organization recommended wearing face masks. Masks have become an urgent necessity throughout the pandemic, the study's goal was to track the impact of wearing masks on immunological responses. &lt;b&gt;Materials and Methods:&lt;/b&gt; This study was conducted on 40 healthy people who were working in health care at Nineveh Governorate Hospitals from September-December, 2020. They wore face masks at work for more than 8 months for an average of 6 hrs a day. The control sample included 40 healthy individuals, who wore masks for very short periods. All samples underwent immunological and physiological tests to research the effects of wearing masks for extended periods within these parameters. &lt;b&gt;Results:&lt;/b&gt; The results showed a significant decrease in total White Blood Count and the absolute number of neutrophils, lymphocytes, monocytes and phagocytic activity. However, there was a significant increase in the absolute number of eosinophils in participants compared with the control. The results also suggested there were no significant differences in IgE, haemoglobin concentration and blood O&lt;sub&gt;2 &lt;/sub&gt;saturation in participants who wore masks for more than 6 hrs compared to the control group. The results showed a significant increase in pulse rate in participants who wore masks for more than 6 hrs compared to the control group. The results also showed a strong correlation coefficient between the time of wearing masks and some immunological, haematological parameters. &lt;b&gt;Conclusion:&lt;/b&gt; Wearing masks for long periods alters immunological parameters that initiate the immune response, making the body weaker in its resistance to infectious agents.

Decontamination and Reuse of N95 Filtering Facepiece Respirators: Where Do We Stand?

The coronavirus disease 2019 (COVID-19) pandemic created an extraordinary demand for N95 and similarly rated filtering facepiece respirators (FFR) that remains unmet due to limited stock, production constraints, and logistics. Interest in decontamination and reuse of FFR, a product class designed for single use in health care settings, has undergone a parallel surge due to shortages. A worthwhile decontamination method must provide effective inactivation of the targeted pathogen(s), and preserve particle filtration, mask fit, and safety for a subsequent user. This discussion reviews the background of the current shortage, classification, structure, and functional aspects of FFR, and potentially effective decontamination methods along with reference websites for those seeking updated information and guidance. The most promising techniques utilize heat, hydrogen peroxide, microwave-generated steam, or ultraviolet light. Many require special or repurposed equipment and a detailed operational roadmap specific to each setting. While limited, research is growing. There is significant variation between models with regard to the ability to withstand decontamination yet remain protective. The number of times an individual respirator can be reused is often limited by its ability to maintain a tight fit after multiple uses rather than by the decontamination method itself. There is no single solution for all settings; each individual or institution must choose according to their need, capability, and available resources. As the current pandemic is expected to continue for months to years, and the possibility of future airborne biologic threats persists, the need for plentiful, effective respiratory protection is stimulating research and innovation.

Individual- and Household-Level Interventions to Reduce Air Pollution Exposures and Health Risks: a Review of the Recent Literature

PURPOSE OF REVIEW

We reviewed recent peer-reviewed literature on three categories of individual- and household-level interventions against air pollution: air purifiers, facemasks, and behavior change.

RECENT FINDINGS

High-efficiency particulate air/arresting (HEPA) filter air purifier use over days to weeks can substantially reduce fine particulate matter (PM2.5) concentrations indoors and improve subclinical cardiopulmonary health. Modeling studies suggest that the population-level benefits of HEPA filter air purification would often exceed costs. Well-fitting N95 and equivalent respirators can reduce PM2.5 exposure, with several randomized crossover studies also reporting improvements in subclinical cardiovascular health. The health benefits of other types of face coverings have not been tested and their effectiveness in reducing exposure is highly variable, depends largely on fit, and is unrelated to cost. Behavior modifications may reduce exposure, but there has been little research on health impacts. There is now substantial evidence that HEPA filter air purifiers reduce indoor PM2.5 concentrations and improve subclinical health indicators. As a result, their use is being recommended by a growing number of government and public health organizations. Several studies have also reported subclinical cardiovascular health benefits from well-fitting respirators, while evidence of health benefits from other types of facemasks and behavior changes remains very limited. In situations when emissions cannot be controlled at the source, such as during forest fires, individual- or household-level interventions may be the primary option. In most cases, however, such interventions should be supplemental to emission reduction efforts that benefit entire communities.

Improving protection from bioaerosol exposure during postoperative patient interaction in the COVID-19 era, a quality improvement study

PURPOSE

During patient transport from operating room to post-operative recovery area, anesthesia staff are at increased risk of particle aerosolization from patients despite wearing face shields. Current single-use face shields do not provide anesthesia staff from adequate protection from bioaerosolized particles expired during a patient's cough, particularly during transfer from the operating room to the post-anesthesia recovery unit. In this study, we compare the efficacy of single-use face shield currently available at our institution to a newly designed face shield that provides better protection while still maintaining cost-effectiveness and the ease-of-use of a disposable device.

MATERIALS AND METHODS

A patient actor, simulated movements from a patient post-procedure, during transport from operating room to postoperative recovery area. Patterns of exposure of bioaerosolized particles produced from a cough between different face shields was evaluated using fluorescein dye.

MAIN RESULTS

More extensive coverage of the lower face, as provided by the Enhanced Protection Face Shield, offers improved droplet protection from bioaerosolized particles emitted from a cough.

CONCLUSIONS

Transfer from the operating room to the post-operative recovery unit is a hands-on process and involves managing multiple aspects of patient care physically. Current single-use face shields are convenient and cost-effective, but do not provide adequate protection from droplet aerosolization by patients during transfer. Other masks that provide adequate coverage are costly and are not designed to be single-use. A single-use disposable face shield that offers improved coverage of the lower face provides improved protection for anesthesia staff while maintaining cost-effectiveness, ease-of-use, and infection control.

Do "brassy" sounding musical instruments need increased safe distancing requirements to minimize the spread of COVID-19?

Brass wind instruments with long sections of cylindrical pipe, such as trumpets and trombones, sound "brassy" when played at a fortissimo level due to the generation of a shock front in the instrument. It has been suggested that these shock fronts may increase the spread of COVID-19 by propelling respiratory particles containing the SARS-CoV-2 virus several meters due to particle entrainment in the low pressure area behind the shocks. To determine the likelihood of this occurring, fluorescent particles, ranging in size from 10-50 μm, were dropped into the shock regions produced by a trombone, a trumpet, and a shock tube. Preliminary results indicate that propagation of small airborne particles by the shock fronts radiating from brass wind instruments is unlikely.

Conducting an evaluation of CBRN canister protection capabilities against emerging chemical and radiological hazards

In the event of a chemical, biological, radiological, or nuclear (CBRN) hazard release, emergency responders rely on respiratory protection to prevent inhalation of these hazards. The National Institute for Occupational Safety and Health's (NIOSH) CBRN Statement of Standard calls for CBRN respirator canisters to be challenged with 11 different chemical test representative agents (TRAs) during certification testing, which represent hazards from 7 distinct Chemical Families; these 11 TRAs were identified during the original 2001 CBRN hazard assessment. CBRN hazards are constantly evolving in type, intent of use, and ways of dissemination. Thus, new and emerging hazards must be identified to ensure CBRN canisters continue to provide protection to emergency responders against all hazards that would most likely be used in an intentional or unintentional event. The objectives are to: (1) update the CBRN list of hazards to ensure NIOSH-approved CBRN canisters continue to provide adequate protection capabilities from newly emerging chemical and radiological hazards and (2) identify the need to update NIOSH TRAs to ensure testing conditions represent relevant hazards. These objectives were accomplished by reviewing recent hazard assessments to identify a list of chemical and radiological respiratory hazards, evaluate chemical/physical properties and filtration behavior for these hazards, group the hazards based on NIOSH's current Chemical Families, and finally compare the hazards to the current TRAs based on anticipated filtration behavior, among other criteria. Upon completion of the evaluation process, 237 hazards were identified and compared to NIOSH's current CBRN TRAs. Of these 237 hazards, 203 were able to be categorized into one of NIOSH's current seven Chemical Families. Five were identified for further evaluation. Based on reviewing key chemical/physical properties of each hazard, NIOSH's current 11 TRAs remain representative of the identified respiratory CBRN hazards to emergency responders and should continue to be used during NIOSH certification testing. Thus, NIOSH's CBRN Statement of Standard remains unchanged. The process developed standardizes a methodology for future hazard evaluations.

Effect of speech volume on respiratory emission of oral bacteria as a potential indicator of pathogen transmissibility risk

Respiratory droplets emitted during speech can transmit oral bacteria and infectious viruses to others, including COVID-19. Loud speech can generate significantly higher numbers of potentially infectious respiratory droplets. This study assessed the effect of speech volume on respiratory emission of oral bacteria as an indicator of potential pathogen transmission risk. Loud speech (average 83 dBA, peak 94 dBA) caused significantly higher emission of oral bacteria (p = 0.004 compared to no speech) within 1 ft from the speaker. N99 respirators and simple cloth masks both significantly reduced emission of oral bacteria. This study demonstrates that loud speech without face coverings increases emission of respiratory droplets that carry oral bacteria and may also carry other pathogens such as COVID-19.

Identifying airborne transmission as the dominant route for the spread of COVID-19

Various mitigation measures have been implemented to fight the coronavirus disease 2019 (COVID-19) pandemic, including widely adopted social distancing and mandated face covering. However, assessing the effectiveness of those intervention practices hinges on the understanding of virus transmission, which remains uncertain. Here we show that airborne transmission is highly virulent and represents the dominant route to spread the disease. By analyzing the trend and mitigation measures in Wuhan, China, Italy, and New York City, from January 23 to May 9, 2020, we illustrate that the impacts of mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the pandemic trends in the three epicenters. This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. Our work also highlights the fact that sound science is essential in decision-making for the current and future public health pandemics.

Identifying airborne transmission as the dominant route for the spread of COVID-19

Various mitigation measures have been implemented to fight the coronavirus disease 2019 (COVID-19) pandemic, including widely adopted social distancing and mandated face covering. However, assessing the effectiveness of those intervention practices hinges on the understanding of virus transmission, which remains uncertain. Here we show that airborne transmission is highly virulent and represents the dominant route to spread the disease. By analyzing the trend and mitigation measures in Wuhan, China, Italy, and New York City, from January 23 to May 9, 2020, we illustrate that the impacts of mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the pandemic trends in the three epicenters. This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. Our work also highlights the fact that sound science is essential in decision-making for the current and future public health pandemics.

A technique to measure respirator protection factors against aerosol particles in simulated workplace settings using portable instruments

The aim of this study was to develop a new method to measure respirator protection factors for aerosol particles using portable instruments while workers conduct their normal work. The portable instruments, including a set of two handheld condensation particle counters (CPCs) and two portable aerosol mobility spectrometers (PAMSs), were evaluated with a set of two reference scanning mobility particle sizers (SMPSs). The portable instruments were mounted to a tactical load-bearing vest or backpack and worn by the test subject while conducting their simulated workplace activities. Simulated workplace protection factors (SWPFs) were measured using human subjects exposed to sodium chloride aerosols at three different steady state concentration levels: low (8x10³ particles/cm³), medium (5x10⁴ particles/cm³), and high (1x10⁵ particles/cm³). Eight subjects were required to pass a quantitative fit test before beginning a SWPF test for the respirators. Each SWPF test was performed using a protocol of five exercises for 3 min each: (1) normal breathing while standing; (2) bending at the waist; (3) a simulated laboratory-vessel cleaning motion; (4) slow walking in place; and (5) deep breathing. Two instrument sets (one portable instrument {CPC or PAMS} and one reference SMPS for each set) were used to simultaneously measure the aerosol concentrations outside and inside the respirator. The SWPF was calculated as a ratio of the outside and inside particles. Generally, the overall SWPFs measured with the handheld CPCs had a relatively good agreement with those measured with the reference SMPSs, followed by the PAMSs. Under simulated workplace activities, all handheld CPCs, PAMSs, and the reference SMPSs showed a similar GM SWPF trend, and their GM SWPFs decreased when simulated workplace movements increased. This study demonstrated that the new design of mounting two handheld CPCs in the tactical load-bearing vest or mounting one PAMS unit in the backpack permitted subjects to wear it while performing the simulated workplace activities. The CPC shows potential for measuring SWPFs based on its light weight and lack of major instrument malfunctions.

Secondhand Smoke Exposure in Public Places and Support for Smoke-Free Laws in Japan: Findings from the 2018 ITC Japan Survey

Comprehensive smoke-free policies such as those called for by the WHO FCTC are the only way to protect the public effectively from the harms of secondhand smoke (SHS), yet Japan has been slow to implement this important health measure. This study examines baseline levels of smoking and SHS exposure in public places and support for smoking bans in Japan prior to the implementation of the 2018 national smoke-free law. Data are from the International Tobacco Control (ITC) Japan Wave 1 Survey (Feb-Mar 2018), a web survey of adult cigarette smokers, heated tobacco product users, dual users, and non-users (total N = 4684). Measures included prevalence of smoking (whether respondents noticed people smoking inside restaurants and bars at their last visit, and workplaces in the last month), and support for complete smoking bans in these venues. Smoking prevalence in each venue was high overall in 2018 (49% of workplaces, 55% of restaurants, and 83% of bars), even higher than in China, the country with the greatest toll of SHS. Support for complete smoking bans was very high overall (81% for workplaces, 78% for restaurants, and 65% for bars). Non-users were less likely to be exposed to SHS and had higher support for smoking bans than tobacco users. These findings point to the ineffectiveness of partial smoke-free laws in Japan and reinforce the call for comprehensive smoke-free laws, which even smokers would support at higher levels than in many other ITC countries.

Assessment of aloe vera for qualitative fit testing of particulate respirators: a logistic regression approach

Fit testing procedure is required for filtering facepiece respirators (FFRs) to ascertain an acceptable fit between the skin and facepiece sealing surface. The present study seeks to compare the efficacy of Aloe vera (A. vera) and commercial BitrexTM as challenge agents of qualitative fit testing of particulate respirators. An herbal solution consisting of A. vera at seven different concentrations was developed. Threshold Screening Tests (TSTs) of A. vera solutions were compared to BitrexTM. To do so, solutions were administered randomly on a total of 62 participants. A placebo was also tested to ensure the taste response being valid. Statistical analysis was performed using R 3.2.5.0 software. There were no statistically significant differences between the A. vera (41.7, 58.3, 75, and 91.7 mg/ml) and BitrexTM threshold tests. Therefore, the minimum concentration of A. vera to develop the threshold solution was considered to be 41.7 mg/ml. When commercial products are expensive and unavailable, a cost-effective technique would be to replace A. vera solution with a commercial product as a challenge agent of qualitative fit testing of respirators.

Masks for the Reduction of Methyl Methacrylate Vapor Inhalation

BACKGROUND

Exposure to methyl methacrylate vapor (MMA) presents an occupational risk to orthopedic surgeons and ancillary personnel in the operating room. The purpose of this study was to identify a disposable face mask to reduce MMA organic vapor inhalation in the operative suite.

METHODS

First, the effectiveness of MMA vapor filtration was determined in the laboratory. A section of activated carbon impregnated filter face mask (Model 8514, 3M Inc.) was exposed to 150 ppm MMA vapor and MMA ppm of filtered air was monitored until MMA vapor was detectable. The face mask was then worn as directed in the operating room during routine cement mixing during total knee arthroplasty to determine the exposure to MMA vapors during the procedure both with and without the activated carbon impregnated filter face mask.

RESULTS

The activated carbon impregnated face mask was effective in reducing MMA vapor inhalation to non-detectable levels for up to 40 minutes in the laboratory at steady-state exposure of 150 ppm MMA vapor as well as throughout cement mixing and curing in the operative suite during routine total knee arthroplasty.

CONCLUSIONS

An activated carbon impregnated face mask offers a solution for the orthopedic surgeon and supporting personnel who wish to limit their exposure to MMA vapors due to health concerns.Level of Evidence: III.

A randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children

Children are more vulnerable to the risks of air pollution, including susceptibility to acquiring chronic diseases in their developing lungs. Despite these, there are no specific masks designed for and tested in children that are available to protect our young from the common particulate air pollutants today. We evaluated safety, fit and comfort of a specially designed paediatric N95 mask with an optional micro ventilator (micro fan, MF) in healthy children aged 7-14 years, in a randomized, two-period crossover design. The subjects' cardiorespiratory physiological measurements were assessed in different states of physical activity under different interventions (mask without and with MF). A total of 106 subjects were recruited between July-August 2016. The use of the mask without MF increased the End-Tidal CO2 (ETCO2) and Fractional concentration of Inspired CO2 (FICO2) at rest and on mild exertion, as expected. The use of the mask with MF brought FICO2 levels comparably closer to baseline levels without the mask for both activities. The mask, with or without the MF, was found to be well fitting, comfortable and safe for use in children at rest and on mild exertion. The N95 mask tested offers a promising start for more studies in the paediatric population.

Cleaning workers' exposure to volatile organic compounds and particulate matter during floor polish removal and reapplication

The floor polish removal (FPR) and reapplication (FPA) are important cleaning tasks in public buildings that have hard floor surfaces. Usually, the FPR and FPA are conducted once or twice a year, during the periodic cleaning of these buildings. The FPR can be performed either chemically (CFPR) or by using dry scrubber (DFPR), when the polish is ground from the floor. In this study, cleaning workers' exposure to volatile organic compounds (VOCs) and particulate matter (PM) during the FPR and FPA, and the differences in the exposures between the two FPR methods were investigated. In total, three buildings located in Central Finland were included, and total of six cleaning workers (two per building) participated in the study. In Buildings 1 and 2, the CFPR and FPA were performed and in Building 3, the DFPR was conducted. TVOC (total volatile organic compounds) concentrations in the breathing zone of the workers during the CFPR were 8,740 and 390 µg/m³ (SD 3,290 and 180 µg/m³) for Buildings 1 and 2, respectively. During the DFPR in Building 3, the average TVOC concentration was 400 µg/m³ (SD 180 µg/m³, stationary sampling). The TVOC concentrations during the FPA were high, 1,640 and 2,170 µg/m³ on average (SD 1,570 and 930 µg/m³) for Buildings 1 and 2, respectively. Glycol ethers were the most prominent VOCs during the CFPR and FPA, whereas carboxylic acids were the most common during the DFPR. The inhalable dust concentrations in the workers' breathing zone were noticeably higher during the DFPR (1.55 mg/m³ on average, SD 0.01 mg/m³) than the CFPR (0.24 mg/m³ on average, SD 0.05 mg/m³). Finnish occupational exposure limit value for organic inhalable dust is 5 mg/m³. As the products used during the CFPR and FPA contain glycol ethers and ethanolamines that are absorbed via the skin as well, the use of skin protection is recommended. Whereas the use of FFP3 respirators and skin protection are recommended during the DFPR to prevent the PM exposure.

Turbulent Aggregation and Deposition Mechanism of Respirable Dust Pollutants under Wet Dedusting using a Two-Fluid Model with the Population Balance Method

In this paper, a mathematical model based on the two-fluid (Euler–Euler) frame model for wet dedusting process is proposed. The model considers in detail the aggregation of particles and droplets caused by turbulence and Brownian diffusion as well as the gravitational deposition process. The population balance model (PBM) is used to describe the spatiotemporal evolution of particle size distribution (PSD) for the dust particle and the water droplet. The wet dedusting process under different conditions is simulated and compared with the detailed experimental data. The results show that the experimental data and simulation results are within the allowable range of error (about 32.3–61.2% in dedusting efficiency for respirable dust by experimental data and about 47.3–57.9% in it by simulation results). This model can be used to predict the effect of PSD of the dust particle, spray flow, and ventilation rate on dedusting efficiency of wet dedusting. The parameter analysis shows that dedusting efficiency decreases as particle size decreases. In order to ensure high capture efficiency of respirable dust, the diameter of droplets should be controlled to between 15 μm and 70 μm. The ratio of droplet volume flow to dust volume flow increases from 2.0 to 12.0, while dedusting efficiency only increases from 39.2% to 54.7%, so it is clear that for spray quantity to dedusting efficiency, larger is not necessarily better. Besides this, the speeds of both spray droplets and ventilation also have great influence on dedusting efficiency, and the related formulas are given.

Evaluation of filtration characteristics and microbial recovery rates of commercial filtering facepiece respirators against airborne bacterial particles

Many brands of filtering facepiece respirators are used against air pollution, including bioaerosols; however, studies have explored exposure to bioaerosols from the inside surfaces of respirators. We evaluated the filtration efficiencies and microbial recovery rates of commercial filtering facepiece respirators against bioaerosols. Eight filtering facepiece respirators and one surgical mask were selected, all with high market shares in the Republic of Korea and certified by national or international standards. The tested filtering facepiece respirators were installed on the head of a mannequin under various airflow velocity and relative humidity (RH) conditions. The filtration efficiency against Staphylococcus epidermidis and Escherichia coli bioaerosols, the pressure drop of the filter, and the relative recovery rates for the bacteria were evaluated. The filtration efficiency of each filtering facepiece respirator ranged from 82% to 99%, depending on the filtration grade. The pressure drop was significantly affected by variations in the surrounding RH. The mean relative recovery rates of all filtering facepiece respirators were 14 ± 4.8% and 9 ± 4.7% for S. epidermidis and E. coli, respectively. These results indicate that airborne microorganisms can survive and accumulate on the surfaces of filtering facepiece respirators, which may lead to harmful health outcomes. Our findings will be useful as background information for the development of commercial filtering facepiece respirators while considering their biological properties and reliable guidance to users.

Motivational Interviewing: A High-Yield Interactive Session for Medical Trainees and Professionals to Help Tobacco Users Quit

Introduction

Motivational interviewing (MI) is a collaborative patient-focused counseling technique that is effective in promoting smoking cessation but is not consistently taught/practiced in training.

Methods

This training session was implemented in a pediatric residency training program and also given four times to pediatric practitioners as part of a 2-day tobacco training sponsored by the American Academy of Pediatrics (AAP). Pediatric residents (N = 33) participated in a 1-hour interactive session focused on addressing tobacco. Knowledge was assessed with pre- and 6-month postsurveys. Retention of skills was evaluated between 6 and 9 months posttraining by resident performance on two scenarios with standardized patients, which was scored utilizing the Behavior Change Counseling Index (BECCI), by two MI-trained physicians. AAP trainees (N = 115) participated in tobacco trainings with a session dedicated to MI; sessions were evaluated by pre- and posttests.

Results

Residents who completed the session (n = 12) performed significantly better on eight of 10 items of the BECCI and on the overall BECCI score (p < .001) compared with those who had not completed the session (n = 12). Feedback on AAP training sessions (N = 115) indicated that practitioners felt able to perform MI and incorporate MI into practice. The percentage of trainees who felt comfortable counseling about tobacco doubled from pre- to posttraining.

Discussion

A hands-on MI training session provided pediatric residents and practicing clinicians with knowledge and skills to address tobacco use with patients/families. The session is easily incorporated into different training environments.

A pilot study of minimum operational flow for loose-fitting powered air-purifying respirators used in healthcare cleaning services

The objective of this pilot study was to determine the minimum operational flow for loose-fitting powered air-purifying respirators (PAPR) used in healthcare cleaning services. An innovative respiratory flow recording device was worn by nine healthcare workers to obtain the minute volume (MV, L/min), mean inhalation flow (MIF, L/min), and peak inhalation flow (PIF, L/min) while performing "isolation unit work" (cleaning and disinfecting) of a patient room within 30 min. The MV and PIF were compared with the theoretical values obtained from an empirical formula. The correlations of MV, MIF, and PIF with subjects' age, weight, height, body surface area (A_Du), and body mass index (BMI) were analyzed. The average MV, MIF, and PIF were 33, 74, and 107 L/min, with maximal airflow rates of 41, 97, and 145 L/min, respectively, which are all below the current 170 L/min minimum operational flow for NIOSH certified loose-fitting PAPRs.

A Control Banding Framework for Protecting the US Workforce from Aerosol Transmissible Infectious Disease Outbreaks with High Public Health Consequences

Recent high-profile infectious disease outbreaks illustrate the importance of selecting appropriate control measures to protect a wider range of employees, other than those in healthcare settings. In such settings, where routine exposure risks are often high, control measures may be more available, routinely implemented, and studied for effectiveness. In the absence of evidence-based guidelines or established best practices for selecting appropriate control measures, employers may unduly rely on personal protective equipment (PPE) because of its wide availability and pervasiveness as a control measure, circumventing other effective options for protection. Control banding is one approach that may be used to assign job tasks into risk categories and prioritize the application of controls. This article proposes an initial control banding framework for workers at all levels of risk and incorporates a range of control options, including PPE. Using the National Institutes of Health (NIH) risk groups as a surrogate for toxicity and combining the exposure duration with the exposure likelihood, we can generate the risk of a job task to the worker.

Inactivation of airborne bacteria using different UV sources: Performance modeling, energy utilization, and endotoxin degradation

Airborne bacteria-containing bioaerosols have attracted increased research attention on account of their adverse effects on human health. Ultraviolet germicidal irradiation (UVGI) is an effective method to inactivate airborne microorganisms. The present study models and compares the inactivation performance of three UV sources in the UVGI for aerosolized Escherichia coli. Inactivation efficiency of 0.5, 2.2 and 3.1 logarithmic order was obtained at an exposure UV dose of 370 J/m³ under UVA (365 nm), UVC (254 nm) and UVD (185 nm) sources, respectively. A Beer-Lambert law-based model was developed and validated to compare the inactivation performances of the UV sources, and modeling enabled prediction of inactivation efficiency and analysis of the sensitivity of several parameters. Low influent E. coli concentrations and high UV doses resulted in high energy consumption (EC). The change in airborne endotoxin concentration during UV inactivation was analyzed, and UVC and UVA irradiation showed no marked effect on endotoxin degradation. By contrast, both free and bound endotoxins could be removed by UVD treatment, which is attributed to the ozone generated by the UVD source. The results of this study can provide a better understanding of the air disinfection and airborne endotoxin removal processes.

Pilot study on the efficiency of water-only decontamination for firefighters' turnout gear

Firefighters are exposed to toxic environments upon entering burning structures. Many structures contain synthetic materials which release toxic chemicals when on fire. These chemicals can enter the body through multiple routes of exposure, including inhalation and skin absorption. Thus, according to the fire departments included in this study, firefighters now conduct on-site decontamination procedures to remove hazardous chemicals, including polycyclic aromatic hydrocarbons (PAHs) from the surface of firefighter turnout gear. Several methods are being practiced at the local level, including decontamination with soap and water, and decontamination with water alone. The water-only decontamination method requires less time and supplies yet has not been investigated as a suitable method for removing polycyclic aromatic hydrocarbons from turnout gear. Therefore, we evaluated the efficiency of this method by measuring PAH concentration levels before and after water-only decontamination. The calculated efficiency displays the percentage of PAHs removed (or not removed) at post-decontamination in relation to the initial sample collected at pre-decontamination. The turnout gear was sampled after live residential structure fires. Firefighter turnout gear was worn throughout Attack, Overhaul Search and Rescue, and Rescue from Fire operations. All firefighters came to a central location for sampling after completing their job responsibilities. Water only decontamination did not appear to be effective, resulting in an overall 42% increase in PAH contamination. The unexpected increase may have been due to disparate pre- and post-decontamination sampling sites on turnout gear.

Exposure to airborne nano-titanium dioxide during airless spray painting and sanding

The objectives of the study were to measure and characterize exposure to airborne nanoscale titanium dioxide during airless spraying and sanding of a nano-enabled paint, and to evaluate the effectiveness of dust capture methods in reducing airborne nanoparticle concentrations. A tradesperson performed the work activities in an environmentally controlled chamber. Samples were collected in the tradesperson's breathing zone and in surrounding areas to assess bystander exposure. Filter-based samples were analyzed using gravimetric methods, scanning electron microscopy, and energy dispersive spectroscopy. Differential particle count data were obtained by means of a scanning mobility particle sizer. Local exhaust ventilation provided statistically significant reductions of airborne nanoparticle concentrations during sanding. Sanding the paint after drying with a handheld power sander generated relatively low levels of airborne titanium dioxide. In contrast, task-based exposure measurements collected during the initial airless spray application of the nano-enabled paint suggested a potential for occupational exposures to exceed the time-weighted average exposure limit for ultrafine titanium dioxide recommended by the National Institute for Occupational Safety and Health. Painters applying nano-enabled coatings may have little recourse but to rely, in some instances, on lower tiers of the hierarchy of controls, such as personal protective equipment. In light of these findings, employers and industrial hygienists should characterize exposures and implement the hierarchy of controls to ensure painters are sufficiently protected.

Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China

IMPORTANCE

Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear.

OBJECTIVES

To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018.

EXPOSURES

Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 μm [PM2.5] and ≤1.0 μm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 μm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]).

MAIN OUTCOMES AND MEASURES

Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods.

RESULTS

Participants included 15 477 adults (47.3% women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8%, and the prevalence of cardiometabolic risk factors ranged from 8.6% (hyperbetalipoproteinemia) to 40.5% (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) μg/m3 (for NO2) to 123.1 (14.6) μg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95% CI, 1.03-1.78] for a 10-μg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95% CI, 1.02-1.09] for a 10-μg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-μg/m3 increase in PM1.0, 1.22 [95% CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95% CI, 0.98-1.16] in participants without hyperbetalipoproteinemia).

CONCLUSIONS AND RELEVANCE

In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.

Effectiveness of commercial face masks to reduce personal PM exposure

Cycling and walking are promoted as means of transportation which can contribute to the reduction of traffic pollution in urban areas. However, cyclists and pedestrians may be exposed to high concentrations of air pollutants due to their proximity to vehicle emissions. Commercial face mask respirators are widely used, in both developing and developed countries, as an individual protective measure against particle pollution. However scientific data on the efficacy of face mask respirators in reducing airborne particle exposure is limited. In this study, a custom experimental set-up was developed in order to measure the effectiveness of nine different respirators under real environmental conditions in terms of particle mass concentration below 2.5 μm (PM_2.5), particle number concentration (PNC), Lung Deposited Surface Area (LDSA) and Black Carbon concentration (BC). Face mask performances were assessed in a typical traffic affected urban background environment in the city of Barcelona under three different simulated breathing rates to investigate the influence of flow rate. Results showed a median face mask effectiveness for PM_2.5 equal to 48% in a range of 14-96%, 19% in a range of 6%-61% for BC concentration, 19% in a range of 4%-63% for PNC and 22% in a range of 5%-65% for LDSA. For each pollutant under investigation, the best performance was found always with the same mask (N7) although it is not the most expensive (in a range of price of 1 to 44, its cost was 20 euros), which has a filter on the entire surface except for the 2 exhalation valves where air cannot enter but just exit and shows a good fit on the dummy head.

Assessment of displacement ventilation systems in airborne infection risk in hospital rooms

Efficient ventilation in hospital airborne isolation rooms is important vis-à-vis decreasing the risk of cross infection and reducing energy consumption. This paper analyses the suitability of using a displacement ventilation strategy in airborne infection isolation rooms, focusing on health care worker exposure to pathogens exhaled by infected patients. The analysis is mainly based on numerical simulation results obtained with the support of a 3-D transient numerical model validated using experimental data. A thermal breathing manikin lying on a bed represents the source patient and another thermal breathing manikin represents the exposed individual standing beside the bed and facing the patient. A radiant wall represents an external wall exposed to solar radiation. The air change efficiency index and contaminant removal effectiveness indices and inhalation by the health care worker of contaminants exhaled by the patient are considered in a typical airborne infection isolation room set up with three air renewal rates (6 h-1, 9 h-1 and 12 h-1), two exhaust opening positions and two health care worker positions. Results show that the radiant wall significantly affects the air flow pattern and contaminant dispersion. The lockup phenomenon occurs at the inhalation height of the standing manikin. Displacement ventilation renews the air of the airborne isolation room and eliminates the exhaled pollutants efficiently, but is at a disadvantage compared to other ventilation strategies when the risk of exposure is taken into account.