Comfort and tolerability of protective face masks used by healthcare professionals during the COVID-19 pandemic

Year 2022, Volume: 3 Issue: 1, 17 - 26, 12.03.2022

Murat Duyan , İbrahim Ulaş Özturan , Mustafa Ayhan Ozbek Hüseyin Sevıl Ökkeş Zortuk , Resmiye Nur Okudan , Fatih Selvi , Aslıhan Yürüktümen Ünal , Yıldıray Çete

https://doi.org/10.48176/esmj.2022.48

Abstract

Introduction: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is transmitted by respiratory droplets, and all healthcare professionals (HCPs) have been required to use protective face masks during long working hours. However, the tolerability of different types of face masks varies and can lead to physical or psychological burden for wearer. This study aimed to determine the tolerability and symptoms of commonly used face masks among HCPs.
Methods: This prospective observational study was conducted in the COVID-19 areas of three academic emergency departments (EDs). HCPs, including physicians, nurses, and other personnel were included. The comfort and tolerability of surgical masks, filtering face piece-2 (FFP2), and FFP3 respirators and the symptoms experienced during the four-hour study period were evaluated hourly. The primary outcomes were the severity and duration of discomfort or symptoms experienced according to the type of mask used.
Results: A total of 181 volunteer HCPs were included in the study. Dyspnea was the most common symptom. According to a seven-point Likert scale that measured the wearer’s experience of symptoms, the severity of the first discomfort/symptom was two points on average, and the main discomfort/symptom that led to masking removal was four points. The median time for the appearance of discomfort/symptoms was 70 minutes for the single-layer surgical masks and 50 minutes for the FFP2 and FFP3 masks.
Conclusion: Dyspnea and headache were the most common causes of intolerance to masks used by HCPs. Although statistical significance was not achieved, the duration of mask use was lower in those who used FFP2 and FFP3 masks.  

Keywords

Occupational Health, Personal protective equipment, COVID-19, Face mask, Respiratory Protection/Respirators

COVID-19 Salgını Sırasında Sağlık Profesyonelleri Tarafından Kullanılan Koruyucu Yüz Maskelerinin Rahatlığı ve Tolere Edilebilirliğinin Değerlendirilmesi

Abstract

Giriş: Şiddetli akut solunum sendromu koronavirüs 2 (SARS-CoV-2) virüsü solunum damlacıkları ile bulaşır ve tüm sağlık çalışanlarının uzun çalışma saatleri boyunca koruyucu yüz maskeleri kullanmaları istenmiştir. Bununla birlikte, farklı yüz maskelerinin tolere edilebilirliği değişiklik gösterir ve kullanıcı için fiziksel veya psikolojik yüke yol açabilir. Bu çalışma, sağlık çalışanları arasında yaygın olarak kullanılan yüz maskelerinin tolere edilebilirliğini ve semptomlarını belirlemeyi amaçlamıştır.
Yöntemler: Bu prospektif gözlemsel çalışma, üç akademik acil servisin (ED) COVID-19 alanlarında yürütülmüştür. Doktorlar, hemşireler ve diğer personel dahil olmak üzere tüm sağlık çalışanları dahil edildi. Cerrahi maskeler, FFP2 ve FFP3 solunum cihazlarının konforu ve tolere edilebilirliği ile dört saatlik çalışma süresi boyunca yaşanan semptomlar saatlik olarak değerlendirildi. Birincil sonuçlar, kullanılan maske tipine göre yaşanan rahatsızlık veya semptomların şiddeti ve süresiydi.
Bulgular: Çalışmaya toplam 181 gönüllü sağlık çalışanı dahil edildi. Dispne en sık görülen semptomdu. Kullanıcının semptom deneyimini ölçen yedi puanlık bir Likert ölçeğine göre, ilk rahatsızlığın/semptomun şiddeti ortalama iki puan ve maskenin çıkarılmasına yol açan ana rahatsızlık/semptomun dört puan olduğu görüldü. Rahatsızlık/semptomların ortaya çıkması için medyan süre, tek katmanlı cerrahi maskeler için 70 dakika ve FFP2 ve FFP3 maskeleri için 50 dakika idi.
Sonuç: Dispne ve baş ağrısı, sağlık çalışanları tarafından kullanılan maskelere karşı en yaygın intoleransın nedenleriydi. İstatistiksel anlamlılık elde edilemese de FFP2 ve FFP3 maske kullananlarda maske kullanım süresi daha düşüktü.

Keywords

İş Sağlığı, Kişisel koruyucu donanım, COVID-19, Yüz maskesi, Solunum Koruması/Solunum Cihazları

References

• References 1. Huang, C., Y. Wang, X. Li, L. Ren, et al., Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020. 395(10223): p. 497-506.
• 2. COVID-19 Dashboard. 2021 [cited 2021 September]; Available from: https://gisanddata.maps.arcgis.com/apps/dashboards/bda7594740fd40299423467b48e9ecf6.
• 3. Paules, C.I., H.D. Marston, and A.S. Fauci, Coronavirus Infections-More Than Just the Common Cold. JAMA, 2020. 323(8): p. 707-708.
• 4. Osseiran, N. WHO calls for healthy, safe and decent working conditions for all health workers, amidst COVID-19 pandemic. 2020 [cited 2021 May]; Available from: https://www.who.int/news/item/28-04-2020-who-calls-for-healthy-safe-and-decent-working-conditions-for-all-health-workers-amidst-covid-19-pandemic.
• 5. WHO, Rational use of personal protective equipment for coronavirus disease (COVID-19) and considerations during severe shortages, in COVID-19: Infection prevention and control, W. Headquarters, Editor. 2020.
• 6. NIOSH. COVID-19 Information for Workers. 2018 [cited 2021 April]; Available from: https://www.cdc.gov/niosh/index.htm.
• 7. Wizner, K., M. Nasarwanji, E. Fisher, A.L. Steege, and J.M. Boiano, Exploring respiratory protection practices for prominent hazards in healthcare settings. J Occup Environ Hyg, 2018. 15(8): p. 588-597.
• 8. Zhang, X., H. Li, S. Shen, and M. Cai, Investigation of the flow-field in the upper respiratory system when wearing N95 filtering facepiece respirator. J Occup Environ Hyg, 2016. 13(5): p. 372-82.
• 9. Gillespie, C. Does Wearing a Face Mask Reduce Oxygen—and Can It Increase CO2 Levels? Here's What Experts Say. 2020 [cited 2021 April]; Available from: https://www.health.com/condition/infectious-diseases/coronavirus/does-wearing-face-mask-increase-co2-levels.
• 10. Johnson, A.T., Respirator masks protect health but impact performance: a review. J Biol Eng, 2016. 10: p. 4.
• 11. Scarano, A., F. Inchingolo, and F. Lorusso, Facial Skin Temperature and Discomfort When Wearing Protective Face Masks: Thermal Infrared Imaging Evaluation and Hands Moving the Mask. Int J Environ Res Public Health, 2020. 17(13).
• 12. Siegel, J.D., E. Rhinehart, M. Jackson, L. Chiarello, and C. Health Care Infection Control Practices Advisory, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control, 2007. 35(10 Suppl 2): p. S65-164.
• 13. Rosner, E., Adverse Effects of Prolonged Mask Use among Healthcare Professionals during COVID-19. Journal of Infectious Diseases and Epidemiology, 2020. 6: p. 130.
• 14. Coronavirus disease (COVID-19): Masks. 2020 [cited 2021 April]; Available from: https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-masks.
• 15. Kumar, S. and A. Singh, Prolonged Use of n95 Mask a Boon or Bane to Healthcare Workers During Covid-19 Pandemic. Indian J Otolaryngol Head Neck Surg, 2021: p. 1-4.
• 16. Derrick, J.L. and C.D. Gomersall, Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks. J Hosp Infect, 2005. 59(4): p. 365-8.
• 17. Improve How Your Mask Protects You. About COVID-19. 2021 [cited 2021 April]; Available from: https://www.cdc.gov/coronavirus/2019-ncov/your-health/effective-masks.html.
• 18. World Health Organization. Coronavirus Disease (COVID-19) Advice for the Public: Myth Busters. 2020 [cited 2021 April]; Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters.
• 19. Considerations for Wearing Cloth Face Coverings. 2020 [cited 2021 April]; Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html.
• 20. Ipek, S., S. Yurttutan, U.U. Gullu, T. Dalkiran, et al., Is N95 face mask linked to dizziness and headache? Int Arch Occup Environ Health, 2021.
• 21. Smith, C.L., J.L. Whitelaw, and B. Davies, Carbon dioxide rebreathing in respiratory protective devices: influence of speech and work rate in full-face masks. Ergonomics, 2013. 56(5): p. 781-90.
• 22. Geiss, O., Effect of Wearing Face Masks on the Carbon Dioxide Concentration in the Breathing Zone. Aerosol Air Qual. Res., 2021. 21(200403).