Monday, June 15, 2020

Respirators vs. Surgical Masks- What's the Difference?



Respirator vs. Surgical Mask - What's the Difference?
Written by: Dr. Robert Bard, MD, PC, DABR, FASLMS  |  Edited by: Cheri Ambrose

Months into the pandemic, we have confirmed that following CDC safety and prevention guidelines of wearing some approved form of face covering in public (or around others) is directly connected to the reduction and control of Covid-19 infection rates.  Time and time again, scientists and medical experts have valid proof that viruses travel through micro-droplets in the form of airborne contaminants. 

Fact: ANY PPE is better than NO PPE!  The science of prevention states that measures toward a reduction in risk can greatly support life-saving others - and yourself.  Meanwhile, discerning the difference between face coverings, specifically MASKS vs RESPIRATORS can be useful in identifying which situation to use which type of mask. There is a significant difference between the two, and wearing one vs. the other provides differing results.

The FDA defines a surgical mask as a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. If worn properly, a surgical mask is meant to help block large-particle droplets (NOT MICRO-DROPLETS), splashes, sprays, or splatter that may contain germs (viruses and bacteria), keeping it from reaching your mouth and nose. Surgical masks may also help reduce exposure of your saliva and respiratory secretions to others. While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the mask and your face.

Meanwhile, an N95 respirator is an "efficient filter and a respiratory protective device designed to PROTECT YOU from airborne particles". Note that the edges of the respirator are designed to form a seal around the nose and mouth. Surgical N95 Respirators are commonly used in healthcare settings and are a subset of N95 Filtering Facepiece Respirators (FFRs), often referred to as N95s because it is actually rated by NIOSH to keep out or resist an estimated 95% of the harmful particulates in the air. [11]



KILLER BREATH CONTAINED GLOBALLY BY "MASKING TOGETHER"
by: Dr. Pierre Kory, M.D., M.P.A.

As far as respiratory protection, there has been quite a bit of confusion about MASK vs. RESPIRATOR in the early stages of COVID-19.  This was not just in the general public, but among many hospitals and infection control departments.  

Initially, there was a great deal of reluctance in accepting the belief that COVID-19 could be transmitted via airborne means.  To explain this, viral infections (like the flu) are considered to be transmitted by what's called large droplets. When speaking, we all force out a little spittle with sizes ranging from visible to microscopic- such that you don't see leaving the mouth. The larger droplets do not travel far and do not “float” in the air and thus, social distancing is highly effective at preventing contact with a contaminated droplet reaching your oral mucosa or face. 

However, AIRBORNE droplets are tiny, and can float and linger in the air for a period of time.  Airborne micro-droplets can be directly inhaled along with the virus without any person-to-person contact and even at large distances of separation. Just sharing the same room with an infected person, you can inhale the floating particles that they are exhaling, if they are not wearing a mask. This is what makes this infection different and much more dangerous than others. However, if an infected person near you is wearing a mask, even a simple one, the mask will trap the larger droplets so that smaller droplets are not created and will not become airborne. To achieve this protection, you need near 100% mask-wearing in confined indoor spaces.


Without near universal mask wearing, you get these "super spreader" events where someone went to choir practice and 52 of the 60 people there all came home sick. That's because tiny droplets were out in the air and floating. The only way to protect yourself from an airborne sized droplet emitted by a non-mask wearer is by you yourself wearing an N95 respirator. In such a situation, your N95 will filter out those tiny little particles from entering your airways. If fitted properly the N95 blocks 99% of the particles- and there's significant proof that the rates of infection among healthcare workers went drastically down after we started using N95 everywhere around COVID patients, none of whom were wearing any kind of mask which would have helped protect us.



Covid-19 : LaVision imaging technique shows how masks restrict the spread of exhaled air.  The primary way of person-to-person corona virus transmission is via aerosols or small droplets created by breathing, sneezing or coughing. The reach of exhaled air can be effectively reduced using a face mask as shown in the video. A simple Schlieren imaging technique is applied to visualize the air flow caused by a person breathing and coughing. Using a face mask the exhaled air flow is blocked reducing effectively the risk of infection. 



At a certain point, I was convinced that the entire world had to get an N95 mask to achieve sufficient protection from transmission within indoor spaces- but then I learned later that using a standard cloth mask (or a even a surgical mask) actually DOES work. And the reason why the data's showing such masks work is that if you look at a lot of the countries which successfully controlled the spread of this infection, all of those countries had mandated a hundred percent use of general face covering throughout the population. The way it works is, when two or more people are using a NON-N95 mask in a room, those large droplets would be trapped in the mask- not transmitting and not forming micro-particles that go airborne! By me wearing a mask, it actually protects YOU from me making those little airborne particles. 

An effective scarf or home-made cloth mask may not have the same makeup as the N95, but they DO block about 60 to 70% of the particles. So they're not perfect, but what the data shows and what the epidemiological data shows from all those successful countries that controlled their cases is that as long as everybody wears a mask, any type of mask, the combined performance of two people  with those masks from each other actually reduces the risk of transmission to a very, very low level.



CONTRIBUTORS

ROBERT L. BARD, MD, PC, DABR, FASLMS
Advanced Imaging & Diagnostic Specialist
Dr. Bard received the 2020 nationally acclaimed Ellis Island Award for his lifetime achievement in advanced cancer diagnostic imaging. He co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital imaging technology and has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered sonograms, Power Doppler Histogram, sonofluoroscopy, 3D/4D image reconstruction and the Power Doppler Histogram  are safe, noninvasive, and do not use ionizing radiation. 

PIERRE KORY, M.D., M.P.A.
Dr. Kory is Board Certified in Internal Medicine, Critical Care, and Pulmonary Medicine. He served as the Medical Director of the Trauma and Life Support Center at the University of Wisconsin where he was an Associate Professor and the Chief of the Critical Care Service. He is considered a pioneer and national/international expert in the field of Critical Care Ultrasound and is the senior editor of the widely read textbook “Point-of-Care Ultrasound” (winner of the President’s Choice Award for Medical Textbooks from the British Medical Association in 2015).  Most recently, Dr. Kory joined the emergency volunteer team during the early COVID-19 pandemic in NYC at Mount Sinai Beth Israel Medical Center. He is also a founding member of the Front Line COVID-19 Critical Working Group (flccc.net) composed of 5 critical care experts that devised the COVID-19 treatment protocol called MATH+. (www.covid19criticalcare.com/)


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POTENTIAL HEALTH RISKS BEHIND THE MASK
Introduction By: R. Christenson, MD (From: "Holding the Front Line with Zero"- an essay by a covid health responder)

During the worst 2 months of the pandemic in New York, I spent countless double-shifts in a constantly slammed Long Island Covid Unit, tending to what seemed like a never-ending avalanche of critical cases.  The vast majority of our medical team was stretched to the very max of their professional tolerance, where each traumatic situation bred severe anxiety, PTSD and a rising count of suicide.

Exhaustion came in many forms; the drain on our mental composure ate away at our physical endurance as did the absence of sleep, zero nutrition plus the eminent fear and threat of death allaround us all. Add all that to the much reduced air supply from expired respirator use plus hedging on a number of serious complications from excessive CO2 intake - and you've got yourself the makings of some serious health conditions that may easily answer for what we simply call "burnout".


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The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts

Source: NIOSH SCIENCE BLOG/ CDCOriginal post on by Jon Williams, PhD; Jaclyn Krah Cichowicz, MA; Adam Hornbeck, MSN, APRN, FNP-BC, FNP-C; Jonisha Pollard, MS, CPE; and Jeffrey Snyder, MSN, CRNP.

Healthcare workers (HCW) and first responders often work long, physically and mentally exhausting shifts and are also required to wear personal protective equipment (PPE), which may include N95 filtering facepiece respirators (FFRs) elastomeric half-mask respirators, or powered air-supplied respirators (PAPRs). Particular features of PPE can impose a physiological (how the body normally functions) burden on the HCW which can be exacerbated by long work hours without adequate breaks for eating, hydration and self-care. HCWs should be provided regular opportunities to take breaks and a supportive environment to report symptoms related to their PPE use. For example, using an FFR for an extended period may cause dizziness (as well as other symptoms), which could compromise the worker, workplace, and patient safety. Dizziness is an important warning sign, as it can be caused by dehydration, hyperventilation (gasping for breath), elevated carbon dioxide [CO2] levels in the blood, low blood sugar, and anxiety, among other things.
When HCWs are working longer hours without a break while continuously wearing an N95 FFR, CO2 may accumulate in the breathing space inside of the respirator and continuously increase past the 1-hour mark, which could have a significant physiological effect on the wearer (Lim et al., 2006). Some of the known physiological effects of breathing increased concentrations of CO2 include:
  1. Headache;
  2. Increased pressure inside the skull;
  3. Nervous system changes (e.g., increased pain threshold, reduction in cognition – altered judgement, decreased situational awareness, difficulty coordinating sensory or cognitive, abilities and motor activity, decreased visual acuity, widespread activation of the sympathetic nervous system that can oppose the direct effects of CO2 on the heart and blood vessels);
  4. Increased breathing frequency;
  5. Increased “work of breathing”, which is result of breathing through a filter medium;
  6. Cardiovascular effects (e.g., diminished cardiac contractility, vasodilation of peripheral blood vessels);
  7. Reduced tolerance to lighter workloads.


Disclaimer: All content from "the above article (The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts" ) is republished in this associated blogsite / newsletter from its original source (NIOSH/CDC Science Blogand is done so with express permission from NIOSH/CDC and is in compliance with the source's agency regulations. Whereas use of any and all materials, information and links to the materials on the CDC [Centers for Disease Control and Prevention], ATSDR or HHS [Health and Human Services] websites, does not imply endorsement by CDC, ATSDR, HHS or the United States Government of this publication, the NY Cancer Resource Alliance, IntermediaWorx Educational Publications and other producers/publishers herein. 


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UV-C Light is used to disinfect & extend PPE life for reuse
UVC and the Coronavirus
By: Dr. Robert L. Bard & Lennard Gettz

A rising trend in hospital disinfecting (as well as in commercial areas and public institutions) is the installation and use of UV-C disinfecting technology. From small 8" x 10" boxes that extend the life of face masks in the healthcare field, to 8-foot transportable setups that fully sanitize hospital recovery and surgical rooms to (lately) subway trains covering a daily chemical-free sanitizing program.  Controlling infections with UV-C is fast earning public acceptance as a low-risk, non-chemical solution with significantly proven effectiveness.

Hospitals that use UV-light disinfection typically applies this technology as a 2nd step to cleaning and disinfecting measures.  This process is recognized by clinical infection control professionals and agencies to significantly mitigate infection risks associated with environmentally mediated transmission routes. (see complete article)


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RESOURCE 1: REPORTING BOGUS RESPIRATORS (part 1)
By: Stephanie Stevens (CDC / NIOSH / OD)


AD: Review on Counterfeit PPE for Health Responders-
sponsored by: The Advocacy for Professional Safety
According to Megan Casey, MPH, a nurse epidemiologist in NIOSH’s Personal Protective Technology Laboratory: Coronavirus is thought to spread through respiratory droplets produced when an infected person coughs or sneezes, but some medical procedures could potentially suspend virus particles in the air that healthcare providers are breathing. Wearing appropriate respiratory protection is a vital line of defense during these procedures. Counterfeit respirators can compromise the safety of anyone who uses them, including healthcare providers.

NIOSH receives reports of possible counterfeit respirators through a number of channels.This includes reports from manufacturers who are trying to protect the integrity of their own NIOSH approval. We may also be contacted by purchasers and users who have concerns about product or marketing materials. NIOSH staff may also identify instances of counterfeits or misleading information, including through web searches or from reports from stakeholders.  

When NIOSH becomes aware of counterfeit respirators or those misrepresenting NIOSH approval on the market, these respirators are posted online to alert users, purchasers, and manufacturers. As per our regulation, NIOSH only has authority over companies that hold a NIOSH approval. If the devices are not approved by NIOSH, we have no authority over them. We can only report these issues on our Trusted Source webpage for Counterfeit Respirators/Misrepresentation of NIOSH-Approval.


Resources to help identify counterfeit respirators:


Also see our expanded feature: The "Wild West" PPE Industry + A special feature on COUNTERFEIT RESPIRATORS


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SUGGESTED SAFETY GUIDELINES FOR MEDICAL OFFICES

Copyright © 2020- IntermediaWorx Inc. Educational Publications & NY Cancer Resource Alliance


As essential health and medical service providers, our community looks to us to set the standards when it comes to implementing safety measures, risk prevention strategies and sanitizing efforts.  We are all in the same fight to control the spread of pathogens and to preserve the health of our patients and our staff.  These same priorities align with our commitment to share these top recommended protocols for HEALTH & SAFETY which we assembled from a wide survey of safety‐minded colleagues. We urge you to review and consider these safety measures for your office.  Only together can we continue 'flattening the curve' and win this global health crisis- one office at a time!


1) BY APPOINTMENT ONLY:    As private practices are now beginning to re-open on a cautiously limited and adjusted schedule, communicate with your patients that you are officially open for in-person patient care and your new office hours. Adjusted scheduling allows you to better spread out all appointments for better crowd control and allows your staff time to disinfect and clean between patients. Also, emphasize NO WALK-INS.

2) TEMPERATURE CHECKS AT THE DOOR: More and more businesses and professional practices are now requiring temporal temperature checks at the door as an essential public safety measure.  The doorway is a major point of contact with the public at large- and one of your first lines of defense, starting with temperature screenings. Also, you can suggest all patients to check their temperature prior to traveling to your office - and stay home if they have above 101 degree reading.

3) PATIENTS ANNOUNCE THEMSELVES UPON ARRIVAL: When the patient reaches your facility for their appointment, request that they announce themselves via phone from outside. This gives your staff a chance to adjust in case the office is backed up- or if you can see them earlier. If possible, encourage patients to wait outside the building until their time is ready.

4) THE "NEW" WAITING ROOM: More and more doctors’ offices are now reducing the number of seats, and others are even eliminating their waiting rooms altogether.  Waiting rooms have been recognized as a potential ground for sharing bacteria and viral pathogens.  Reducing the wait capacity to the least number of patients (ONE or TWO max) is crowd-control and supports social distancing. 



Brought to you in part by the NY Cancer Resource Alliance and the Advocacy for Professional Safety, publishers of Prevention101.org







REFERENCES-
2) Visual Detection of Bacteria and Microbes;  https://aabme.asme.org/posts/device-quickly-detects-live-bacteria-for-life-saving-diagnosis

3) Acute Oxygen Therapy: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1113909/

4) Healthcare suggers from PTSD... https://ohsonline.com/Articles/2020/05/19/Healthcare-Workers-Suffer-from-PTSD-and-Burnout-During-COVID19.aspx?Page=3

5) The Physiological Burden of Prolonged PPE Use on Healthcare Workers during Long Shifts  https://blogs.cdc.gov/niosh-science-blog/2020/06/10/ppe-burden/

6) Compliance Safety and Health Officers (CSHOs) for enforcing the Respiratory Protection standard: https://www.osha.gov/memos/2020-04-24/enforcement-guidance-decontamination-filtering-facepiece-respirators-healthcare

7) Study: Think Twice About Reusing KN95 or Surgical Masks- https://www.medpagetoday.com/infectiousdisease/infectioncontrol/87077?xid=nl_popmed_2020-06-16&eun=g1405490d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=DailyUpdate_061620&utm_term=NL_Daily_Breaking_News_Active

11) https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-and-face-masks

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