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Surgical mask placement over N95 filtering facepiece respirators: physiological effects on healthcare workers.

Roberge RJ; Coca A; Williams WJ; Palmiero AJ; Powell JB
Respirology 2010 Apr; 15(3):516-521
Ten healthcare workers wearing N95 filtering facepiece respirators with, and without, a surgical mask outer covering were physiologically monitored. No significant differences in heart rate, breathing rate, tidal volume, minute volume, transcutaneous carbon dioxide and oxygen saturation were observed with application of the surgical mask. Background and objective: Filtering facepiece respirators ('N95 Masks') may be in short supply during large-scale infectious outbreaks. Suggestions have been made to extend their useful life by using a surgical mask as an outer barrier, but the physiological impact of this added barrier upon the wearer has not been studied. Methods: A surgical mask was worn over an N95 filtering facepiece respirator by 10 healthcare workers for 1 h at each of two work rates. Heart rate, respiratory rate, tidal volume, minute volume, oxygen saturation, transcutaneous carbon dioxide levels and respirator dead space gases were monitored and compared with controls (N95 filtering facepiece respirator without a surgical mask). Subjective perceptions of exertion and comfort were assessed by numerical rating scales. Results: There were no significant differences in physiological variables between those who used surgical masks and controls. Surgical masks decreased dead space oxygen concentrations of the filtering facepiece respirators at the lesser work rate (P = 0.03) and for filtering facepiece respirators with an exhalation valve at the higher work rate (P = 0.003). Respirator dead space oxygen and carbon dioxide levels were not harmonious with Occupational Safety and Health Administration workplace ambient atmosphere standards. Exertion and comfort scores were not significantly impacted by the surgical mask. Conclusions: Use of a surgical mask as an outer barrier over N95 filtering facepiece respirators does not significantly impact the physiological burden or perceptions of comfort and exertion by the wearer over that experienced without use of a surgical mask.
Respirators; Respiratory-protective-equipment; Respiratory-protection; Personal-protection; Personal-protective-equipment; Infection-control; Infectious-diseases; Ventilation; Ventilation-systems; Viral-diseases; Viral-infections; Epidemiology; Statistical-analysis; Health-care-personnel; Medical-personnel; Author Keywords: environmental and occupational health and epidemiology; infection control; respiratory infection (non-tuberculous); ventilation; viral infection
Raymond Roberge, National Personal Protective Technology Laboratory/NIOSH, 626 Cochrans Mill Road, Pittsburgh, PA 15236, USA
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Page last reviewed: May 11, 2023
Content source: National Institute for Occupational Safety and Health Education and Information Division