Excellent audit data from a major Australian teaching hospital reporting on the fit test results of their tested 2,161 healthcare workers across four different N95/P2 mask designs.

Why is this important?

Many healthcare workers and significantly, the general public, do not have access to formal Fit Testing (requires expertise, facilities & equipment). We also know that as face shape varies among individuals, so does the effectiveness of protection for different mask types – this is particularly significant for women who have more difficulty in finding suitably-fitting N95 respirators. (Notably 73% of Fit Tested staff in this study were women.)

The results of this study may allow individuals to make educated choices on suitable masks even when they do not have access to Fit Testing, as well as guiding institutional mask purchases.

What did they find?

Three-panel flat-fold N95 masks performed best (3M Aura 9320A+) both for fit test (96% pass) and wearer comfort and usability.

The other three tested designs were not as performant:

• Semi-rigid cup type (3M 1860 or 1860S): 65% FT pass.
• Duckbill type: (BSN ProShield or Halyard Fluidshield): 59% FT pass.
• Flat-fold cup type: (BYD Care DE2322): 32% FT pass.

summary

• Irene Ng, Benjamin Kave, Fiona Begg, Charles R Bodas, Reny Segal, and Daryl Williams.
• The Royal Melbourne Hospital, Melbourne, VIC.
• Med. J. Aust. 2022 Jul 18; 217 (2): 88-93.

ObjectivesTo compare the performance of four N95 respirator types with respect to quantitative fit test pass rate and health care worker-rated usability and comfort.Design, Setting, ParticipantsHealth care workers who participated in the respiratory protection program at the Royal Melbourne Hospital, 1 October 2020 - 31 May 2021. Participants underwent quantitative N95 respirator fit testing (at least three of four types: semi-rigid cup, flat-fold cup, duckbill, and three-panel flat-fold types), and were invited to complete an online usability and comfort assessment for respirators for which their fit test results were passes.Main Outcome MeasuresFit test pass rate, and user-rated overall comfort and assessment ratings (five-point Likert scales), by N95 respirator type.ResultsA total of 2161 health care workers underwent quantitative fit testing (women, 1586 [73.4%]; nurses, 1271 [58.8%]). The overall fit test pass rates were 65.0% for the semi-rigid cup respirators (1029/1583 tests), 32.4% for the flat-fold respirator (660/2035 tests), 59.2% for the duckbill respirators (2005/3387 tests), and 96.4% for the three-panel flat-fold respirator (1876/1946 tests). 378 health care workers completed the comfort and usability survey. Overall comfort and assessment ratings each differed by respirator group (P < 0.001); the median overall comfort (4; IQR, 3-4) and overall assessment values (4; IQR, 3-5) were highest for the three-panel flat-fold respirator and lowest for the semi-rigid cup respirators (comfort: 2 [IQR, 1-3]; assessment: 2 [IQR, 2-3]).ConclusionsThe three-panel flat-fold N95 respirator outperformed the three alternative types with regard to fit test pass rate and user-rated comfort and usability. To maximise respiratory protection for health care workers, these factors should be considered when making respirator procurement decisions.© 2022 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.

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