Throughout the COVID-19 pandemic, and during a summer of bushfires, P2 or N95 masks have been held up as the best protection against contaminants in the air, but their effectiveness can be severely reduced because one size does not fit all.
- A survey reveals only one in five doctors have had their N95 or P2 masks professionally fit-tested
- Experts warn the masks must create a seal around the face to be fully effective in filtering air
- If you can’t have your mask professionally fit-tested, health authorities recommended doing a “fit check”
When a patient in an emergency department needs a breathing tube inserted, it will often be an anaesthetist who is called on to do it.
For the last five months, one of Melbourne’s senior anaesthetists, who asked to remain anonymous, has carried out this procedure on dozens of patients suspected of being infected with COVID-19.
As the process can cause tiny particles from the patient’s throat to spray into the air, she has been wearing an N95 face mask, which she believed would stop her from breathing in coronavirus.
Last week, when she had a test to see if the mask was a proper fit, she discovered it had not been protecting her after all.
“I thought, ‘Oh my God, I’ve actually exposed myself unwittingly,'” she said.
Many people now wear N95 or P2 masks because they believe they will filter out tiny particles, such as airborne viruses, and stop them entering their lungs.
What many people may not realise is the masks only work if they fit in a way that creates a tight seal, forcing air to be drawn through the fabric of the mask, rather than through the gaps around the side.
Respirator masks are commonly worn on construction sites and in industrial workplaces across the country to protect workers from dangerous contaminants in the air.
Workers in those industries have to undergo annual fit tests to ensure they are not breathing in harmful substances.
Katie Blair, a respiratory specialist with a company that specialises in workplace safety, said without fit testing, you cannot be sure the mask you are wearing creates a complete seal with your face.
“Everyone’s got a different size nose bridge, the length of your chin, the height of your cheekbones — [these measurements] all come into play when trying to find the perfect fit,” she said.
And while we know P2 and N95 masks filter out the most particles, they do come in different shapes and sizes.
A fit test will measure how much air is escaping around the edge of the mask while the wearer moves around.
Concerns about fit-testing in hospitals
A national survey of doctors has revealed fit testing of masks is not happening across many Australian health workplaces.
Emergency department locum Dr Mian Bi surveyed more than 1,000 doctors working across Australia and New Zealand in hospitals, GP clinics and aged care and found only one in five were getting their masks properly fit-tested before they used it.
“When you are at the coalface, you want the best protection and know that you are safe,” he said.
“It was shocking to see the survey results.
“The general feeling is that we have been let down by the system that’s meant to keep us safe.”
Out of 1,108 doctors working with patients, only 277 had masks properly fitted to their face to ensure they were safe.
Most of those who had fit-tested masks were anaesthetists and physicians such as cardiologists.
Of concern, less than half the doctors surveyed working in intensive care had their masks fitted properly.
And fewer than one-third of doctors in emergency departments had masks checked.
Dr Bi said some of the comments from the doctors in the survey were extremely worrying.
“One consultant doctor asked the hospital for an N95 mask and was told no, then he ended up contracting COVID-19,” he said.
“Another told us some junior medical staff in the department caught COVID-19 because they were only offered surgical masks. Now the hospital has changed to N95 masks but there is still no fit-testing.”
A common complaint from medical staff was hospital management had respiratory masks “locked away in an office” with doctors having to justify why they should be allowed to use them.
Hospitals not fit-testing masks ‘beggars belief’
The Melbourne anaesthetist said many hospitals were not carrying out fit-testing, even though staff needed to wear N95 masks to protect them from airborne dangers.
She was recently fit-tested for the first time only because the Australian Society of Anaesthetists arranged for their members to have it done.
She is worried the nurses she works with are being exposed to the coronavirus.
“It ought to be our employer’s responsibility,” she said.
Australia’s workplace safety experts make it clear that employers have a duty of care to ensure staff are protected from any pollutants in the air.
What you need to know about coronavirus:
According to Safe Work Australia, if it is not possible to eliminate a health risk in a workplace, the employer should minimise the risk by providing personal protective equipment of the right size and fit.
Carl Straurins, a certified occupational hygienist, said he could not understand why general industry was required to fit-test their staff but healthcare services did not all do it.
“It beggars belief, really, why we’re talking about [it], and not just doing it,” he said.
His company works with industries such as makers of kitchen benchtops, which have just had to put strict practices in place to protect workers from silicosis.
“If a simple stone industry can get it right, why can’t more sophisticated healthcare providers get it right?” he said.
Since the second wave of COVID-19 took hold in Victoria, more than 3,000 healthcare workers have contracted the disease.
Victorian Premier Daniel Andrews announced a range of measures to curb the spread of the virus in hospitals and aged care facilities, including trialling a fit-testing programme.
Sealing your mask
While experts say P2 and N95 masks should be reserved for healthcare workers, if you are using one and want it to be effective, fit-testing is an important step.
Ms Blair said a professional fit-test would help determine which style and size was best and teach you how to wear the mask in a way that created a seal on your face.
She said the bottom strap should reach from under your ear to the back of your neck, and the top strap over the crown of your head so the edges of the mask are pulled flat against your face.
Then you should mould the edge of the mask down around your nose to get 100 per cent contact with your face and an airtight seal.
“If you don’t have a proper seal, every time you breathe in, the air is not going to want to pass through the mask paper, and is going to come through any gaps first,” Ms Blair said.
With that, could come particles containing coronavirus, which is particularly worrying for healthcare workers treating COVID-19 patients.
If you cannot get your own mask professionally fit-tested, you can do what’s called a “fit check”.
This process can help ensure your mask is properly sealed to your face, although it is not as effective as a fit test.
Queensland Health recommends following these steps for a P2 or N95 respirator fit check:
- Place the respirator on your face
- Place the headband or ties over your head and at the base of your neck
- Compress the respirator to ensure a seal across your face, cheeks and the bridge of your nose
- Check the positive pressure seal of the respirator by gently exhaling. If air escapes, the respirator needs to be adjusted
- Check the negative pressure seal of the respirator by gently inhaling. If the respirator is not drawn in towards your face, or air leaks around the face seal, readjust the respirator and repeat the process, or check for defects in the respirator
- Always refer to the manufacturer’s instructions for fit-checking of individual brands and types of P2 or N95 respirators
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