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Impact of facial skin protectants on qualitative fit testing of N95 masks

A study led by researchers at Harvard Medical School in Boston found the use of skin protectants to prevent skin irritation can interfere with the fit of the N95 respirator masks. While skin irritation from prolonged N95 mask use is a concern, the study’s authors suggest healthcare workers should not trade the efficacy of the mask for comfort.

The study published online ahead of print in the Journal of the American Academy of Dermatology (June 17, 2020) recommends against the use of anything between the skin and the mask, or to re-test the fit of the mask if skin protectants are applied.

“Proposed strategies for [the] replacement of brand or style of N95 are reasonable, but these results show that current recommendations for liquid protectants should be reconsidered,” the authors wrote in the study. “Healthcare workers electing to use skin protectants should confirm appropriate fit [of the mask] prior to use in clinical settings.”

The Covid-19 pandemic has created a need for prolonged use of N95 masks, leading to wounds, purpura and indentations on healthcare workers’ faces. The use of skin protectants may prevent skin irritation caused by the N95 masks by providing a barrier or redistributing pressure. However, according to the researchers, the impact of skin protectants on the respirator fit had not previously been studied.

To evaluate the impact of the use of skin protectants on the N95 respirator qualitative fit-test (QLFT) results and user comfort, researchers enrolled adult employees at Brigham Health and Dana-Farber Cancer Institute that were previously fit tested for N95 masks (n=25) via a standardized QLFT protocol.

Each participant underwent QLFT for five types of skin protectants on a 3M 1860 N95 mask after self-application using a standardized protocol. Participants underwent repeat QLFT of their respirator for each dressing and rated dressing comfort.

Most subjects were female (76%), with an average age of 28 years. QLFT passing rates ranged from 88% for Cavilon film to 56% for DuoDERM CGF, with the highest failure rates noted with movement manoeuvres. A total of 36% of participants passed with all five materials.

Mepitac tape and DuoDERM CGF (88.0% positive rating) were reported to be more comfortable than Cavilon film (22.0%). Cavilon film and DuoDERM CGF had the most negative qualitative comments, with odor and impact on mask fit or seal quality as common concerns, respectively.

“It is important to consider how different materials impact respirator fit and comfort,” the authors wrote. “No dressing had a complete QLFT passing rate. Passing rates were highest with Cavilon film 82 (88%) but it had the most negative (24%) comfort ratings.”

The researchers note larger studies examining fit and user experience across different mask and dressing types are needed. The study’s authors suggest that healthcare workers and institutions electing to use facial skin protectants should ensure adequate fit by undergoing fit testing with facial skin protectants in place before using the masks in high-risk clinical settings.

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