Improved protection

Posted to Articles on 12th Nov 2020, 12:51 Share:

Ellie Yakimov looks at how our changed relationship with airborne pathogens brings a new level of protection.

ACCORDING TO the World Health Organization, “Airborne transmission of infectious agents refers to the transmission of disease caused by dissemination of droplet nuclei that remain infectious when suspended in air over long distance and time.” Airborne transmission, known as “preferential”, has multiple routes of transmission besides the traditional, or “obligate” transmission through droplet nuclei. These routes can be material surfaces that have been into contact with a sick person, but also with fine mist, dust, aerosols, or liquids generated from a source of infection such as an infected patient or animal. As is now common knowledge, the coronavirus pandemic resulted from the spread of the airborne COVID-19 viral contagion via these multiple routes.

In less than a year, the persistence and global reach of the coronavirus have changed the ways we work, interact and conduct our daily lives. In addition to the PPE-clad professions with high airborne contagion risk, such as asbestos removal, plastering, joinery and workers in chemical environments, now every profession, where aerosol is generated, requires heavy-duty respiratory protection. Surgeons have always worn disposable surgical masks in theatre; post-COVID19 it is mandatory for them to wear a mask upon entering the hospital. Dentists now must wear enhanced PPE, at least FFP2 or FFP3 respirators during all aerosol-generating procedures they perform.

Even as, at the writing of this, Pfizer and BioNTech are planning to make the first effective Coronavirus vaccine available for use by the end of November 2020, our new, socially distant routines, full of precautions and PPE, aren’t likely to be relaxed. The multitude of newly launched pandemic masks are here to stay, although these ones aren’t going to become fixtures in doctors’ and dentists’ surgeries. Most of the snazzy new masks designed for the pandemic, with all of their novel features, clear face windows, sleek designs and smart brand names, don’t provide the necessary level of protection from airborne pathogens and don’t pass stringent certification testing.

WHO recommends that everyone expecting to come into contact with a coronavirus carrier has to wear a tight-fitting respirator that filters their inhale breath. Such respirators have always been available to the heavy industries mentioned earlier. In fact, they have been created especially for these industries. Hence, their design, size and shape typically fit the average male, but tend to not cover the fit of females or people with smaller facial features. This has become more obvious during the mandatory fit tests these types of RPE require. According to the latest guidance on the HSE’s website, fit testing of “face masks to avoid transmission during the coronavirus pandemic should be carried out the first time a worker uses a particular type of respirator.” In addition, “the wearer should carry out a pre-use seal check or fit check, which they should repeat every time they put a respirator on.” These rules apply to all tight-fitting respirators (such as the recommended to healthcare workers disposable FFP3 masks and reusable half masks) which rely on having a good seal with the wearer’s face. However, with women providing 71% of community dental services in 2017 and the numbers of female doctors on the rise - England 48%,Wales - 46%, Scotland - 53% and Northern Ireland 51% in 2019, a great number of healthcare workers fail their fit tests. Thus, in addition to the general shortage of PPE and RPE filters that surfaced after the first lockdown in the UK, a good number of our front-line workers have had difficulty finding the right RPE for themselves. This distressing reality is due to change at the beginning of 2021, not only because of the government’s promise of sufficient PPE stock for the NHS, but also because UK-based manufacturers have been called on to provide 70% and more of the needed health and safety equipment.

Respiratory Technology Limited (RTL) is one such Wales-based manufacturer of a special pandemic respirator. Unlike most novelties on the market, its Clir 100H and Clir 200H respirator models have been designed especially with healthcare workers in mind. Designed by experts in respiratory protection with 20 years of experience, the two types of medical masks come with a multitude of attractive features, but most importantly: they protect wearers from COVID-19 with filtration efficiency in excess of 99.95%. Both models have passed CE certification.

Clir 100H provides superior filtration through advanced filter media and boasts two large free flow inhalation valves. This means low breathing resistance, or easy breathing for the wearer, even during long shifts. The strategically positioned exhale valve directs exhalations towards the ground and away from others, protecting everyone in the room from the possibility of airborne pathogens. Each respirator variant features a large clear speech recognition window which reduces the number of layers of material to allow maximum sound transmission. It also facilitates visual communication and lip reading, whilst the transparent oronasal further aids expression recognition.

The Clir 100H has been designed to seamlessly work with the world’s first in-mask quantitative daily fit check technology, for sale by the same manufacturer. The FitCheck technology reassures, via a visual indicator, both the wearer and everyone in proximity, that the mask is fitted and sealed correctly. The technology then monitors the mask during use and alerts the user to possible issues, allowing her to check and adjust the respirator as required.

Clir 200H offers the same superb features as Clir 100H, with one added function. The filters on the Clir 200H half-mask provide filtration to not just the inhale, but also the exhale breath, for added protection to the wearer and others in the vicinity from the chance of airborne pathogens.

RTL has made sure that both masks come in 3 new sizes that fit even the smallest of adult faces, increasing comfort and fit test passes for a much wider user base. Importantly for medics, Clir 100H and 200H are made from easy-to-clean non-porous materials and can be decontaminated using a number of processes. Last but not least, the unique I.D tag on the mask and storage container can be signed for personal identification, so there can be no confusion as to ownership or cross contamination.

The NHS has been trialling the new pandemic masks by RTL across dozens of UK hospitals in the past three months, to unanimous approval. However, it is important to remember that aerosols may be generated from biological waste products that accumulate in garbage cans and dry containers, which means that wearing RPE outside of hospitals may soon be a matter of common sense.

Many clinically important airborne diseases are caused by a variety of pathogens including bacteria, viruses, and fungi, meaning that airborne risks to human health won’t diminish with the management of COVID-19. Moreover, airborne diseases do not include disorders caused by air pollution, poisons, smog, and dust. If it is mandated by law for people working in hazardous environments to wear respirators at work, then securing RPE for oneself for all situations, even when pathogenic risk isn’t imminent, may soon be the norm.

References:

“Airborne Precautions”, by Binish Ather; Taaha M. Mirza; Peter F. Edemekong.

Retrieved on 09/11/20, from https://www.ncbi.nlm.nih.gov/books/NBK531468/

“Covid vaccine: First 'milestone' vaccine offers 90% protection” BBC News Online. Published by James Gallagher. Retrieved on 09/11/20 fromhttps://www.bbc.co.uk/news/health-54873105
“Fit testing face masks to avoid transmission during the coronavirus pandemic”, published by HSE staff on 02/11/20. Retrieved on 09/11/20 from https://www.hse.gov.uk/coronavirus/ppe-face-masks/face-mask-ppe-rpe.htm?utm_source=hse.gov.uk&utm_medium=refferal&utm_campaign=coronavirus&utm_term=rpe&utm_content=news-page
“The state of medical education and practice in the UK: The workforce report 2019”. Published by General Medical Council. Retrieved on 09/11/20 from https://www.gmc-uk.org/-/media/documents/the-state-of-medical-education-and-practice-in-the-uk---workforce-report_pdf-80449007.pdf
British Dental Association website. Women in Dentistry.https://bda.org/womenindentistry Visited on 09/11/20.
“Coronavirus: Has the NHS got enough PPE?”