Evaluating N95 respirator designs: A mixed-methods pilot and feasibility study

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has had a global impact, underscoring the importance of personal protective equipment (PPE). Use of N95s reduces the risk of airborne infection; however, in the absence of equitable designs, health care workers (HCWs) who do not fit the average White male head and face are at an increased risk of airborne infectious diseases. OBJECTIVES: Primary: Feasibility of a mixed-method study, with a sample size of 100, 50% of participants self-identifying as non-White and having at least one characteristic of interest. Secondary: (1) Generate quantitative evidence on N95 fit using a PortaCount fit test, (2) describe participant-reported feelings on fit and breathability, and (3) evaluate the impacts of the pandemic on a HCW's physical and mental well-being. METHODS: This was a mixed-method prospective pilot and feasibility study. Quantitative fit was assessed using a TSI PortaCount test and measurements of bizygomatic breadth and Menton-Sellion length. A survey was administered to collect sociodemographic information, HCWs' assessment of N95 fit, comfort, and the impact of PPE-related challenges on well-being. RESULTS: This study was limited by a small sample size, as COVID-19 pandemic restrictions prevented adequate recruitment to detect differences between groups. We describe key findings that should inform analyses of the impact of gender and ethnicity on N95 respirator fit. Following a study amendment to increase eligible sites, 37 of the 41 (90.2%) approached HCWs consented to participate. Compared to other HCWs, non-White females had the lowest mean fit factor. Differences in Menton-Sellion length and bizygomatic breadth were observed between males, females, and White and non-White HCWs. Most HCWs reported physical discomfort and negative impacts on their psychological well-being. CONCLUSIONS: We identified gender and ethnicity as key factors in the fit of N95s. Differences in gender, ethnicity, and anthropometric measures must be considered in respirator designs.