The real risks of wearing the wrong size N95 mask for healthcare workers

In healthcare, personal protective equipment (PPE) is crucial for safeguarding both workers and patients. Among the various types of PPE, the N95 mask is the standard respiratory protection to be worn when exposure to an airborne pathogen is expected. However, the effectiveness of an N95 mask - or any tight-fitting respirator hinges on its proper fit. Using the wrong size can lead to serious risks, particularly for healthcare workers who frequently encounter infectious agents.

Understanding Respirators

N95 masks, like all tight-fitting respirators are designed with two key factors in mind.

1. The filter of the mask - this determines what size of particle is filtered through the mask. For the N95, it filters at least 95% of non-oil aerosol particles larger than 0.1 microns. (for oil based particles a R or P respirator is needed).

2. The fit of the mask - this determines what size of particle is able to enter around the mask. The tight seal between the mask and your face ensures that all air and particles are directed through the filter.

Thankfully the masks go through rigorous testing to ensure they effectively filter out the smallest particles you might be exposed to (such as Tuberculosis). But that expertly designed mask provides little benefit if those same particles it is filtering out, are easily being breathed in around the seal between the mask and your face!

This is why a proper fit is critical for optimal protection.

It is clear that if a mask is too loose, unfiltered air can enter around the mask, and be inhaled. But it is also important to consider is if a mask is too tight or uncomfortable, as this often leads to modifications to the mask or improper wearing. Both of these situations result in the increased likelihood of your exposure.

Plus we can't overlook the mental toll of wearing a poorly fitted mask. Reports indicate that nearly 50% of healthcare workers experienced higher anxiety levels related to PPE during peak infection periods. When caring for patients with airborne infections, our focus should be on providing the best care we can - not worrying if we might also get sick.

So how can you ensure a proper respiratory protection?

Conduct a Fit Test (so you know which size to choose)

The standard and regulated way to ensure you have a proper fitting mask is with a respirator fit test. This testing procedure assesses whether the selected N95 mask or respirator forms an adequate seal around your face, and maintains this seal with expected breathing changes, movement and talking you would do while wearing it. Regular fit testing every 2 years is essential, especially when new masks are introduced or when your facial structure changes due to factors like weight loss or aging.

Understand the training (so you know how to get a proper fit)

Ensuring you are familiar with the steps to create the adequate seal on your own, each time you need to wear a N95 mask. This includes the position of the straps and the mask on your face, the moulding of the nose portion of the mask, and ensuring you always have tight contact between the mask and the skin (no interference from facial hair, piercings or facial coverings).

People are not One-size-fits-all.

Just as you wouldn't expect a large pair of gloves to fit the hands of every nurse adequately to properly protect their skin, we cannot assume 1 size of N95 mask would fit the face of every health care worker. If you work in a role where you may be asked to wear a N95 mask - ensure you know what size to wear, and how to wear it safely with a fit test.