By Dr. Artaud

Guest Contributor 

I’m not a Doctor; the screen Name Dr. Artuad (It’s from a 2001 Movie Called “No Such Thing”). Other than excerpts from OSHA, the content is authored by myself and not taken from other sites.

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Surgical masks (no experience) and respirators (often referred to as masks) much experience. I am an optician by training (and worked as a dispensing optician), all but completed pharmacy technician school, and I have an associate in specialized technology in electronics.

I worked in electrical maintenance at an industrial level (circuit breakers the size of refrigerators, etc.) for my career. During that 25 year career, I was, for 7+ years, an appointed union representative, and due to that, had the opportunity to become involved in instruction. For 7+ years, I was involved in instructing company and union employees like negative pressure air-purifying respirators. They were half and full-face elastomeric (silicone or rubber) that used 2 external filters, chemical cartridges, or combination filter/chemical cartridges.

Our facility had extreme environmental exposure possibilities. Hydrogen Sulfide, Hydrogen Cyanide, Anhydrous Ammonia, for the shortlist. For these jobs, one cannot use an air-purifying respirator per se (OSHA permits a “Gas Mask” for Anhydrous Ammonia (presumably at some known level), a full-face respirator with ammonia cartridges does not meet that requirement; therefore, our facility used SCBAs (Self Contained Breathing Apparatus) or supplied air via hoses. If the exposure was severe enough for any of these chemicals, a HazMat Level A Suit was required.

For other substances, Benzene and Xylene were noteworthy in our facility, various filterable gasses, and vapors, and particulates, and fumes (fumes come from heated metal, such as occurs during welding). Air-purifying respirator use was daily for some and commonplace for others. Air-purifying respirators are what I instructed.

Elastomeric respirators are referred to as tight-fitting. To wear a respirator (i.e., required usage), the employee needs a yearly medical evaluation and yearly respirator fit test; this applies for N95 and the elastomeric respirators we wore.

For the fit-test (during the fit-test and in use, men must be clean-shaven), the subject had to do the following for 60 seconds each (Unless otherwise specified):

““1. Normal breathing. In a normal standing position, without talking, the subject shall breathe normally.
2. Deep breathing. In a normal standing position, the subject shall breathe slowly and deeply, taking caution to not hyperventilate.
3. Turning head side to side. Standing in place, the subject shall slowly turn his/her head from side to side between the extreme positions on each side. The head shall be held at each extreme momentarily so the subject can inhale at each side.
4. Moving head up and down. Standing in place, the subject shall slowly move his/her head up and down. The subject shall be instructed to inhale in the up position (i.e., when looking toward the ceiling).
5. Talking. The subject shall talk out loud slowly and loud enough to be heard clearly by the test conductor. The subject can read from a prepared text such as the Rainbow Passage, count backward from 100, or recite a memorized poem or song.
6. Grimace (15 Seconds Only). The test subject shall grimace by smiling or frowning. (This applies only to QNFT testing; it is not performed for QLFT)
7. Bending over. The test subject shall bend at the waist as if he/she were to touch his/her toes. Jogging in place shall be substituted for this exercise in those test environments such as shroud type QNFT or QLFT units that do not permit bending over at the waist.
8. Normal breathing. Same as exercise 1.

The test subject shall be questioned by the test conductor regarding the respirator’s comfort upon completing the protocol. If it has become unacceptable, another model of respirator shall be tried. The respirator shall not be adjusted once the fit test exercises begin. Any adjustment voids the test, and the fit-test must be repeated.””

So, yearly, I received a physical and then a fit-test for each make, model, and size elastomeric respirator I wore, in my case, it was a half-face respirator, a full-face air-purifying respirator, and a full-face Scott supplied-air facepiece used for specialized work and rescue operations (I never used the last one during my career, it was required that we trained yearly in their use with SCBAs but others routinely handled rescue and serious leak situations).

Respirators have an Assigned Protection Factor (APF). This is the amount of contaminant they can remove when used as appropriate and fitted and worn correctly.

Half Face Negative Pressure Air Purifying Respirator has an Assigned Protection Factor of 10.

Full Face Negative Pressure Air Purifying Respirator has an Assigned Protection Factor of 50.

A properly fitted, Elastomeric Half-face Air Purifying Respirator allows 1/10 of the contaminant to get into the respirator facepiece. A properly fitted, Elastomeric Full Face Air Purifying Respirator allows 1/50 of the contaminant to get into the respirator facepiece. If the seal is compromised, even briefly, more contaminants will get in. Notice that they don’t completely eliminate the contaminant. If you are wearing these, a certain amount of the contaminant will get in.

To guard against too much contaminant infiltration, the following applies:

Before using air-purifying respirators:

● The nature of the contaminants and the levels of the contaminants must be known.
● The contaminants’ level must be below the Immediately Dangerous to Life and Health Level (IDLH) and within the Maximum Use Concentration (MUC) for the type of respirator used.

APF is the Assigned Protection Factor of the respirator.
PEL is the Permissible Exposure Limit for the chemical or chemicals set by OHSA.

APF × PEL = MUC (i.e., is a half-face or full-face air-purifying respirator needed or supplied air).

● Selection of a half or full face respirator must be made based on the potential for harm to the eyes or contaminant infiltration into the eyes, such as black mold remediation possibly requiring a full-face respirator (as appropriate for the extent of the mold) to prevent the mold from entering the sinuses via the eyes.
● The cartridges, filters, or combination filter/cartridges must be suitable for the exposure.
● Oxygen levels must be 19.5% minimum (and in practice, 23.5% maximum for other reasons).
● End of Service Life Indicator (ESLI) on chemical cartridges or a change-out schedule must be utilized to ensure the cartridges are changed before they become ineffective. Particulate cartridge change-out will be covered by the change-out schedule.

The above is not intended to be inclusive; rather, it shows some of the things involved in the Selection of air-purifying respirators. NIOSH (National Institutes for Occupational Safety and Health) certifies respirators, and the CDC presides over NIOSH.

Surgical masks are loose-fitting; there is no face-to-face piece seal. Wearing them as intended, they are not protective of the wearer to stop many airborne pathogens from being inhaled. There is reason to believe, concerning coughs and sneezes, that masks are less than effective in capturing viruses, as they seem to redirect the cough or sneeze products to the sides of the masks and not from the front. Dr. Merritt even explained in a presentation that nurses working with a surgeon in surgery are taught to remain facing the surgeon to sneeze (not to turn their head) since the products of the sneeze exit the mask to the side.

In my opinion, double masking and especially doing so tightly will impede respiration. OSHA, in a letter of interpretation of the respirator standard, explains these concerning respirators:

“Response: Non-voluntary use of a filtering facepiece (dust mask/disposable paper type dust respirator) requires that the employer establish and implement a written respiratory protection program with worksite-specific procedures. The respiratory protection program must include the medical evaluation of employees……”

“The employer shall provide a medical evaluation to determine that the employee’s ability to use a respirator before the employee is fit tested or required to use the respirator in the workplace.” Employees that use any respirators, including respirators such as air, supplied positive pressure face masks or hoods, must have a medical evaluation before use. Medical evaluations are needed to prevent injuries and illnesses that can arise from respirator use. Clinical studies show that even positive pressure respirator use can harm an employee. Respirator use of all kinds can cause alterations in breathing patterns, hypoventilation, retention of carbon dioxide, and an increase in workload on the body.”

Although masks are not respirators, attempts are increasingly being made to force them into a quasi-respirator roll. If the argument could be made, they are trying to approach the qualities of an N95 when they (masks) are worn double-masked. If their use is obligatory, the government may be violating standards and precautions that it has set for industry. To reiterate OSHA: “Respirator use of all kinds can cause alterations in breathing patterns, hypoventilation, retention of carbon dioxide, and an increase in workload on the body.”

If the government wants to force quasi-respirator level protection from masks (double masking) or seriously suggests that double masking is used, they may be harming people, and they seem to be doing it with willful ignorance of other standards they impose on employees in industry and businesses.