Este artigo descreverá alguns dos requisitos que devem ser considerados pelas equipes que desenvolvem máscaras de bricolage para resolver a falta de suprimentos durante a pandemia do COVID-19.
Perguntas de pesquisa
- Medidas em relação às máscaras graduadas (N95, N100). Os resultados da literatura ainda apresentam uma grande variedade de faixas (10%-70%) para máscaras faciais, o que serve para entender que nem todas as máscaras DIY são feitas e usadas da mesma forma.
- Avaliação DIY (teste em condições experimentais e feedback de uso real)
- Adaptação a diferentes formatos e tamanhos de rosto: os designs precisam ser adaptáveis ou paramétricos.
- As boas práticas de confecção e uso de máscaras devem ser reproduzidas para que as máscaras façam sentido.
- Filtros industriais: alguns projetos de bricolage estão atualmente considerando o uso de filtros HEPA. Considere questões como o custo e a disponibilidade desses filtros em seu local para uso sustentado por profissionais de saúde ou pela população em geral.
- Toalha de chá (pano de chá) ou camadas de tecido: Alguns estudos corroboram a viabilidade do uso de tecido em camadas para fazer máscaras. Diferentes considerações devem ser usadas ao projetar máscaras de pano.
- Filtro EVA: Alguns projetos de bricolage usaram o EVA como filtro, por ser um material barato e amplamente disponível.
- PLA ou outros materiais impressos em 3D: uma discussão atual foi levantada em torno da qualidade porosa das máscaras impressas em 3D, o que levanta a questão de saber se elas são o melhor material para máscaras caseiras.
Custo e adequação
- Disponibilidade de materiais: até que ponto os materiais são fáceis de encontrar? Eles são encontrados em todos os lugares do mundo?
- Custo total: quanto custa para reproduzir.
- Facilidade de documentação: essas máscaras são totalmente reproduzíveis? Existem variações em como as pessoas os farão?
- A falta de ferramentas de fabricação digital em certas áreas pode limitar a forma como essas máscaras são feitas.
- Serão reutilizados/desinfetados? Calor, luz UV, água, sabão, álcool.
- Disponibilidade de filtros ou máscaras de substituição.
- Microplásticos da impressão 3D com efeito na saúde devido ao uso sustentado.
- Para onde vai a umidade da boca do usuário.
- As pessoas usarão uma máscara por mais tempo se se sentirem confortáveis com ela.
- More protective masks are less comfortable to breathe through.
The following literature will serve to evaluate design considerations for different types of masks, considering the surge of designs by many communities. Some previous studies have evaluated the effectiveness of different homemade masks. While "none of these are as effective as a commercially designed face mask", they all offer some protection when other options are not available. It could be argued that a cloth face mask design can be effective and therefore a recommended measure as long as the design is good and hygiene training is in place for all users.
DIY mask design and testing
Shaffer, R., Krah Cichowicz, J., Chew, G., & Hsu, J. (2018). Non-occupational Uses of Respiratory Protection – What Public Health Organizations and Users Need to Know. NIOSH Science Blog. Retrieved March 20, 2021, from https://blogs.cdc.gov/niosh-science-blog/2018/01/04/respirators-public-use/
- Research Questions you're answering:
- Summary notes from article/source:
- Masks are likely to be worn incorrectly: independently of the mask used, a great part of the effort must be put into training the general population on the correct usage of masks.
- Fit tests must be performed for each user.
MacIntyre CR, Seale H, Dung TC, et al. A cluster randomised trial of cloth masks compared with medical masks in healthcare workers. BMJ Open 2015;5:e006577. doi: 10.1136/bmjopen-2014-006577
- This study recommends against the use of cloth masks.
- "Penetration of cloth masks by particles was almost 97% and medical masks 44%."
Xiao J, Shiu EYC, Gao H, Wong JW, Fong MW, Ryu S, et al. Nonpharmaceutical measures for pandemic influenza in nonhealthcare settings—personal protective and environmental measures. Emerg Infect Dis. 2020 March 24. https://doi.org/10.3201/eid2605.190994
- Medical masks: "There is limited evidence for their effectiveness in preventing influenza virus transmission either when worn by the infected person for source control or when worn by uninfected persons to reduce exposure (...)"
- "Proper use of face masks is essential because improper use might increase the risk for transmission."
Shakya, K., Noyes, A., Kallin, R. et al. Evaluating the efficacy of cloth facemasks in reducing particulate matter exposure. J Expo Sci Environ Epidemiol 27, 352–357 (2017). https://doi.org/10.1038/jes.2016.42
"When the cloth masks were tested against lab-generated whole diesel particles, the filtration efficiency for three particle sizes (30, 100, and 500 nm) ranged from 15% to 57%."
Samy Rengasamy, Benjamin Eimer, Ronald E. Shaffer, Simple Respiratory Protection—Evaluation of the Filtration Performance of Cloth Masks and Common Fabric Materials Against 20–1000 nm Size Particles, The Annals of Occupational Hygiene, Volume 54, Issue 7, October 2010, Pages 789–798, https://doi.org/10.1093/annhyg/meq044. Retrieved from https://academic.oup.com/annweh/article/54/7/789/202744
- This article poses the dangers of single-layered cloth face masks, over a variety of materials.
- The level of instantaneous penetration is 40%-90%.
Professional and Home-Made Face Masks Reduce Exposure to Respiratory Infections among the General Population] Marianne van der Sande, Peter Teunis, Rob Sabel PLoS ONE 3(7): e2618. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/pdf/pone.0002618.pdf
A study compared the effectiveness of three masks to prevent virus transmission: a homemade mask made from a tea cloth, a surgical mask, and Filter Facepiece Against Particles (FFP2). Subjects performed a variety of different physical actions. The study included both adults and children.
- FFP2 provided 50 times as much protection as a homemade mask.
- A surgical mask provided 25 times as much protection as a homemade mask.
- "Masks worn by patients may not offer as great a degree of protection against aerosol transmission."
- Regardless of mask type, children were less well protected.
- Masks were more effective at inward protection (to protect the wearer from the environment).
Fit vs Protection
Fit Factors vs. Protection Factors. Application Note ITI-023, TSI Inc. Retrieved from https://www.tsi.com/getmedia/f07681c1-a465-40d0-9add-85cc5813f0ad/Fit-Factors-vs-Protection-Factors-App-Note-(ITI-023)-US
Protection factor can be divided into:
- Fit Factor (FF): It is a simulation of workplace activities. It can be defined as the ratio of challenge aerosol concentration outside the respirator and the challenge aerosol concentration that leaks inside the respirator during the test.
- Workplace Protection Factor (WPF): Actual level of protection during workplace use.
- Assigned Protection Factor (APF): It is the level of protection expected of a mask on 95% of the time it is used.
Dato, V. M., Hostler, D., & Hahn, M. E. (2006) Simple respiratory mask. Emerging Infectious Diseases, 12(6), 1033-1034. https://dx.doi.org/10.3201/eid1206.051468, 2006 Jun
In this research, a home-made mask using eight layers of 2-ply t-shirt was tested for effectiveness and fit against a N95 mask. The most important take away from this paper is that fabric masks are less effective due to lack of proper fitting, but a good design of fabric mask from recycled T-shirts may be able to provide two thirds of the protection of an N95 mask.
- While N95 masks require fit factor of 100, this mask had a fit factor of 67.
- "(...) offered substantial protection from the challenge aerosol and showed good fit with minimal leakage."
- May be less effective when made by naïve users
- May be uncomfortable
- "No easy, definitive, and affordable test can demonstrate effectiveness before each use."
Davies, A., Thompson, K., Giri, K., Kafatos, G., Walker, J., & Bennett, A. (2013). Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic? Disaster Medicine and Public Health Preparedness, 7(4), 413-418. doi:10.1017/dmp.2013.43. Retrieved from https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/testing-the-efficacy-of-homemade-masks-would-they-protect-in-an-influenza-pandemic/0921A05A69A9419C862FA2F35F819D55
- This study had subjects make their own masks.
- Regarding vacuum cleaner bags for masks: "bag's stiffness and thickness created a high pressure drop across the material, rendering it unsuitable for a face mask."
- Regarding cotton: "the pillowcase and the 100% cotton t-shirt were found to be the most suitable household materials for an improvised face mask. The slightly stretchy quality of the t-shirt made it the more preferable choice for a face mask as it was considered likely to provide a better fit."
- "Only the 2 layers of tea towel material demonstrated a significant increase in filtration efficiency that was marginally greater than that of the face mask."
- Surgical masks are still much better at filtering smaller particles.
- "It is likely that materials conditioned with water vapor, to create a fabric similar to that which has been worn for a couple of hours, would show very different filtration efficiencies and pressure drops."
Jung, H., Kim, J., Lee, S., Lee, J., Kim, J., Tsai, P., & Yoon, C. (2014). Comparison of filtration efficiency and pressure drop in anti-yellow sand masks, quarantine masks, medical masks, general masks, and handkerchiefs. Aerosol Air Qual Res, 14(14), 991-1002. Retrieved from: http://aaqr.org/files/article/668/36_AAQR-13-06-OA-0201_991-1002.pdf
- From the abstract: "Medical masks, general masks, and handkerchiefs were found to provide little protection against respiratory aerosols."
- "For virus, some N95 respirators may fall below 95%" (level of effectiveness).
- Handkerchiefs over a person's face have 98% of penetration regardless of used material.
- Use of nylon hosiery material ("panty hose") to hold the handkerchief material or the disposable face mask to the face was found to be very effective in preventing leakage (Cooper et al., 1983b). Such a combination could be expected to reduce leakage around the handkerchief to about 10% or less in practice, and around the mask to less than 1.0%.
Surgical Mask vs N95
Loeb M, Dafoe N, Mahony J, et al. Surgical Mask vs N95 Respirator for Preventing Influenza Among Health Care Workers: A Randomized Trial. JAMA. 2009;302(17):1865–1871. doi:10.1001/jama.2009.1466. Retrieved from: https://jamanetwork.com/journals/jama/article-abstract/184819
This study found that the rate of infection was similar between surgical masks and N95 masks on a randomized controlled trial: "our data show that the incidence of laboratory-confirmed influenza was similar in nurses wearing the surgical mask and those wearing the N95 respirator. Surgical masks had an estimated efficacy within 1% of N95 respirators. Based on the prespecified definition, the lower CI for the difference in effectiveness of the surgical mask and N95 mask was within −9% and the statistical criterion of noninferiority was met. That is, surgical masks appeared to be no worse, within a prespecified margin, than N95 respirators in preventing influenza."
Chughtai, A. A., Seale, H., & MacIntyre, C. R. (2013). Use of cloth masks in the practice of infection control—evidence and policy gaps. Int J Infect Control, 9(3).
This article does not have any conclusive information.
- Three factors were highlighted in these studies in regards to the filtration capacity of a cloth mask: 1) closeness of the gauze/cloth threads; 2) number of gauze/cloth layers and 3) type of gauze/cloth.
- Number of layers seems to increase the effectiveness of filtration in cloth masks.