Repurposing Surgical Wrap Textiles for Use as Protective Masks During Pandemic Response.

We are in the midst of a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus. At the time of writing, there were 2.17 million global coronavirus disease 2019 (COVID-19) cases with 146,000 deaths. Unfortunately, some of these deaths represent health care workers and first responders. One major challenge in preventing the occupational spread of SARS-CoV-2 is the lack of personal protective equipment (PPE), particularly filtering facepiece respirators (FFRs). (Our use of the phrase “surgical mask design or type” below is to denote the appearance of the mask. It is the textile that we believe makes this design of mask an FFR, as it creates a negative pressure environment that filters Bitrex particles out of the air that the user is breathing.) We acknowledge up front that we do not have enough data to submit a research article yet; we are pursuing standard FFR (quantitative) testing. However, in this time of pandemic crisis, we recognize the severe lack of PPE on the front lines of the pandemic and thus offer an option that might meet responder needs. We hope that this information is helpful for both research and practice while we further study these materials. Herein, we report efforts to provide a “crisis” alternative mask that provides improved fit compared to a surgical mask (SM), being more like an FFR. We adapted and evaluated the use of a medical-grade textile for mask development. Initially proposed by University of Florida researchers, the 2-ply spunpolypropylene sterilization wrap, Halyard H600 (Owens & Minor), was suggested to serve as a viable material for mask creation. We created 26 sewn masks that resembled typical SM designs (Figure 1, A, B, C, and D models) and 2 designs that resemble N95s (Figure 1, E and F models) from Halyard textiles (H200, H300, H600, or H650). Variations of these designs were sewn from at least two 7 8 in. (“larger” size) or two 7 6.5 in. (“smaller” size) for SM-style designs. In addition, up to 4 layers of textiles were tested for fit, comfort, and resistance to breathing. The H600 textile used as a surgical wrap is 2-ply. We started with this thickness and increased the thickness sequentially. Masks were secured to the face by elastic headbands or tied with textile straps. Masks had pliable metal stays inserted to assist sealing at the nose bridge and chin. We used qualitative fit testing to determine which masks “sealed” to the face as determined by Bitrex exclusion (ie, the test is passed if the subject fails to taste the Bitrex). Qualitative testing of the masks also included evaluating their comfort and wearability (1 1⁄4 best; 3 1⁄4 worst) and resistance to breathing or breathability (1 1⁄4 easiest; 3 1⁄4 hardest). One author with a “larger face” and 2 authors with “smaller” faces evaluated the mask designs by qualitative fit testing, supervised by a certified nurse. We present the results of those masks that passed the fit test in Table 1. Each SM design made from 2or more layers of Halyard textiles and secured with elastic straps (Figure 1, model SMC) excluded Bitrex when fit tested on adults of typical (“larger”) face size. The elastic straps appeared to hold masks tighter to the face, thus excluding Bitrex even with up-down and side-to-side head movements (and other exercises) during each 20to 30-minute test. In addition, each N95 design made from 2 layers of Halyard textiles secured with elastic, or textile, straps excluded Bitrex (with head movement) on “larger” and “smaller” faces (Figure 1, models 95-E and F, respectively). However, no SM design of 2or more layer combination of Halyard products secured with textile straps (Figure 1, models A and B), consistently excluded Bitrex as determined by tester grimace. In addition to straps feeling less comfortable and less secure, these masks often initially excluded Bitrex and then