Use

Fit testing is a critical component to a respiratory protection program whenever workers use tight-fitting respirators. OSHA (US) requires an initial respirator fit test to identify the right model, style, and size respirator for each worker; as well, as annual fit tests. Additionally, tight-fitting respirators, including the N95, require a user seal check each time one is put on. Facial hair at the sealing area of the respirator will cause it to leak.

Respirators require a medical evaluation before use because they can make breathing more difficult. Some conditions that could prevent respirator use include heart conditions, lung disease, and psychological conditions such as claustrophobia. In the United States medical evaluation is required once, prior to initial fit testing and use, although it may need to be repeated if any adverse signs or symptoms are observed. The use of the respirator, decreases the chances of getting a virus that spreads through-out the air into your body.

For persons who are medically disqualified from negative-pressure respirators, or who cannot pass a fit test due to facial hair or other reasons, a powered air-purifying respirator is a possible alternative.

In industryedit

N95 respirators were originally designed for industrial use in sectors such as mining, construction, and painting. They have also been shown to be effective as protection against engineered nanoparticles.:12–14

According to the NIOSH Respirator Selection Logic, respirators with filters in the N, R, and P series are recommended for concentrations of hazardous particulates that are greater than the relevant occupational exposure limit but less than the immediately dangerous to life or health level and the manufacturer's maximum use concentration, subject to the respirator having a sufficient assigned protection factor.

N series respirators, including the N95 respirator, are only effective in the absence of oil particles, such as lubricants, cutting fluids, or glycerine. For substances hazardous to the eyes, a respirator equipped with a full facepiece, helmet, or hood is recommended. They are not effective during firefighting, in oxygen-deficient atmosphere, or in an unknown atmosphere; in these situations a self-contained breathing apparatus is recommended instead. They are not effective against hazardous gases or vapors, for which a cartridge respirator is recommended.

In industrial settings where infectious disease exposure is not a concern, users can wear and reuse a filtering facepiece respirator until it is damaged, soiled, or causing noticeably increased breathing resistance, unless there is a manufacturer-specified duration of use. However, in laboratories at biosafety level 2 and higher, respirators are recommended to be discarded as hazardous waste after a single use.

Some industrial N95 series respirators have an exhaust valve to improve comfort, making exhalation easier, reducing leakage on exhalation and steaming-up of glasses. Such respirators are not suitable for source control of disease, such as COVID-19, when worn by asymptomatic, but possibly infected users, even if excess N95 respirators are available when healthcare needs are met.

In healthcareedit

Respirators used in healthcare are traditionally a specific variant called a surgical respirator, which is both approved by NIOSH as a respirator and cleared by the Food and Drug Administration as a medical device similar to a surgical mask. These may also be labeled "Surgical N95", "medical respirators", or "healthcare respirators". As part of the Families First Coronavirus Response Act, changes were made to liability and certification laws to allow industrial respirators to be used in healthcare settings, in response to shortages of respirators during the COVID-19 pandemic.

In the United States, the Occupational Safety and Health Administration (OSHA) requires healthcare workers who are expected to perform patient activities with those suspected or confirmed to be infected with COVID-19 to wear respiratory protection, such as an N95 respirator. The CDC recommends the use of respirators with at least N95 certification to protect the wearer from inhalation of infectious particles including Mycobacterium tuberculosis, avian influenza, severe acute respiratory syndrome (SARS), pandemic influenza, and Ebola.

Unlike a respirator, a surgical mask is designed to provide barrier protection against droplets and does not have an air-tight seal and thus does not protect its wearer against airborne particles such as virus material to the same extent.

Use during shortagesedit

During crisis situations where there is a shortage of N95 respirators, such as the COVID-19 pandemic, the U.S. Centers for Disease Control and Prevention (CDC) has recommended strategies for optimizing their use in healthcare settings. N95 respirators can be used beyond their manufacturer-designated shelf life, although components such as the straps and nose bridge material may degrade, making it particularly important that the wearer perform the expected seal check. N95 respirators can be reused a limited number of times after being removed, as long as they have not been used during aerosol-generating procedures and are not contaminated with patients' bodily fluids, although this increases the risk of surface contamination with pathogens. The respirator manufacturer may recommend a maximum number of donnings or uses; if no manufacturer guidance is available, preliminary data suggests limiting to five uses per device. Respirators approved under standards used in other countries and are similar to NIOSH-approved N95 respirators—including FFP2 and FFP3 respirators regulated by the European Union—can be used.

According to NIOSH, respirators may still be used in crisis situations if standard respirator fit testing is not available, as a respirator will still provide better protection than a surgical mask or no mask. In this case, best practices for getting a good face seal include trying different models or sizes, using a mirror or asking a colleague to check that the respirator is touching the face, and doing multiple user seal checks.

Given that the global supply of personal protective equipment (PPE) is insufficient during the pandemic, as of 2 February 2020, the World Health Organization recommends minimizing the need for PPE through telemedicine, physical barriers such as clear windows, allowing only those involved in direct care to enter a room with a COVID-19 patient, using only the PPE necessary for the specific task, continuing use of the same respirator without removing it while caring for multiple patients with the same diagnosis, monitoring and coordinating the PPE supply chain, and discouraging the use of masks for asymptomatic individuals. It should be stressed that for advice updates up until 3 July 2020, the CDC and WHO recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.

When it is no longer possible for all healthcare workers to wear N95 respirators when caring for a COVID-19 patient, CDC recommends that respirators be prioritized for workers performing aerosol-generating procedures on symptomatic persons, and those within three feet of an unmasked symptomatic person. Under these conditions, masking of symptomatic patients with a surgical mask and maintaining distance from the patient are particularly important to reduce the risk of transmission. When no respirators are left, workers who are at higher risk for severe illness may be excluded from caring for patients, and workers who have clinically recovered from COVID-19 may be preferred to care for patients. Portable fans with HEPA filters may also be used to increase ventilation in isolation rooms when surgical masks are being used in place of respirators. A high-quality HEPA filter that can trap 99.97% of dust particles that are 0.3 microns in diameter. If neither respirators nor surgical masks are available, as a last resort, it may be necessary for healthcare workers to use masks that have never been evaluated or approved by NIOSH or homemade masks, such as cloth face masks, although caution should be exercised when considering this option.

Decontaminationedit

Disposable filtering facepiece respirators such as N95 respirators are not approved for routine decontamination and reuse as standard of care. However, their decontamination and reuse may need to be considered as a crisis capacity strategy to ensure continued availability.

There have been efforts to evaluate cleaning methods for respirators in emergency shortages, although there is concern that this may reduce filter performance, or affect mask fit by deforming the mask. Duke University researchers have published a method for cleaning N95 respirators without damaging them using vaporized hydrogen peroxide to allow reuse for a limited number of times. Battelle received an Emergency Use Authorization from the U.S. Food and Drug Administration for its technology used to sterilize N95 respirators.

OSHA does not currently have any standards for disinfecting N95 respirators. NIOSH recommends that during shortages N95 respirators may be used up to five times without cleaning them, as long as aerosol-generating procedures are not performed, and respirators are not contaminated with patients' bodily fluids. Contamination can be reduced by wearing a cleanable face shield over an N95 respirator, as well as using clean gloves when donning and seal-checking a used N95 respirator and discarding the gloves immediately after. According to CDC, ultraviolet germicidal irradiation, vaporous hydrogen peroxide, and moist heat showed the most promise as potential methods to decontaminate N95 respirators and other filtering facepiece respirators.

Contrast with surgical maskedit

A surgical mask is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment. If worn properly, a surgical mask is meant to help block large-particle droplets, splashes, sprays, or splatter that may contain viruses and bacteria. Surgical masks may also help reduce exposure of the wearer's saliva and respiratory secretions to others.

A surgical mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the face mask and the face. Collection efficiency of surgical mask filters can range from less than 10% to nearly 90% for different manufacturers’ masks when measured using the test parameters for NIOSH certification. However, a study found that even for surgical masks with "good" filters, 80–100% of subjects failed an OSHA-accepted qualitative fit test, and a quantitative test showed 12–25% leakage.

The U.S. Centers for Disease Control and Prevention recommends surgical masks in procedures where there can be an aerosol generation from the wearer, if small aerosols can produce a disease to the patient.