The Great Gender Divide: Gender-related discrepancies of N95 mask protection

Abstract

Background: During the COVID-19 pandemic, healthcare professionals are at increased risk of transmission due to their direct contact with infected patients. To ensure protection, properly fitting personal protective equipment (PPE) must be worn. N95 respirator masks are a component of PPE outlined by the CDC for COVID-19; however, N95 masks do not offer protection if they do not fit properly. Fit testing is performed to ensure adequate seal of the mask and proper fit.

Objective: The objective of this project was to attempt to identify a gender-related difference in fittesting failure rates.

Methods: A single institutional retrospective review was performed on individuals who underwent fit testing from December 2019 to June 2020. Two mask sizes were available for fit testing (Model 3M1860, Regular/Small). Fit test results were divided into two groups, male or female, and evaluated for failure rates. Reasons for fit test failures were noted as: large-boned, small-boned, facial asymmetry, facial hair, and/or no reason reported. Exclusion criterion included failure due to facial hair. Results: A total of 336 tests were performed during this period, with 31 exclusions for facial hair. Data analyzed included 305 total respirator fit test results: 110 male and 195 female. Females fail at signifcantly higher rates, 6.67%, compared to males, 2.27% (p=0.001). Specifcally, females failed due to being small-boned when compared to reasons for male fit testing failures (p<0.0001).

Conclusion: Gender-related differences in PPE fit is not new; however, the COVID- 19 pandemic has made the situation more acute. Females are faced with wearing masks that do not properly fit; N95 masks were not designed for female facial dimensions and because of inadequate fit, female healthcare workers are not properly protected. Developing a gender-specifc approach to designing N95 masks is vital in the upcoming months, as a potential second wave of COVID-19 is approaching.