{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T13:45:42Z","timestamp":1767707142730,"version":"3.40.5"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T00:00:00Z","timestamp":1661299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>The COVID-19 pandemic has infected hundreds of millions of people resulting in millions of deaths worldwide. While N95 respirators remain the gold standard as personal protective equipment, they are resource-intensive to produce and obtain. Surgical masks, easier to produce and obtain, filter \u226595% submicron particles but are less protective due to a lack of seal around a user\u2019s face. This study tested the ability of a simple surgical mask modification using rubber bands to create a seal against particle exposure that would pass N95 standards.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods and findings<\/jats:title><jats:p>Forty healthcare workers underwent TSI PortaCount mask fit testing using an ASTM Level 1 surgical mask modified with rubber bands. Fit Factor was determined after testing four standard OSHA N95 fit testing scenarios. Performance of the properly-modified surgical mask was compared to that of a poorly-modified surgical mask, an unmodified standard surgical mask, and an N95 respirator. Thirty-one of forty (78%) healthcare workers passed Fit Factor testing using a properly-modified mask. The Fit Factor success rate significantly improved by subsequent test date (p = 0.043), but was not associated with any other participant characteristics. The average Fit Factor score for the properly-modified mask was 151 (SD 65.2), a significantly better fit than the unmodified mask score of 3.8 (SD 3.1, p&lt;0.001) and the poorly-modified mask score of 24.6 (SD 48.4, p&lt;0.001) but significantly lower than a properly fitted N95 score of 199 (SD 4.5, p&lt;0.001).do.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Conclusions<\/jats:title><jats:p>Rubber bands, a low-cost and easily-accessible modification, can improve the seal and protective ability of a standard surgical mask to the level of an N95 respirator. This could mitigate N95 respirator shortages worldwide and provide individuals in under-resourced regions a practical means for increased personal respiratory protection.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0272834","type":"journal-article","created":{"date-parts":[[2022,8,24]],"date-time":"2022-08-24T17:26:42Z","timestamp":1661362002000},"page":"e0272834","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["A simple surgical mask modification to pass N95 respirator-equivalent fit testing standards during the COVID-19 pandemic"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9868-5201","authenticated-orcid":true,"given":"Agnes Z.","family":"Dardas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Viviana M.","family":"Serra Lopez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren M.","family":"Boden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel J.","family":"Gittings","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Heym","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Koerber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taras","family":"Grosh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8151-9987","authenticated-orcid":true,"given":"Jaimo","family":"Ahn","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,8,24]]},"reference":[{"unstructured":"WHO Coronavirus (COVID-19) Dashboard. World Health Organization. 2022 May 31 [Cited 2022 May 31]. https:\/\/covid19.who.int\/.","key":"pone.0272834.ref001"},{"key":"pone.0272834.ref002","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1016\/S0140-6736(20)31142-9","article-title":"Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis","volume":"395","author":"DK Chu","year":"2020","journal-title":"Lancet"},{"key":"pone.0272834.ref003","article-title":"Covid-19 has caused a shortage of face masks. But they\u2019re surprisingly hard to make","author":"E Feng","year":"2020","journal-title":"National Public Radio"},{"unstructured":"Electronic Code of Federal Regulations. Title 42, Chapter I, Subchapter G, Part 84 \u2013Approval of Respiratory Protective Devices. Office of the Federal Register, Government Publishing Office. 2020 Apr 16 [Cited 2021 May 5]. https:\/\/www.ecfr.gov\/current\/title-42\/part-84.","key":"pone.0272834.ref004"},{"unstructured":"ASTM F2100-21. ASTM International. 2021 [Cited 2022 May 31]. https:\/\/www.astm.org\/f2100-21.html.","key":"pone.0272834.ref005"},{"issue":"10","key":"pone.0272834.ref006","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1080\/15459620903120086","article-title":"Performance of an N95 filtering facepiece particulate respirator and a surgical mask during human breathing: two pathways for particle penetration","volume":"6","author":"SA Grinshpun","year":"2009","journal-title":"J Occup Environ Hyg"},{"issue":"8","key":"pone.0272834.ref007","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1093\/occmed\/kqaa167","article-title":"COVID-19: smoke testing of surgical mask and respirators","volume":"70","author":"JDM Douglas","year":"2020","journal-title":"Occup Med"},{"unstructured":"Fix The Mask Data\u2013V1.0, V2.0. 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