Assessment of the chemical composition of respiratory and dermal protective equipment used by the population during the COVID-19 pandemic

Introduction: The use of personal protective equipment during the COVID-19 pandemic has affected the majority of the global population. The use of face masks has been proven to reduce the incidence of COVID-19 by 53 % and to be an effective means of prevention, both separately and in combination with other non-pharmaceutical measures. Wearing of face masks and gloves was mandated in different regions of the Russian Federation depending on the epidemiological situation, and it is still required in certain areas and workplaces at high risk of this severe infectious disease. Our literature review has shown that the prolonged mask and gloves use has adverse health effects including headaches, difficulty breathing, and various skin reactions.

Objective: To analyze chemicals contained in commercially available face masks and protective gloves as one of the stages of hygienic assessment of personal protective equipment and to assess whether the established chemical composition can pose a risk of adverse health outcomes.

Materials and methods: In 2021, four types of commercial face masks and protective gloves were analyzed in an accredited testing laboratory center to establish concentrations of chemicals after modeling their release into the aquatic and air environment.

Results: We established that, in all types of masks, the levels of detected chemicals did not exceed their appropriate permissible values. Formaldehyde was found in cotton and latex coated cotton gloves in concentrations exceeding the permissible ones by 1.48 and 1.16 times, respectively. A 1.17-fold excess of the acceptable limit was also registered for zinc in latex coated cotton gloves.

Conclusions: Increased levels of formaldehyde and zinc were found in cotton and latex coated cotton gloves. Formaldehyde can induce adverse skin reactions. Stricter control over production of respiratory and dermal protective equipment and a comprehensive hygienic assessment of PPE are required.

1. European Centre for Disease Prevention and Control. Using face masks in the community: first update – Effectiveness in reducing transmission of COVID-19. 15 February 2021. ECDC: Stockholm; 2021. Accessed November 17, 2021. https://www.ecdc.europa.eu/en/publications-data/using-face-masks-community-reducing-covid-19-transmission

2. Food and Drug Administration. Medical gloves for COVID-19. November 4, 2021. Accessed November 17, 2021. https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/medical-gloves-covid-19

3. Li Y, Guo YP, Wong KC, Chung WY, Gohel MD, Leung HM. Transmission of communicable respiratory infections and facemasks. J Multidiscip Healthc. 2008;1:17-27. doi: 10.2147/jmdh.s3019

4. Talic S, Shah S, Wild H, et al. Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. BMJ. 2021;375:e068302. doi: 10.1136/bmj-2021-068302

5. Ong, JJY, Bharatendu C, Goh Y, et al. Headaches associated with personal protective equipment – A cross-sectional study among frontline healthcare workers during COVID-19. Headache. 2020;60(5):864-877. doi: 10.1111/head.13811

6. Lim EC, Seet RC, Lee KH, Wilder-Smith EP, Chuah BY, Ong BK. Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand. 2006;113(3):199-202. doi: 10.1111/j.1600-0404.2005.00560.x

7. Szepietowski JC, Matusiak Ł, Szepietowska M, Krajewski PK, Białynicki-Birula R. Face mask-induced itch: A self-questionnaire study of 2,315 responders during the COVID-19 pandemic. Acta Derm Venereol. 2020;100(10):adv00152. doi: 10.2340/00015555-3536

8. Hu K, Fan J, Li X, Gou X, Li X, Zhou X. The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine (Baltimore). 2020;99(24):e20603. doi: 10.1097/MD.0000000000020603

9. Matusiak Ł, Szepietowska M, Krajewski P, Białynicki-Birula R, Szepietowski JC. Inconveniences due to the use of face masks during the COVID-19 pandemic: A survey study of 876 young people. Dermatol Ther. 2020;33(4):e13567. doi: 10.1111/dth.13567

10. Mitrokhin O, Shashina E, Makarova VМ. Use of face masks by students of the medical university during COVID-2019 pandemic. In: Public Health Issues in the Context of the COVID-19 Pandemic: Proceedings of the Third International Electronic Conference on Environmental Research and Public Health, January 11-25, 2021. doi: 10.3390/ECERPH-3-08988

11. Shashina EA, Makarova VV, Shcherbakov DV, et al. Use of respiratory protection devices by medical students during the COVID-19 pandemic. Int J Environ Res Public Health. 2021;18(11):5834. doi: 10.3390/ijerph18115834

12. Alenius H, Turjanmaa K, Palosuo T. Natural rubber latex allergy. Occup Environ Med. 2002;59(6):419-424. doi: 10.1136/oem.59.6.419

13. Taylor JS, Erkek E. Latex allergy: diagnosis and management. Dermatol Ther. 2004;17(4):289-301. doi: 10.1111/j.1396-0296.2004.04024.x

14. Lan J, Song Z, Miao X, et al. Skin damage among health care workers managing coronavirus disease–2019. J Am Acad Dermatol. 2020;82(5):1215-1216. doi: 10.1016/j.jaad.2020.03.014

15. Yan Y, Chen H, Chen L, et al. Consensus of Chinese experts on protection of skin and mucous membrane barrier for health-care workers fighting against corona-virus disease 2019. Dermatol Ther. 2020;33(4):e13310. doi: 10.1111/dth.13310

16. Anedda J, Ferreli C, Rongioletti F, Atzori L. Changing gears: Medical gloves in the era of coronavirus disease 2019 pandemic. Clin Dermatol. 2020;38(6):734-736. doi: 10.1016/j.clindermatol.2020.08.003

17. Shashina EA, Isiutina-Fedotkova TS, Makarova VV, Gruzdeva OA, Mitrokhin OV. Approaches to analyzing efficiency of respiratory protective equipment as a way to reduce health risks during COVID-19 pandemic. Health Risk Analysis. 2021;(1):151-158. doi: 10.21668/health.risk/2021.1.16.eng

18. Toxicological Profile for Zinc. U.S. Department of Health and Human Services. Public Health Service. Agency for Toxic Substances and Disease Registry. Atlanta, Georgia; 2005. Accessed November 17, 2021. https://www.atsdr.cdc.gov/toxprofiles/tp60.pdf

19. MSDS: Zinc. Article number: AE99. Version: GHS 2.0 ru. Revision date 05/15/2019. GOST 30333-2007. Group T58. Interstate standard. Safety data sheet for chemical products.

20. López-Sánchez L, Miralles P, Salvador A, Merino- Sanjuán M, Merino V. In vitro skin penetration of bronidox, bronopol and formaldehyde from cosmetics. Regul Toxicol Pharmacol. 2021;122:104888. doi: 10.1016/j.yrtph.2021.104888

21. Scheman A, Jacob S, Zirwas M, et al. Contact allergy: alternatives for the 2007 North American contact dermatitis group (NACDG) Standard Screening Tray. Dis Mon. 2008;54(1-2):7-156. doi: 10.1016/j.disamonth.2007.10.002

22. Aalto-Korte K, Koskela K, Pesonen M. Allergic contact dermatitis and other occupational skin diseases in health care workers in the Finnish Register of Occupational Diseases in 2005–2016. Contact Dermatitis. 2021;84(4):217-223. doi: 10.1111/cod.13753

23. Valdes F, McNamara S, Keri J. Allergic contact dermatitis from transient formaldehyde exposure in a traveler: Are all backpacks created equal? Cureus. 2020;12(12):e12252. doi: 10.7759/cureus.12252

24. Patel V, Atwater AR, Reeder M. Contact dermatitis of the hands: Is it irritant or allergic? Cutis. 2021;107(3):129-132. doi: 10.12788/cutis.0204

25. Toxicological Profile for Formaldehyde. U.S. Department of Health and Human Services. Public Health Service. Agency for Toxic Substances and Disease Registry. Atlanta, Georgia; 1999. Accessed November 17, 2021. https://www.atsdr.cdc.gov/toxprofiles/tp111.pdf

26. Rovira J, Domingo JL. Human health risks due to exposure to inorganic and organic chemicals from textiles: A review. Environ Res. 2019;168:62-69. doi: 10.1016/j.envres.2018.09.027