PRACTICE PERFECT / THE PANDEMIC UPDATE Should Docs Shave Their Beards for Better Mask Fit BY JARROD SHAPIRO, DPM and Performance? Here’s some good and bad news about facial hair. Practice Perfect is a con- en and fit-tested, creating 285 tinuing every-issue column in total tests.3 They found beard which Dr. Shapiro offers his length and density decreased 49 unique personal perspective on mask fit. It’s looking pretty the ins and outs of running a bad for beards. podiatric practice. Cleanliness of Beards he N95 mask is Let’s take a slight detour one of the best and and consider how clean all most sought-after this facial hair is. Wakeam pieces of personal and associates looked at this protective equip- in 2014 when they examined Tment (PPE) around. Today, bacterial colonization rates all clinical encounters occur in 408 male healthcare work- with an N95 mask, and that ers, 199 with facial hair and PPE is becoming as much a 209 without.4 They performed part of the daily clinical dress swab cultures of this predom- as scrubs. In fact, you can al- inantly hospital-based popula- most get used to that upper tion and found no significant respiratory infection feeling difference in bacterial colo- in the sense that the mask nization rates between those squishes one’s nose, making you an obligate mouth-breather. As such, you can’t help but think more Those with facial hair had LESS of staph species about the mask. Obviously, facial hair is very common in healthcare than those who were clean shaven. Microtrauma from providers, and you have to wonder if this presents a problem. Should male shaving may promote growth of Staph. healthcare workers be clean-shaven, or is a beard safe? What about ver- sions of beards? Is a goatee safer than forward in time to 1988, a literature with or without facial hair. They did a full beard? Let’s take a look at the review of 14 studies found the pres- find a difference in the organisms evidence. ence of facial hair increased mask that colonized these different pop- Looking way back to 1984, Skret- leakage by 20-1,000 times.2 ulations with a decrease in Staphy- ved and Loschiavo1 performed qual- More recently in 2017, Floyd, et lococcus aureus and methicillin re- itative and quantitative fit testing in al. performed quantitative fit testing sistant Staph epidermidis. Let’s say 370 males. They found a 330-fold on 19 subjects with beards 0.5 inches that again: those with facial hair had decrease in protection in those indi- long who were then shaved to 0.25, LESS of these staph species than viduals with beards. Moving a little 0.125, 0.063 inches, and clean-shav- Continued on page 50 www.podiatrym.com SEPTEMBER 2020 | PODIATRY MANAGEMENT PRACTICE PERFECT PRESENT Podiatry PRESENT Podiatry (podiatry.com) is a podiatrist-owned-and-run company that proudly serves as the largest provider of online CME to the podiatry profession. One of the key lectures in their online CME collection is high- lighted below. 50 Beards (from page 49) the facial hair, and they then per- er than being clean-shaven (ironic formed quantitative fit testing (the choice of terms, huh?), it reduces those who were clean shaven! The kind all healthcare workers have to the protection your mask provides. authors explain this as resulting from undergo now). They found a fit fac- Maybe we should bring back the the skin microtrauma that occurs as tor for each person, requiring a score mustache? PM a result of shaving with a razor in of 100 to pass. Overall, only 34 of much the same way that surgical site 105 people (32%) achieved an ad- References infections increase after pre-opera- equate fit and none of those with 1 Skretvedt OT, Loschiavo JG. Effect tive skin shaving. Both clean-shaven a full beard achieved adequate fit. of facial hair on the face seal of nega- and those with facial hair increased They found the length of hair in- tive-pressure respirators. Am Ind Hyg the rate of bacterial shedding after versely correlated with quality of Assoc J. 1984 Jan;45(1):63-66. 2 Stobbe TJ, daRoza RA, Watkins MA. touching their faces. Moral of this mask fit5. It’s very interesting that Facial hair and respirator fit: a review of the literature. Am Ind Hyg Assoc J. 1988 Apr;49(4):199-204. Only 47% of the clean-shaven subjects achieved 3 Floyd EL, Henry JB, Johnson DL. Influence of facial hair length, coarseness, adequate fit. It’s not just the beard. It’s the mismatch and areal density on seal leakage of a tight-fitting half-face respirator tight-fitting between the face shape and the mask. half-face respirator. J Occup Environ Hyg. 2018 Apr;15(4):334-340. 4 Wakeam E, Hernandez RA, Rivera Morales D, Finlayson SR, Klompas M, story: beards have less staph, but only 47% of the clean-shaven sub- Zinner MJ. Bacterial ecology of hospi- don’t touch your face! jects achieved adequate fit, which tal workers’ facial hair: a cross-sectional Getting back to our original tells us something about the fit of study. J Hosp Infect. 2014 May;87(1):63- question, just this year, Sandaradu- these masks overall. Not the best 67. ra and colleagues, out of Australia, news to report. 5 Sandaradura I, Goeman E, Pontivo performed a study to evaluate the The verdict? If you want to in- G, Fine E, Gray H, et al. A close shave? fit of N95 respirators on 105 male crease the chance that your N95 Performance of P2/N95 respirators in healthcare workers. I can’t help but mask actually fits you well, and sub- healthcare workers with facial hair: re- point out that the study is named the sequently protect you the way you sults of the BEARDS (BEnchmarking Ade- “BEARDS” trial (BEnchmarking Ad- think it does, you’re better off with- quate Respiratory DefenceS) study. J Hosp Infect. 2020 Apr;104(4):529-533. equate Respiratory DefenceS). How out a beard. If you must have facial creative is that? hair, then a short goatee appears These researchers categorized fa- better than a beard. If it fits within Dr. Shapiro is editor of PRESENT Prac- cial hair by amount, from clean-shav- your N95 mask, then it will likely tice Perfect. He joined the faculty of Western en to stubble to goatee, all the way to create the best seal. Sorry, men. Al- University of Health Sciences, College of Podi- a full beard. Two reviewers classified though a beard appears to be clean- atric Medicine, Pomona, CA in 2010. SEPTEMBER 2020 | PODIATRY MANAGEMENT www.podiatrym.com.