Sir, I write further to the letter Why PAPR suits us (BDJ 2020; 229: 500) by H. Mostafa. The author provides some practical advantages to powered air-purifying respirator (PAPR) use over other respirators but PAPRs are available with either a tight-fitting facepiece (requiring fit testing)1 or facepiece, helmet or hood that is loose-fitting.

PAPRs also possess a greater Assigned Protection Factor in comparison to filtering facepiece respirators (FFRs). Apart from the advantages listed by the author, others include amenability to wearing with a limited amount of facial hair, splash protection for the eyes and face provided by models with hoods or helmets ranging from a limited to a more significant extent. A PAPR could also be more physiologically conducive for the wearer by offering less breathing resistance. The majority of PAPR components can be re-used or shared after being cleaned and disinfected.1

That being said, the author raised the matter of having issues with vision while using FFRs; a PAPR may also interfere with the field of vision as a result of the downward vertical visual field being rather limited, powered PAPRs may impair the hearing ability of the wearer due to blower noise and noise created by the loose head covering during movement.1 PAPRs also require considerable storage space, an approved staff training protocol in maintenance and disinfection, and timely battery replacement or charging to maintain optimal performance.

PAPR components exhibit significant variability across manufacturers and in their reaction to various cleaning, disinfectant methods and solutions which can cause damage or deterioration of components. They are also very specific in how they are to be used and require training to avoid contamination and infectious liability. Most manufacturers recommend the filter be discarded. CDC cautions against the use of these filters for a live virus and recommends the institution of a replacement cycle which is practical to implement till more evidence emerges.1

Therefore, before adopting PAPRs, practices should seriously consider various factors to decide suitability.