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Van Belle TA, King EC, Roy M, Michener M, Hung V, Zagrodney KAP, McKay SM, Holness DL, Nichol KA. Factors influencing nursing professionals' adherence to facial protective equipment usage: A comprehensive review. Am J Infect Control 2024:S0196-6553(24)00164-0. [PMID: 38657906 DOI: 10.1016/j.ajic.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Facial protective equipment (FPE) adherence is necessary for the health and safety of nursing professionals. This review was conducted to synthesize predisposing, enabling, and reinforcing factors that influence FPE adherence, and thus inform efforts to promote adherence. METHODS Articles were collected using Cumulated Index to Nursing and Allied Health Literature and MEDLINE and screened for inclusion. Included articles were original studies focused on FPE adherence by nurses to prevent respiratory infection which contained occupation-specific data from at least 10 individuals and were published in English between January 2005 and February 2022. RESULTS Thirty articles were included, 21 of which reported adherence rates. Adherence ranged from 33% to 100% for respiratory protection and 22% to 100% for eye protection. Predisposing demographic factors influencing adherence included tenure and occupation, while modifiable predisposing factors included knowledge and perception of FPE, infection transmission, and risk. Enabling factors included geography, care settings, and FPE availability. Reinforcing factors included organizational support for health and safety, clear policies, and training. CONCLUSIONS The identified demographic factors suggest populations that may benefit from targeted interventions, while modifiable factors suggest opportunities to enhance education as well as operational processes and supports. Interventions that target these areas have the potential to promote adherence and thereby improve the occupational safety of nurses.
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Affiliation(s)
| | - Emily C King
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Meghla Roy
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Mel Michener
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Vivian Hung
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada
| | - Katherine A P Zagrodney
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Canadian Health Workforce Network, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandra M McKay
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada; Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada; Ted Rogers School of Management, Toronto Metropolitan University, Toronto, Ontario, Canada; The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada; Michener Institute of Education, University Health Network, Toronto, Ontario, Canada; Micheal Garron Hospital, Toronto East Health Network, East York, Ontario, Canada
| | - D Linn Holness
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine and MAP Centre for Urban Health Solutions, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario Canada
| | - Kathryn A Nichol
- Research Department, VHA Home HealthCare, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Research Expertise in Occupational Disease, Toronto, Ontario Canada
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Ramdani C, Ogier M, Coutrot A. Communicating and reading emotion with masked faces in the Covid era: A short review of the literature. Psychiatry Res 2022; 316:114755. [PMID: 35963061 PMCID: PMC9338224 DOI: 10.1016/j.psychres.2022.114755] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
Abstract
Face masks have proven to be key to slowing down the SARS-Cov2 virus spread in the COVID-19 pandemic context. However, wearing face masks is not devoid of "side-effects", at both the physical and psychosocial levels. In particular, masks hinder emotion reading from facial expressions as they hide a significant part of the face. This disturbs both holistic and featural processing of facial expressions and, therefore, impairs emotion recognition, and influences many aspects of human social behavior. Communication in general is disrupted by face masks, as they modify the wearer's voice and prevent the audience from using lip reading or other non-verbal cues for speech comprehension. Individuals suffering from psychiatric conditions with impairment of communication, are at higher risk of distress because masks increase their difficulties to read emotions from faces. The identification and acknowledgement of these "side-effects" on communication are necessary because they warrant further work on adaptive solutions that will help foster the use of face masks by the greatest number.
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Affiliation(s)
- Celine Ramdani
- French Armed Forces Biomedical Research Institute, Bretigny sur Orge, France.
| | - Michael Ogier
- French Armed Forces Biomedical Research Institute, Bretigny sur Orge, France
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3
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Thurman P, Zhuang E, Chen HH, McClain C, Sietsema M, Fernando R, McDiarmid MA, Hines SE. Characteristics Associated With Health Care Worker Knowledge and Confidence in Elastomeric Half-Mask Respirator Use. J Occup Environ Med 2022; 64:802-807. [PMID: 35704776 PMCID: PMC9426319 DOI: 10.1097/jom.0000000000002611] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study evaluated health care workers' (HCWs') knowledge and confidence in using elastomeric half-mask respirator (EHMR) attributes known to influence usage. METHODS Health care workers were surveyed regarding their EHMR donning and doffing experience. Respondents were categorized into competency categories based on their scores. Category differences were analyzed using χ 2 and multiple logistic regression. RESULTS Seventy-two percent showed high levels of EHMR donning and doffing knowledge and confidence (mastery); however, 21% had greater confidence than knowledge (misinformed). Respiratory therapists had greater odds of mastery than other HCWs ( P < 0.05), whereas those working in medical/surgical and pediatric units had greater odds of doubt than other HCWs ( P < 0.01). CONCLUSIONS Although most HCWs show high knowledge and confidence with EHMR use, strategies to confirm respirator use competency may ensure greater HCWs protection.
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Chaaban O, Balanay JAG, Sousan S. Assessment of best-selling respirators and masks: Do we have acceptable respiratory protection for the next pandemic? Am J Infect Control 2022; 51:388-395. [PMID: 35901992 PMCID: PMC9313532 DOI: 10.1016/j.ajic.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 12/04/2022]
Abstract
Background COVID-19 pandemic caused a high demand for respiratory protection, caused a scarcity of approved respirators and the production of alternative respiratory protection. To raise public awareness through the scientific community, bestselling respirators and masks in the United States’ leading online retailer, Amazon.com, were evaluated. Methods Ten respirators and masks, 5 Face Protective Equipment (FPE) and 5 Cloth Face Masks (CFMs), were evaluated compared to the N95 standard. Two groups were established with the intention of comparing all masks together. The fractional efficiency and pressure drop were measured and compared to the National Institute for Occupational Safety and Health (NIOSH) standards. In addition, grading factors for protection, comfort, and affordability were developed that can be used by the scientific community to readily disseminate to consumers for the selection of the appropriate respiratory protection. Results Two FPE provided acceptable efficiency (>95%) similar to the N95, while the remaining products were below or extremely below NIOSH standards. All products provided pressure drops within NIOSH standards (≤35 mmH2O) ranging from 2.3-10.3 mmH2O. The grading factors show that the CFMs have minimal protection, and the N95 has average comfort and affordability compared to all the products. Conclusion The N95 remains the best respiratory protection, and in the event of the next airborne pandemic, FPEs could serve as adequate alternative protection against the viral spread.
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Affiliation(s)
- Omar Chaaban
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC
| | - Jo Anne G Balanay
- Environmental Health Sciences Program, Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC
| | - Sinan Sousan
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC; North Carolina Agromedicine Institute, Greenville, NC.
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5
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Ng I, Kave B, Begg F, Bodas CR, Segal R, Williams D. N95
respirators: quantitative fit test pass rates and usability and comfort assessment by health care workers. Med J Aust 2022; 217:88-93. [PMID: 35645035 PMCID: PMC9347558 DOI: 10.5694/mja2.51585] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022]
Abstract
Objectives To compare the performance of four N95 respirator types with respect to quantitative fit test pass rate and health care worker‐rated usability and comfort. Design, setting, participants Health care workers who participated in the respiratory protection program at the Royal Melbourne Hospital, 1 October 2020 – 31 May 2021. Participants underwent quantitative N95 respirator fit testing (at least three of four types: semi‐rigid cup, flat‐fold cup, duckbill, and three‐panel flat‐fold types), and were invited to complete an online usability and comfort assessment for respirators for which their fit test results were passes. Main outcome measures Fit test pass rate, and user‐rated overall comfort and assessment ratings (five‐point Likert scales), by N95 respirator type. Results A total of 2161 health care workers underwent quantitative fit testing (women, 1586 [73.4%]; nurses, 1271 [58.8%]). The overall fit test pass rates were 65.0% for the semi‐rigid cup respirators (1029/1583 tests), 32.4% for the flat‐fold respirator (660/2035 tests), 59.2% for the duckbill respirators (2005/3387 tests), and 96.4% for the three‐panel flat‐fold respirator (1876/1946 tests). 378 health care workers completed the comfort and usability survey. Overall comfort and assessment ratings each differed by respirator group (P < 0.001); the median overall comfort (4; IQR, 3–4) and overall assessment values (4; IQR, 3–5) were highest for the three‐panel flat‐fold respirator and lowest for the semi‐rigid cup respirators (comfort: 2 [IQR, 1–3]; assessment: 2 [IQR, 2–3]). Conclusions The three‐panel flat‐fold N95 respirator outperformed the three alternative types with regard to fit test pass rate and user‐rated comfort and usability. To maximise respiratory protection for health care workers, these factors should be considered when making respirator procurement decisions.
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Affiliation(s)
- Irene Ng
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
| | | | - Fiona Begg
- The Royal Melbourne Hospital Melbourne VIC
| | | | - Reny Segal
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
| | - Daryl Williams
- The Royal Melbourne Hospital Melbourne VIC
- The University of Melbourne Melbourne VIC
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Cloet A, Griffin L, Yu M, Durfee W. Design considerations for protective mask development: A remote mask usability evaluation. APPLIED ERGONOMICS 2022; 102:103751. [PMID: 35339761 PMCID: PMC8943342 DOI: 10.1016/j.apergo.2022.103751] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 06/14/2023]
Abstract
The design of N95 filtering facepiece respirators (FFRs) continues to pose usability concerns for healthcare workers, which have been exacerbated by the COVID-19 pandemic. The aim of this study was to develop a holistic model to guide mask design improvement. Dental students (n = 38) with experience wearing N95 FFRs participated in a randomized wear trial of three alternative protective masks. A mixed methods survey was used to examine usability of individual mask design components, the relationship of facial/head area to mask features, and overall mask design. Survey results indicated MNmask v1 demonstrated higher usability in seal confidence (M = 3.46), while MNmask v2 performed higher in satisfactory fit (M = 3.50). Design components of nose wire and head/neck bands were the most problematic, while conditions of skin irritation and tight/loose fit created an unfavorable wear experience. To consider healthcare workers' needs in improving the usability of protective masks, a model is presented to consider characteristics of fit, comfort, material, and design.
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Affiliation(s)
- Alison Cloet
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA
| | - Linsey Griffin
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA.
| | - Minji Yu
- College of Design, University of Minnesota, 1985 Buford Ave, 240 McNeal Hall, St. Paul, MN, 55108, USA
| | - William Durfee
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN, 55455, USA
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7
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Young CC, Byrne JD, Wentworth AJ, Collins JE, Chu JN, Traverso G. Respirators in Healthcare: Material, Design, Regulatory, Environmental, and Economic Considerations for Clinical Efficacy. GLOBAL CHALLENGES (HOBOKEN, NJ) 2022; 6:2200001. [PMID: 35601599 PMCID: PMC9110919 DOI: 10.1002/gch2.202200001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Indexed: 06/15/2023]
Abstract
Maintaining an ample supply of personal protective equipment continues to be a challenge for the healthcare industry, especially during emergency situations and times of strain on the supply chain. Most critically, healthcare workers exposed to potential airborne hazards require sufficient respiratory protection. Respirators are the only type of personal protective equipment able to provide adequate respiratory protection. However, their ability to shield hazards depends on design, material, proper fit, and environmental conditions. As a result, not all respirators may be adequate for all scenarios. Additionally, factors including user comfort, ease of use, and cost contribute to respirator effectiveness. Therefore, a careful consideration of these parameters is essential for ensuring respiratory protection for those working in the healthcare industry. Here respirator design and material characteristics are reviewed, as well as properties of airborne hazards and potential filtration mechanisms, regulatory standards of governmental agencies, respirator efficacy in the clinical setting, attitude of healthcare personnel toward respiratory protection, and environmental and economic considerations of respirator manufacturing and distribution.
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Affiliation(s)
- Cameron C. Young
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical School75 Francis StBostonMA02115USA
- Departments of Chemical Engineering and BiochemistryNortheastern University300 Huntington AveBostonMA02115USA
| | - James D. Byrne
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical School75 Francis StBostonMA02115USA
- Harvard Radiation Oncology Program55 Fruit StBostonMA02114USA
- David H. Koch Institute for Integrative Cancer ResearchMassachusetts Institute of Technology500 Main St. Building 76CambridgeMA02142USA
- Department of Mechanical EngineeringMassachusetts Institute of Technology77 Massachusetts AveCambridgeMA02139USA
- Department of Radiation OncologyDana‐Farber Cancer Institute/Brigham and Women's Hospital44 Binney StBostonMA02115USA
| | - Adam J. Wentworth
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical School75 Francis StBostonMA02115USA
- David H. Koch Institute for Integrative Cancer ResearchMassachusetts Institute of Technology500 Main St. Building 76CambridgeMA02142USA
- Department of Mechanical EngineeringMassachusetts Institute of Technology77 Massachusetts AveCambridgeMA02139USA
| | - Joy E. Collins
- David H. Koch Institute for Integrative Cancer ResearchMassachusetts Institute of Technology500 Main St. Building 76CambridgeMA02142USA
- Department of Mechanical EngineeringMassachusetts Institute of Technology77 Massachusetts AveCambridgeMA02139USA
- Division of GastroenterologyMassachusetts General Hospital55 Fruit StBostonMA02114USA
| | - Jacqueline N. Chu
- David H. Koch Institute for Integrative Cancer ResearchMassachusetts Institute of Technology500 Main St. Building 76CambridgeMA02142USA
| | - Giovanni Traverso
- Division of GastroenterologyBrigham and Women's HospitalHarvard Medical School75 Francis StBostonMA02115USA
- David H. Koch Institute for Integrative Cancer ResearchMassachusetts Institute of Technology500 Main St. Building 76CambridgeMA02142USA
- Department of Mechanical EngineeringMassachusetts Institute of Technology77 Massachusetts AveCambridgeMA02139USA
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8
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Advances in respiratory protective equipment: Practical experiences of CleanSpace® HALO™ by healthcare workers. J Hosp Infect 2022; 124:22-28. [DOI: 10.1016/j.jhin.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 12/17/2022]
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Effect of Different Types of Face Masks on the Ventilatory and Cardiovascular Response to Maximal-Intensity Exercise. BIOLOGY 2021; 10:biology10100969. [PMID: 34681068 PMCID: PMC8533493 DOI: 10.3390/biology10100969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
The development of new models of face masks makes it necessary to compare their impact on exercise. Therefore, the aim of this work was to compare the cardiopulmonary response to a maximal incremental test, perceived ventilation, exertion, and comfort using FFP2 or Emotion masks in young female athletes. Thirteen healthy sportswomen (22.08 ± 1.75 years) performed a spirometry, and a graded exercise test on a treadmill, with a JAEGER® Vyntus CPX gas analyzer using an ergospirometry mask (ErgoMask) or wearing the FFP2 or the Emotion mask below the ErgoMask, randomized on 3 consecutive days. Also, menstrual cycle status was monitored to avoid possible intrasubject alterations. The results showed lower values for the ErgoMask+FFP2, compared to ErgoMask or ErgoMask+Emotion, in forced vital capacity (3.8 ± 0.2, 4.5 ± 0.2 and 4.1 ± 0.1 l, respectively); forced expiratory volume in 1 s (3.3 ± 0.2, 3.7 ± 0.2 and 3.5 ± 0.1 l); ventilation (40.9 ± 1.5, 50.6 ± 1.5 and 46.9 ± 1.2 l/min); breathing frequency (32.7 ± 1.1, 37.4 ± 1.1 and 35.3 ± 1.4 bpm); VE/VO2 (30.5 ± 0.7, 34.6 ± 0.9 and 33.6 ± 0.7); VE/VCO2 (32.2 ± 0.6, 36.2 ± 0.9 and 34.4 ± 0.7) and time to exhaustion (492.4 ± 9.7, 521.7 ± 8.6 and 520.1 ± 9.5 s) and higher values in inspiratory time (0.99 ± 0.04, 0.82 ± 0.03 and 0.88 ± 0.03 s). In conclusion, in young healthy female athletes, the Emotion showed better preservation of cardiopulmonary responses than the FFP2.
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10
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Toprak E, Bulut AN. The effect of mask use on maternal oxygen saturation in term pregnancies during the COVID-19 process. J Perinat Med 2021; 49:148-152. [PMID: 33544533 DOI: 10.1515/jpm-2020-0422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Our aim was to evaluate the effect of standard surgical and N-95 respiratory mask use on maternal oxygen saturation, vital signs and result on non-stress tests in term pregnancies. METHODS It is a prospective observational study. The study included healthy, not in labor, singleton pregnant women of 370/7-410/7 weeks who were applied to our hospital for routine obstetric control examination between March 1, 2020, and August 31, 2020. Patients were randomised by coin toss method. Oxygen saturation, systolic, and diastolic arterial blood pressure, pulse, respiratory rate, and temperature of pregnant women using surgical masks and respiratory masks were measured before and after the non-stress test. The tolerance of the masks was also evaluated. Student's t-test was used for variables showing parametric distribution and the Mann Whitney U-test was used for non-parametric tests. The categorical variables between the groups was analyzed by using the Chi square test or Fisher Exact test. The statistical significance level was taken as p<0.05 in all tests. RESULTS A total of 297 pregnant women using masks were included in the study. The effect of mask type on oxygen saturation before and after the non-stress test was found to be significant (97.1±1.8 corresponds to 95.3±2.6 for the surgical mask, p=0.0001; 97.8±1.7 corresponds to 93.7±2.0 for the respiratory mask, p=0.0001). Mask tolerance of patients using respiratory masks was significantly higher than those using surgical masks (mean 8, 1-10, p=0.0001). CONCLUSIONS Surgical mask and respiratory mask usage decreased significantly in oxygen saturation in term pregnancies.
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Affiliation(s)
- Erzat Toprak
- Department of Obstetrics and Gynecology, Division of Perinatology, Kayseri City Education and Research Hospital, Kayseri, Turkey
| | - Ayça Nazlı Bulut
- Department of Obstetrics and Gynecology, Kayseri City Education and Research Hospital, Kayseri, Turkey
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11
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Bakhit M, Krzyzaniak N, Scott AM, Clark J, Glasziou P, Del Mar C. Downsides of face masks and possible mitigation strategies: a systematic review and meta-analysis. BMJ Open 2021; 11:e044364. [PMID: 33619199 PMCID: PMC7903088 DOI: 10.1136/bmjopen-2020-044364] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify, appraise and synthesise studies evaluating the downsides of wearing face masks in any setting. We also discuss potential strategies to mitigate these downsides. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, CENTRAL and EuropePMC were searched (inception-18 May 2020), and clinical registries were searched via CENTRAL. We also did a forward-backward citation search of the included studies. INCLUSION CRITERIA We included randomised controlled trials and observational studies comparing face mask use to any active intervention or to control. DATA EXTRACTION AND ANALYSIS Two author pairs independently screened articles for inclusion, extracted data and assessed the quality of included studies. The primary outcomes were compliance, discomforts, harms and adverse events of wearing face masks. RESULTS We screened 5471 articles, including 37 (40 references); 11 were meta-analysed. For mask wear adherence, 47% (95% CI 25% to 68%, p<0.0001), more people wore face masks in the face mask group compared with control; adherence was significantly higher (26%, 95% CI 8% to 46%, p<0.01) in the surgical/medical mask group than in N95/P2 group. The largest number of studies reported on the discomfort and irritation outcome (20 studies); fewest reported on the misuse of masks, and none reported on mask contamination or risk compensation behaviour. Risk of bias was generally high for blinding of participants and personnel and low for attrition and reporting biases. CONCLUSIONS There are insufficient data to quantify all of the adverse effects that might reduce the acceptability, adherence and effectiveness of face masks. New research on face masks should assess and report the harms and downsides. Urgent research is also needed on methods and designs to mitigate the downsides of face mask wearing, particularly the assessment of possible alternatives. SYSTEMATIC REVIEW REGISTRATION Open Science Framework website https://osf.io/sa6kf/ (timestamp 20-05-2020).
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Affiliation(s)
- Mina Bakhit
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Natalia Krzyzaniak
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Justin Clark
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
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12
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Burton C, Coles B, Adisesh A, Smith S, Toomey E, Chan XHS, Ross L, Greenhalgh T. Performance and impact of disposable and reusable respirators for healthcare workers during pandemic respiratory disease: a rapid evidence review. Occup Environ Med 2021; 78:679-690. [PMID: 33504624 DOI: 10.1136/oemed-2020-107058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/29/2020] [Accepted: 11/20/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To synthesise evidence concerning the range of filtering respirators suitable for patient care and guide the selection and use of different respirator types. DESIGN Comparative analysis of international standards for respirators and rapid review of their performance and impact in healthcare. DATA SOURCES Websites of international standards organisations, Medline and Embase, hand-searching of references and citations. STUDY SELECTION Studies of healthcare workers (including students) using disposable or reusable respirators with a range of designs. We examined respirator performance, clinician adherence and performance, comfort and impact, and perceptions of use. RESULTS We included standards from eight authorities across Europe, North and South America, Asia and Australasia and 39 research studies. There were four main findings. First, international standards for respirators apply across workplace settings and are broadly comparable across jurisdictions. Second, effective and safe respirator use depends on proper fitting and fit testing. Third, all respirator types carry a burden to the user of discomfort and interference with communication which may limit their safe use over long periods; studies suggest that they have little impact on specific clinical skills in the short term but there is limited evidence on the impact of prolonged wearing. Finally, some clinical activities, particularly chest compressions, reduce the performance of filtering facepiece respirators. CONCLUSION A wide range of respirator types and models is available for use in patient care during respiratory pandemics. Careful consideration of performance and impact of respirators is needed to maximise protection of healthcare workers and minimise disruption to care.
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Affiliation(s)
- Christopher Burton
- Academic Unit of Primary Medical Care, The University of Sheffield Faculty of Medicine Dentistry and Health, Sheffield, UK
| | - Briana Coles
- Leicester Real World Evidence Unit, Diabetes Research Centre, University of Leicester, Leicester, Leicestershire, UK
| | - Anil Adisesh
- Occupational Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Simon Smith
- Canadian Standards Biological Aerosols Group, Canadian Standards Association, Toronto, Ontario, Canada
| | - Elaine Toomey
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Ireland
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford Medical Sciences Division, Oxford, Oxfordshire, UK
| | - Lawrence Ross
- Infectious Diseases, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
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13
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Guha S, Herman A, Carr IA, Porter D, Natu R, Berman S, Myers MR. Comprehensive characterization of protective face coverings made from household fabrics. PLoS One 2021; 16:e0244626. [PMID: 33439878 PMCID: PMC7806137 DOI: 10.1371/journal.pone.0244626] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Face coverings constitute an important strategy for containing pandemics, such as COVID-19. Infection from airborne respiratory viruses including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) can occur in at least three modes; tiny and/or dried aerosols (typically < 1.0 μm) generated through multiple mechanisms including talking, breathing, singing, large droplets (> 0.5 μm) generated during coughing and sneezing, and macro drops transmitted via fomites. While there is a growing number of studies looking at the performance of household materials against some of these situations, to date, there has not been any systematic characterization of household materials against all three modes. METHODS A three-step methodology was developed and used to characterize the performance of 21 different household materials with various material compositions (e.g. cotton, polyester, polypropylene, cellulose and blends) using submicron sodium chloride aerosols, water droplets, and mucous mimicking macro droplets over an aerosol-droplet size range of ~ 20 nm to 0.6 cm. RESULTS Except for one thousand-thread-count cotton, most single-layered materials had filtration efficiencies < 20% for sub-micron solid aerosols. However, several of these materials stopped > 80% of larger droplets, even at sneeze-velocities of up to 1700 cm/s. Three or four layers of the same material, or combination materials, would be required to stop macro droplets from permeating out or into the face covering. Such materials can also be boiled for reuse. CONCLUSION Four layers of loosely knit or woven fabrics independent of the composition (e.g. cotton, polyester, nylon or blends) are likely to be effective source controls. One layer of tightly woven fabrics combined with multiple layers of loosely knit or woven fabrics in addition to being source controls can have sub-micron filtration efficiencies > 40% and may offer some protection to the wearer. However, the pressure drop across such fabrics can be high (> 100 Pa).
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Affiliation(s)
- Suvajyoti Guha
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States of America
| | - Alexander Herman
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States of America
| | - Ian A. Carr
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States of America
| | - Daniel Porter
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States of America
| | - Rucha Natu
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States of America
| | - Shayna Berman
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States of America
| | - Matthew R. Myers
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, United States Food and Drug Administration, Silver Spring, MD, United States of America
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14
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Robertsen Ø, Hegseth MN, Føreland S, Siebler F, Eisemann M, Vangberg HCB. The Effect of a Knowledge-Based Intervention on the Use of Respirators in the Norwegian Smelter Industry. Front Psychol 2020; 11:270. [PMID: 32153476 PMCID: PMC7044339 DOI: 10.3389/fpsyg.2020.00270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/04/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction The present study investigated the effect of interventions aiming to improve attitudes toward the use of respiratory protective equipment (RPE), knowledge of RPE and the use of RPE in the Norwegian smelter industry. Method The surveys received 567 respondents to baseline and 240 respondents 2 weeks after the intervention. Participants were invited to either a fit-testing of respirators [Group 1] or a fit-testing combined with a lecture on exposure [Group 2], health effects and RPE. The control group [Group 3] received no training. Questionnaires containing measures of subjective knowledge, attitudes and behavior regarding RPE use were assessed. Results Testing indicated an improvement in knowledge of RPE and a reduction in perceived inconveniences regarding the use of RPE for both intervention groups. Group 1 showed an improvement in attitudes and organizational support, while intervention Group 2 showed an improvement in subjective norms related to RPE use. Intention to use or rate of respirator use was not shown to change significantly for any group using paired testing. Regression analysis indicated that participation in either intervention influenced intention to use respirators. The effect was significant for Group 1 and was marginally significant for intervention Group 2. Conclusion The results indicate that interventions can increase workers’ knowledge and attitudes, and reduce perceived inconvenience regarding the use of respiratory protective equipment. However, even though some variables seemed to positively change, reported respirator use did not improve for either groups participating in the study. It may be that physical barriers with regards to using RPE, such as fogging of protective goggles, sweating, breathing and communication issues outweigh individual attitudes, intentions and social pressure to use respirators. Practical Applications The tailored course and practical training in RPE use in the current intervention can be applied in the smelting industry to provide up to date information on dust exposure, health effects and protective equipment. Some adjustments may be warranted for the content to fit specific risks and exposures of other industries. However, the general pedagogical framework of the educational material regarding health effects and RPE should be useful for most heavy industries.
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Affiliation(s)
- Øystein Robertsen
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Marit Nøst Hegseth
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Solveig Føreland
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Frank Siebler
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Martin Eisemann
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Hans Christian Bones Vangberg
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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15
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Muñoz Sánchez AI, Antolinez Figueroa C. Medidas de protección respiratoria de tuberculosis en personal de salud: revisión integrativa. AVANCES EN ENFERMERÍA 2019. [DOI: 10.15446/av.enferm.v37n3.77318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción: los trabajadores de la salud (TS) son vulnerables a la infección por tuberculosis. Se suma el desconocimiento de los TS de las medidas de protección respiratoria que puede aumentar el riesgo individual de adquirir tuberculosis en instituciones de salud. Objetivo: describir la producción de literatura científica en las bases de datos científicas sobre las medidas de protección respiratoria de la infección tuberculosa durante el periodo 2012-2018. Síntesis de contenido: revisión integrativa a través de: formulación de la pregunta de investigación, recolección de datos, evaluación, análisis e interpretación de datos y presentación de los resultados. 45 artículos cumplieron con los criterios de inclusión. Las características predominantes de los estudios fueron: año 2017 con mayor número de publicaciones, en el continente de África, la metodología de estudio cuantitativo cuasiexperimental. En los estudios se identificaron las características del respirador N95 y la mascarilla quirúrgica, los conocimientos, actitudes y prácticas de las medidas de protección respiratoria y programas educativos. Conclusiones: se evidenció que el respirador N95 es la medida de protección individual más eficiente para el control de la infección tuberculosa en los TS. También se identificó la necesidad del diseño de programas educativos sobre las medidas de protección de la infección tuberculosa.
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16
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Foereland S, Robertsen O, Hegseth MN. Do Various Respirator Models Fit the Workers in the Norwegian Smelting Industry? Saf Health Work 2019; 10:370-376. [PMID: 31497335 PMCID: PMC6717833 DOI: 10.1016/j.shaw.2019.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 06/04/2019] [Accepted: 06/13/2019] [Indexed: 11/09/2022] Open
Abstract
Background Respirator fit testing is a method to assess if the respirator provides an adequate face seal for the worker. Methods Workers from four Norwegian smelters were invited to participate in the study, and 701 respirator fit tests were performed on 127 workers. Fourteen respirator models were included: one FFABE1P3 and 11 FFP3 respirator models produced in one size and two silicone half masks with P3 filters available in three sizes. The workers performed a quantitative fit test according to Health and Safety Executive 282/28 with 5–6 different respirator models, and they rated the respirators based on comfort. Predictors of overall fit factors were explored. Results The pass rate for all fit tests was 62%, 56% for women, and 63% for men. The silicone respirators had the highest percentage of passed tests (92–100%). The pass rate for the FFP3 models varied from 19–89%, whereas the FFABE1P3 respirator had a pass rate of 36%. Five workers did not pass with any respirators, and 14 passed with all the respirators tested. Only 63% passed the test with the respirator they normally used. The mean comfort score on the scale from 1 to 5 was 3.2. The respirator model was the strongest predictor of the overall fit factor. The other predictors (age, sex, and comfort score) did not improve the fit of the model. Conclusion There were large differences in how well the different respirator models fitted the Norwegian smelter workers. The results can be useful when choosing which respirators to include in respirator fit testing programs in similar populations.
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Affiliation(s)
- Solveig Foereland
- Department of Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Geoscience and Petroleum, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Oeystein Robertsen
- Department of Psychology, UiT - the Artic University of Norway, Tromsø, Norway.,Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Marit Noest Hegseth
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Community Medicine, UiT - the Artic University of Norway, Tromsø, Norway
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17
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Radonovich LJ, Wizner K, LaVela SL, Lee ML, Findley K, Yorio P. A tolerability assessment of new respiratory protective devices developed for health care personnel: A randomized simulated clinical study. PLoS One 2019; 14:e0209559. [PMID: 30625169 PMCID: PMC6326489 DOI: 10.1371/journal.pone.0209559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND U.S. health care personnel (HCP) have reported that some respiratory protective devices (RPD) commonly used in health care have suboptimal tolerability. Between 2012 and 2016, the U.S. National Institute for Occupational Safety and Health, and the Veterans Health Administration collaborated with two respirator manufacturers, Company A and B, to bring new RPD with improved tolerability to the U.S. health care marketplace. The purpose of this study was to compare the tolerability of four new prototype RPD to two models commonly used in U.S. health care delivery. METHODS A randomized, simulated workplace study was conducted to compare self-reported tolerability of four new prototype RPD (A1, A2, B1, and B2) worn by HCP and two N95 control respirators commonly used in U.S. health care delivery, the 1870 and 1860, manufactured by 3M Corporation. A new survey tool, the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), developed previously in part for the current study, was used as the primary outcome metric. With a maximum total score of 47, lower R-COMFI scores reflected better self-reported tolerability. Poisson regression analyses were used to estimate prototype relative risks compared to controls. RESULTS Conducted between 2014 and 2015 in two inpatient care rooms at the North Florida/South Georgia Veterans Health System, among 383 participants who enrolled, 335 (87.5%) completed the study. Mean total R-COMFI scores for the 3M 1870, 3M 1860, and prototypes A1, A2, B1, and B2 were 8.26, 9.36, 5.79, 7.70, 6.09, and 5.71, respectively. Compared to the 3M 1870, total R-COMFI unadjusted relative risks (RR) and 95 percent confidence intervals (CI) were A1 (RR 0.70, CI 0.60, 0.82), A2 (RR 0.93, CI 0.82, 1.06), B1 (RR 0.74, CI 0.64, 0.85), and B2 (RR 0.69, CI 0.60, 0.80). Compared to the 3M 1860, prototype total R-COMFI unadjusted RR and 95 percent CI were A1 (RR 0.62, CI 0.53, 0.72), A2 (RR 0.82, CI 0.73, 0.93), B1 (RR 0.65, CI 0.57, 0.74), and B2 (RR 0.61, CI 0.53, 0.70). Similarly, models adjusted for demographic characteristics showed that prototypes A1, B1, and B2 significantly improved tolerability scores compared to both controls, while prototype A2 was significantly improved compared to the 3M 1860. CONCLUSIONS Compared to the 3M 1870 and 3M 1860, two RPDs commonly used in U.S. health care delivery, tolerability improved for three of four newly developed prototypes in this simulated workplace study. The R-COMFI tool, used in this study to assess tolerability, should be useful for future comparative studies of RPD.
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Affiliation(s)
- Lewis J. Radonovich
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA, United States of America
| | - Kerri Wizner
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA, United States of America
| | - Sherri L. LaVela
- Department of Veterans Affairs, VA Health Services Research and Development, Edward J. Hines, Jr. VA Hospital, Chicago, IL, United States of America
- Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
| | - Martin L. Lee
- Department of Veterans Affairs Greater Los Angeles Health care System, Los Angeles, CA, United States of America
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Kimberly Findley
- Department of Veterans Affairs, Center of Innovation on Disability & Rehabilitation Research, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States of America
| | - Patrick Yorio
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA, United States of America
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18
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Best Practices in the Management of Central Vascular Access Devices: An Observational Study in Areas With a High Prevalence of Trained Nurses. JOURNAL OF INFUSION NURSING 2018; 41:319-325. [PMID: 30188454 DOI: 10.1097/nan.0000000000000297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since 2009, the Department of Continuing Education at the Orthopedic and Trauma Center Hospital in Turin, Italy, has provided a training course for nurses in the management of central vascular access devices (CVADs). The course focuses on dressing and flushing procedures, as well as compliance with other CVAD guidelines. An observational study was conducted among nurses to determine the level of best practices in areas with a high prevalence of nurses trained in the management of CVADs. A correlation was observed between best practices and having attended the course, but other variables also influenced best practices.
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19
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Robertsen Ø, Siebler F, Eisemann M, Hegseth MN, Føreland S, Vangberg HCB. Predictors of Respiratory Protective Equipment Use in the Norwegian Smelter Industry: The Role of the Theory of Planned Behavior, Safety Climate, and Work Experience in Understanding Protective Behavior. Front Psychol 2018; 9:1366. [PMID: 30135666 PMCID: PMC6092595 DOI: 10.3389/fpsyg.2018.01366] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/16/2018] [Indexed: 11/15/2022] Open
Abstract
Previous research has revealed a higher prevalence of respiratory symptoms in Norwegian smelter workers compared to average population controls. Nevertheless, respiratory protective equipment (RPE) is not always used, even in situations with high exposure risk. A questionnaire was distributed to workers in the Norwegian smelting industry to investigate the relationship between psychological factors and self-reported use of RPEs. Response rate was 567/1,253. A scale measuring attitudes toward behavior (ATT), subjective norms (SN), perceived behavioral control (PBC), and behavioral intention (BI) was constructed based on the Theory of Planned Behavior (TPB). Reliability and Confirmatory Factor Analyses partially supported the theoretical structure of the TPB-based scale, the Work Experience Measurement Scale (WEMS) and the Short Scale for Safety Climate (SC). A model explaining the relationship between observed variables, latent constructs from TPB, WEMS and SC was developed by SEM-analysis. Significant influence on BI from ATT (β = 0.31 p < 0.01), SN (β = 0.36 p < 0.01), and SC (β = 0.19, p < 0.01) emerged. Among the observed variables included, relationship status (β = −0.12 p < 0.05), education level (β = 0.09, p < 0.05), previously completed respirator fit-testing (β = −0.09, p < 0.05) and average hours spent in exposed areas (β = −0.09) p < 0.05) had significant influence on behavioral intention. The model explained 48% of the variance in BI. BI and PBC significantly predicted PB, with β = 0.65 and β = −0.06, respectively. Results of this investigation can help facilitate further work and development of health & safety routines within industrial settings.
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Affiliation(s)
- Øystein Robertsen
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Frank Siebler
- Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Martin Eisemann
- Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
| | - Marit N Hegseth
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Solveig Føreland
- Department of Occupational Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Geoscience and Petroleum, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hans-Christian B Vangberg
- Department of Occupational and Environmental Medicine, University Hospital of North Norway, Tromsø, Norway.,Department of Psychology, UiT-The Arctic University of Norway, Tromsø, Norway
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20
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Malotle MM, Spiegel JM, Yassi A, Ngubeni D, O'Hara LM, Adu PA, Bryce EA, Mlangeni N, Gemell GSM, Zungu M. Occupational tuberculosis in South Africa: are health care workers adequately protected? Public Health Action 2017; 7:258-267. [PMID: 29584794 DOI: 10.5588/pha.17.0070] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/08/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: A provincial tertiary hospital in Gauteng province, South Africa, with a high burden of tuberculosis (TB) patients and high risk of TB exposure among health care workers (HCWs). Objective: To determine HCWs' adherence to recommended TB infection prevention and control practices, TB training and access to health services and HCW TB rates. Design: Interviews with 285 HCWs using a structured questionnaire as part of a large, international mixed-methods study. Results: Despite 10 HCWs (including seven support HCWs) acquiring clinical TB during their period of employment, 62.8% of interviewees were unaware of the hospital's TB management protocol. Receipt of training was low (34.5% of all HCWs and <5% of support HCWs trained on TB transmission; 27.5% of nurses trained on respirator use), as was use of respiratory protection (44.5% of HCWs trained on managing TB patients). Support HCWs were over 36 times more likely to use respiratory protection if trained; nurses who were trained were approximately 40 times more likely to use respirators if they were readily available. Conclusion: Improved coordination and uptake of TB infection prevention training is urgently needed, especially for non-clinical HCWs in settings of regular exposure to TB patients. Adequate supplies of appropriate respiratory protection must be made available.
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Affiliation(s)
- M M Malotle
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
| | - J M Spiegel
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - A Yassi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - D Ngubeni
- Employee Health and Wellness, Gauteng Provincial Department of Health, Johannesburg, South Africa
| | - L M O'Hara
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - P A Adu
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - E A Bryce
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - N Mlangeni
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
| | - G S M Gemell
- Employee Health and Wellness, Gauteng Provincial Department of Health, Johannesburg, South Africa
| | - M Zungu
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa.,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
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21
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Seo Y, Vaughan J, Quinn TD, Followay B, Roberge R, Glickman EL, Kim JH. The Effect of Inspiratory Resistance on Exercise Performance and Perception in Moderate Normobaric Hypoxia. High Alt Med Biol 2017; 18:417-424. [PMID: 29112466 PMCID: PMC10542912 DOI: 10.1089/ham.2017.0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Seo, Yongsuk, Jeremiah Vaughan, Tyler D. Quinn, Brittany Followay, Raymond Roberge, Ellen L. Glickman, and Jung-Hyun Kim. The effect of inspiratory resistance on exercise performance and perception in moderate normobaric hypoxia. High Alt Med Biol. 18:417-424, 2017. PURPOSE Respirators are simple and efficient in protecting workers against toxic airborne substances; however, their use may limit the physical performance of workers. The purpose of this study was to determine the effect of inspiratory resistance on physical performance and breathing perception in normobaric hypoxia. METHOD Nine healthy men wore a tight-fitting respiratory mask outfitted with one of four different inspiratory resistors (R) (0, 1.5, 4.5, 7.5 cm H2O/L/Sec) while exercising at normobaric hypoxia (17% O2) at submaximal exercise workloads of 50, 100, and 150 W on a cycle ergometer for 10 minutes each, followed by a maximal oxygen uptake (VO2max) test to exhaustion. RESULTS Maximal power output at R7.5 was significantly lower than R0 (p = 0.016) and R1.5 (p = 0.035). Respiration rate was significantly reduced at R4.5 (p = 0.011) and R7.5 (p ≤ 0.001) compared with R0. Minute ventilation was significantly decreased in R7.5 compared with R0 (p = 0.003), R1.5 (p = 0.010), and R4.5 (p = 0.016), whereas VO2 was not significantly changed. Breathing comfort (BC) and breathing effort (BE) were significantly impaired in R7.5 (BC: p = 0.025, BE: p = 0.001) and R4.5 (BC: p = 0.007, BE: p = 0.001) compared with R0, but rating of perceived exertion (RPE) remained unchanged. CONCLUSIONS Added inspiratory resistance limited maximal power output and increased perceptions of BC and BE in normobaric hypoxia. However, low-to-moderate inspiratory resistance did not have a deleterious effect on VO2 or RPE at submaximal or maximal exercise. Perceptual and physiological characteristics of respirators of varying inspiratory resistances should be considered by manufacturers and end users during design and respirator selection processes.
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Affiliation(s)
- Yongsuk Seo
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | - Jeremiah Vaughan
- Department of Exercise Physiology, Kent State University, Kent, Ohio
| | - Tyler D. Quinn
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | - Brittany Followay
- Department of Exercise Physiology, Kent State University, Kent, Ohio
| | - Raymond Roberge
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
| | - Ellen L. Glickman
- Department of Exercise Physiology, Kent State University, Kent, Ohio
| | - Jung-Hyun Kim
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
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22
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Ramirez J, O'Shaughnessy P. Filter penetration and breathing resistance evaluation of respirators and dust masks. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:148-157. [PMID: 27676311 DOI: 10.1080/15459624.2016.1237027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The primary objective of this study was to compare the filter performance of a representative selection of uncertified dust masks relative to the filter performance of a set of NIOSH-approved N95 filtering face-piece respirators (FFRs). Five different models of commercially available dust masks were selected for this study. Filter penetration of new dust masks was evaluated against a sodium chloride aerosol. Breathing resistance (BR) of new dust masks and FFRs was then measured for 120 min while challenging the dust masks and FFRs with Arizona road dust (ARD) at 25°C and 30% relative humidity. Results demonstrated that a wide range of maximum filter penetration was observed among the dust masks tested in this study (3-75% at the most penetrating particle size (p < 0.001). The breathing resistances of the unused FFRs and dust masks did not vary greatly (8-13 mm H2O) but were significantly different (p < 0.001). After dust loading there was a significant difference between the BR caused by the ARD dust layer on each FFR and dust mask. Microscopic analysis of the external layer of each dust mask and FFR suggests that different collection media in the external layer influences the development of the dust layer and therefore affects the increase in BR differently between the tested models. Two of the dust masks had penetration values < 5% and quality factors (0.26 and 0.33) comparable to those obtained for the two FFRs (0.23 and 0.31). However, the remaining three dust masks, those with penetration > 15%, had quality factors ranging between 0.04-0.15 primarily because their initial BR remained relatively high. These results indicate that some dust masks analysed during this research did not have an expected very low BR to compensate for their high penetration.
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Affiliation(s)
- Joel Ramirez
- a Department of Occupational and Environmental Health , College of Public Health, The University of Iowa , Iowa City , Iowa
| | - Patrick O'Shaughnessy
- a Department of Occupational and Environmental Health , College of Public Health, The University of Iowa , Iowa City , Iowa
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23
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LaVela SL, Kostovich C, Locatelli S, Gosch M, Eagan A, Radonovich L. Development and initial validation of the Respirator Comfort, Wearing Experience, and Function Instrument [R-COMFI]. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2017; 14:135-147. [PMID: 27636378 DOI: 10.1080/15459624.2016.1237025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Filtering face-piece respirators (FFRs) are worn to protect health care personnel from airborne particles; however, clinical studies have demonstrated that FFR adherence is relatively low in some settings, in part, due to discomfort and intolerance. The objective of this study was to develop and initially evaluate the psychometric properties of an instrument designed to measure the comfort and tolerability of FFRs. Instrument items were developed through literature reviews, focus groups, and several iterations of ranking and refining by experts. Psychometric evaluation of the instrument was conducted using Rasch partial credit model (PCM) analysis. Pivot anchoring was used to specify the threshold defining item difficulty; in our analyses, this was the point that participants moved from possessing none of the trait to some of the trait. The final instrument was completed by 165 health care personnel from 3 Veterans Health Administration facilities, and data were analyzed using Rasch PCM. Seven items were removed because they: (1) violated the assumption of independence; (2) were mis-fitting; and/or (3) were deemed not relevant. Category function analysis demonstrated that all categories progressed monotonically. Principal components analysis demonstrated the existence of three subscales (Discomfort, General Wearing Experience, and Function). Final reliability analyses showed that the scale had moderate to high person reliability and high item reliability. The final instrument contained 21 items. Until now, to our knowledge no instrument with evidence supporting its reliability and validity to assess discomfort and tolerance of FFRs among health care personnel has been published. A 21-item psychometrically sound measure of comfort and tolerability of FFRs, Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), was developed. The significance of developing such an instrument is that it will help identify respirators that are likely to have better adherence in practice settings. The R-COMFI may be used within and beyond the VA healthcare system as a psychometrically sound instrument to evaluate the comfort and tolerability of respirators, including developmental prototypes.
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Affiliation(s)
- Sherri L LaVela
- a Department of Veterans Affairs , VA Health Services Research and Development , Hines , Illinois
- b Department of Physical Medicine and Rehabilitation , Feinberg School of Medicine, Northwestern University , Chicago , Illinois
| | - Carol Kostovich
- a Department of Veterans Affairs , VA Health Services Research and Development , Hines , Illinois
- c Marcella Niehoff School of Nursing , Loyola University Chicago , Chicago , Illinois
| | - Sara Locatelli
- a Department of Veterans Affairs , VA Health Services Research and Development , Hines , Illinois
| | - Megan Gosch
- d National Center for Occupational Health and Infection Control, Office of Public Health, Veterans Health Administration , Department of Veterans Affairs , Washington , DC
| | - Aaron Eagan
- d National Center for Occupational Health and Infection Control, Office of Public Health, Veterans Health Administration , Department of Veterans Affairs , Washington , DC
| | - Lewis Radonovich
- d National Center for Occupational Health and Infection Control, Office of Public Health, Veterans Health Administration , Department of Veterans Affairs , Washington , DC
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Locatelli SM, LaVela SL, Gosch M. Health care workers' reported discomfort while wearing filtering face-piece respirators. Workplace Health Saf 2015; 62:362-8. [PMID: 25102476 DOI: 10.3928/21650799-20140804-03] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 06/25/2014] [Indexed: 11/20/2022]
Abstract
Filtering face-piece respirators (FFRs) are one method of protecting health care workers from airborne particles; however,research suggests adherence is poor, perhaps due to worker discomfort. Three separate focus groups were conducted at two Veterans Affairs health care facilities. Seventeen health care workers who reported using FFRs as part of their job duties were in the focus groups. Focus group transcripts were coded using qualitative descriptive coding techniques. Participants described experiences of discomfort and physical mask features they believed ,contributed to discomfort. Participants believed FFRs influenced patient care because some patients felt uneasy and changed healthcare workers' behaviors (e.g., doffing procedures, loss of concentration, rushed patient care, and avoidance of patients in isolation resulting from FFR discomfort). Assessment of comfort and tolerability should occur during fit-testing. These factors should also be taken into account by management when training employees on the proper use of FFRs, as well as in future research to improve comfort and tolerability.
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Shaffer RE, Janssen LL. Selecting models for a respiratory protection program: what can we learn from the scientific literature? Am J Infect Control 2015; 43:127-32. [PMID: 25499425 DOI: 10.1016/j.ajic.2014.10.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/23/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND An unbiased source of comparable respirator performance data would be helpful in setting up a hospital respiratory protection program. METHODS The scientific literature was examined to assess the extent to which performance data (respirator fit, comfort and usability) from N95 filtering facepiece respirator (FFR) models are available to assist with FFR model selection and procurement decisions. RESULTS Ten studies were identified that met the search criteria for fit, whereas 5 studies met the criteria for comfort and usability. CONCLUSION Analysis of these studies indicated that it is difficult to directly use the scientific literature to inform the FFR selection process because of differences in study populations, methodologies, and other factors. Although there does not appear to be a single best fitting FFR, studies demonstrate that fit testing programs can be designed to successfully fit nearly all workers with existing products. Comfort and usability are difficult to quantify. Among the studies found, no significant differences were noted.
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Gershon RRM, Pearson JM, Westra LJ. Evaluation Tool for the Assessment of Personal Protective Respiratory Equipment. Infect Control Hosp Epidemiol 2015; 30:716-8. [DOI: 10.1086/600290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kim JH, Roberge RJ, Powell JB, Shaffer RE, Ylitalo CM, Sebastian JM. Pressure drop of filtering facepiece respirators: How low should we go? Int J Occup Med Environ Health 2015; 28:71-80. [PMID: 26159949 PMCID: PMC4499853 DOI: 10.13075/ijomeh.1896.00153] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study was undertaken to determine the mean peak filter resistance to airflow (Rfilter) encountered by subjects while wearing prototype filtering facepiece respirators (PRs) with low Rfilter during nasal and oral breathing at sedentary and low-moderate work rates. MATERIAL AND METHODS In-line pressure transducer measurements of mean Rfilteracross PRs with nominal Rfilter of 29.4 Pa, 58.8 Pa and 88.2 Pa (measured at 85 l/min constant airflow) were obtained during nasal and oral breathing at sedentary and low-moderate work rates for 10 subjects. RESULTS The mean Rfilter for the 29.4 PR was significantly lower than the other 2 PRs (p < 0.000), but there were no significant differences in mean Rfilter between the PRs with 58.8 and 88.2 Pa filter resistance (p > 0.05). The mean Rfilter was greater for oral versus nasal breathing and for exercise compared to sedentary activity (p < 0.001). CONCLUSIONS Mean oral and nasal Rfilter for all 3 PRs was at, or below, the minimal threshold level for detection of inspiratory resistance (the 58.8-74.5 Pa/l×s-1), which may account for the previously-reported lack of significant subjective or physiological differences when wearing PRs with these low Rfilter. Lowering filtering facepiece respirator Rfilter below 88.2 Pa (measured at 85 l/min constant airflow) may not result in additional subjective or physiological benefit to the wearer.
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Affiliation(s)
- Jung-Hyun Kim
- Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, United States of America (National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Technology Research Branch)
| | - Raymond J Roberge
- Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, United States of America (National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Technology Research Branch).
| | - Jeffrey B Powell
- Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, United States of America (National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Technology Research Branch)
| | - Ronald E Shaffer
- Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, United States of America (National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Technology Research Branch)
| | - Caroline M Ylitalo
- 3M Company, St. Paul, Minnesota, United States of America (3M Personal Safety Division)
| | - John M Sebastian
- 3M Company, St. Paul, Minnesota, United States of America (3M Personal Safety Division)
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Roberge RJ, Kim JH, Powell JB, Shaffer RE, Ylitalo CM, Sebastian JM. Impact of low filter resistances on subjective and physiological responses to filtering facepiece respirators. PLoS One 2013; 8:e84901. [PMID: 24386434 PMCID: PMC3873997 DOI: 10.1371/journal.pone.0084901] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/27/2013] [Indexed: 11/18/2022] Open
Abstract
Ten subjects underwent treadmill exercise at 5.6 km/h over one hour while wearing each of three identical appearing, cup-shaped, prototype filtering facepiece respirators that differed only in their filter resistances (3 mm, 6 mm, and 9 mm H2O pressure drop). There were no statistically significant differences between filtering facepiece respirators with respect to impact on physiological parameters (i.e., heart rate, respiratory rate, oxygen saturation, transcutaneous carbon dioxide levels, tympanic membrane temperature), pulmonary function variables (i.e., tidal volume, respiratory rate, volume of carbon dioxide production, oxygen consumption, or ventilation), and subjective ratings (i.e., exertion, thermal comfort, inspiratory effort, expiratory effort and overall breathing comfort). The nominal filter resistances of the prototype filtering facepiece respirators correspond to airflow resistances ranging from 2.1 - 6.6 mm H2O/L/s which are less than, or minimally equivalent to, previously reported values for the normal threshold for detection of inspiratory breathing resistance (6 - 7.6 mm H2O/L/sec). Therefore, filtering facepiece respirators with filter resistances at, or below, this level may not impact the wearer differently physiologically or subjectively from those with filter resistances only slightly above this threshold at low-moderate work rates over one hour.
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Affiliation(s)
- Raymond J. Roberge
- Technology Research Branch, National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
| | - Jung-Hyun Kim
- Technology Research Branch, National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, United States of America
| | - Jeffrey B. Powell
- Technology Research Branch, National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, United States of America
| | - Ronald E. Shaffer
- Technology Research Branch, National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania, United States of America
| | - Caroline M. Ylitalo
- Personal Safety Division, 3M Company, St. Paul, Minnesota, United States of America
| | - John M. Sebastian
- Personal Safety Division, 3M Company, St. Paul, Minnesota, United States of America
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Benson SM, Novak DA, Ogg MJ. Proper use of surgical n95 respirators and surgical masks in the OR. AORN J 2013; 97:457-67; quiz 468-70. [PMID: 23531312 PMCID: PMC7105909 DOI: 10.1016/j.aorn.2013.01.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Revised: 02/21/2012] [Accepted: 01/25/2013] [Indexed: 12/14/2022]
Abstract
Proper adherence to infection control precautions, including appropriate selection and use of personal protective equipment (PPE), is of significant importance to the health and well-being of perioperative personnel. Surgical masks are intended for use as a barrier to protect the wearer's face from large droplets and splashes of blood and other body fluids; however, surgical and high-filtration surgical laser masks do not provide enough protection to be considered respiratory PPE. Potential exposure to airborne contaminants and infectious agents, including those present in surgical smoke, necessitates the use of respiratory PPE, such as a surgical N95 particulate filtering facepiece respirator. Filtering facepiece respirators greatly reduce a wide size range of particles from entering the wearer's breathing zone and are designed to protect the user from both droplet and airborne particles. Every health care worker who must use a respirator to control hazardous exposures in the workplace must be trained to properly use the respirator and pass a fit test before using it in the workplace.
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Affiliation(s)
- Stacey M Benson
- University of Pittsburgh Graduate School of Public Health, USA
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Fukakusa J, Rosenblat J, Jang B, Ribeiro M, Kudla I, Tarlo SM. Factors influencing respirator use at work in respiratory patients. Occup Med (Lond) 2011; 61:576-82. [DOI: 10.1093/occmed/kqr132] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Roberge RJ, Coca A, Williams WJ, Powell JB, Palmiero AJ. Reusable elastomeric air-purifying respirators: physiologic impact on health care workers. Am J Infect Control 2010; 38:381-6. [PMID: 20189685 PMCID: PMC7115335 DOI: 10.1016/j.ajic.2009.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2009] [Revised: 11/23/2009] [Accepted: 11/30/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Elastomeric air-purifying respirators offer the benefit of reusability, but their physiological impact on health care workers is unknown. METHODS Ten health care workers exercised at 2 health care-associated work rates wearing an elastomeric air-purifying respirator. Mixed inhalation/exhalation respirator dead space gases (oxygen, carbon dioxide) were sampled, and physiological parameters were monitored (heart rate, breathing rate, tidal volume, minute volume, oxygen saturation, transcutaneous carbon dioxide). Numerical rating scales were used to evaluate comfort and exertion. RESULTS Compared with controls (no respirator), significant decreases in the breathing rate at both work rates (P < .05) and increases in tidal volume at the lower work rate (P < .01) were noted with respirator use. Approximately half the subjects had transcutaneous carbon dioxide levels above the upper limit of normal after 1 hour of use. Although well tolerated, comfort was negatively impacted by elastomeric air-purifying respirators wear. CONCLUSION Reusable elastomeric air-purifying respirators impose little additional physiological burden over the course of 1 hour at usual health care work rates. However, the potential for carbon dioxide retention in a significant proportion of users exists and requires further investigation.
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Affiliation(s)
- Raymond J Roberge
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA 16236, USA.
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Roberge RJ, Coca A, Williams WJ, Palmiero AJ, Powell JB. Surgical mask placement over N95 filtering facepiece respirators: physiological effects on healthcare workers. Respirology 2010; 15:516-21. [PMID: 20337987 DOI: 10.1111/j.1440-1843.2010.01713.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Filtering facepiece respirators ('N95 Masks') may be in short supply during large-scale infectious outbreaks. Suggestions have been made to extend their useful life by using a surgical mask as an outer barrier, but the physiological impact of this added barrier upon the wearer has not been studied. METHODS A surgical mask was worn over an N95 filtering facepiece respirator by 10 healthcare workers for 1 h at each of two work rates. Heart rate, respiratory rate, tidal volume, minute volume, oxygen saturation, transcutaneous carbon dioxide levels and respirator dead space gases were monitored and compared with controls (N95 filtering facepiece respirator without a surgical mask). Subjective perceptions of exertion and comfort were assessed by numerical rating scales. RESULTS There were no significant differences in physiological variables between those who used surgical masks and controls. Surgical masks decreased dead space oxygen concentrations of the filtering facepiece respirators at the lesser work rate (P = 0.03) and for filtering facepiece respirators with an exhalation valve at the higher work rate (P = 0.003). Respirator dead space oxygen and carbon dioxide levels were not harmonious with Occupational Safety and Health Administration workplace ambient atmosphere standards. Exertion and comfort scores were not significantly impacted by the surgical mask. CONCLUSIONS Use of a surgical mask as an outer barrier over N95 filtering facepiece respirators does not significantly impact the physiological burden or perceptions of comfort and exertion by the wearer over that experienced without use of a surgical mask.
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Affiliation(s)
- Raymond J Roberge
- National Personal Protective Technology Laboratory/National Institute for Occupational Safety and Health, Laboratory/NIOSH, 626 Cochrans Mill Road, Pittsburgh, PA 15236, USA.
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Baig AS, Knapp C, Eagan AE, Radonovich LJ. Health care workers' views about respirator use and features that should be included in the next generation of respirators. Am J Infect Control 2010; 38:18-25. [PMID: 20036443 PMCID: PMC7132692 DOI: 10.1016/j.ajic.2009.09.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Revised: 09/05/2009] [Accepted: 09/08/2009] [Indexed: 11/25/2022]
Abstract
BACKGROUND Numerous studies have demonstrated that health care workers are, in general, poorly compliant with respiratory protection guidelines, especially when a N95 respirator is recommended. The purpose of this study was to assess health care workers' views about respirator use and the features they prefer to be included in the next generation of respirators. METHODS A 63-item survey was distributed to health care workers in 27 units of 2 tertiary care medical centers. RESULTS From a total of 559 surveys distributed at both hospitals, 159 responses were returned (response rate, 28%). Survey results indicated that health care workers seek respirators that are more comfortable, interfere less with breathing, diminish heat buildup, are disposable, and permit the user to have facial hair. Multivariate analyses suggest that emergency department staff had 12.3 greater odds of wanting a new respirator (P = .031) as compared with their referent group. Males were more likely to indicate that the N95 respirator was comfortable to wear versus females (P = .003). CONCLUSION To increase substantially the acceptance of respiratory protective equipment and improve compliance rates, respirators should be modified to meet the specific needs of health care workers.
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Affiliation(s)
- Aliya S Baig
- National Center for Occupational Health and Infection Control, Office of Public Health and Environmental Hazards, Veterans Health Administration, US Department of Veterans Affairs, Gainesville, FL 23608, USA.
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Siow S, Bryce EA, Scharf S. Health care workers' perceptions of respiratory and gastrointestinal algorithms for patient management in emergency care settings. Am J Infect Control 2009; 37:759-65. [PMID: 19576661 PMCID: PMC7132684 DOI: 10.1016/j.ajic.2009.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 03/04/2009] [Accepted: 03/05/2009] [Indexed: 11/16/2022]
Abstract
Background Patients with respiratory or gastrointestinal illness in emergency care settings are often not yet diagnosed but are at risk of transmitting disease. Infection control algorithms delineating a standard approach to patient management decrease risk of secondary exposure, but few articles document health care workers' (HCWs) perceptions as to their effectiveness and ease of implementation. Methods A cross-sectional survey approach was used to explore HCWs perceptions in 2 emergency departments of the current algorithms for management of potentially infectious respiratory and gastrointestinal illnesses. Results Surveys from 96 HCWs revealed that algorithms were perceived as invaluable in protecting staff, patients, and colleagues. Differences in self-reported compliance, clarity, and ease of implementation of the respiratory algorithm were noted between facilities, likely reflecting variation in the physical plant. Physicians scored significantly lower for compliance with the respiratory algorithm. Conclusion Algorithms were perceived to offer a clear and consistent approach to patient management and protect HCWs in spite of environmental and resource limitations.
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Roberge RJ. Physiological Burden Associated with the Use of Filtering Facepiece Respirators (N95 Masks) during Pregnancy. J Womens Health (Larchmt) 2009; 18:819-26. [DOI: 10.1089/jwh.2008.1072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Raymond Joseph Roberge
- National Personal Protective Technology Laboratory/National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania
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