Respiratory protection policies and practices among the health care workforce exposed to influenza in New York State: evaluating emergency preparedness for the next pandemic.

BACKGROUND: New York State hospitals are required to implement a respiratory protection program (RPP) consistent with the Occupational Safety and Health Administration respirator standard. Guidance provided during the 2009 novel H1N1 pandemic expanded on earlier recommendations, emphasizing the need to keep staff in all health care settings healthy to maintain services. METHODS: New York State hospitals with emergency departments having more than 1,000 visits annually were invited to participate; 23 hospitals participated. Health care workers, unit managers, and hospital managers were interviewed regarding knowledge, beliefs, and practices of respiratory protection. Interviewees were observed donning and doffing an N-95 respirator as they normally would during patient care. Written RPPs for each hospital were evaluated. RESULTS: The majority of the hospitals surveyed had implemented an RPP, although unawareness of the policies and practices, as well as inadequacies in education and training exist among health care workers. CONCLUSION: Health care workers and other hospital employees may be unnecessarily exposed to airborne infectious diseases. Having an RPP ensures safe and effective use of N-95 respirators and will help prevent avoidable exposure to disease during a pandemic, protecting the health care workforce and patients alike.

Assessment of carbon monoxide exposure during the operation of indoor drive-through mass vaccination clinics.

BACKGROUND: Drive-through mass vaccination clinics are an increasingly popular component of public health emergency response plans. One potential disadvantage, however, is the exposure of clinicians, volunteers, public health responders, and the public to carbon monoxide (CO) from vehicle exhaust emissions when clinics are held within garages or other enclosed structures. METHODS: CO levels were monitored during indoor drive-through clinics held on the same day at 2 separate locations in a rural upstate New York county. Each clinic was operated for 2 hours during which seasonal influenza vaccines were administered to county residents as they remained within their vehicles. At each location, vehicle engines remained operating indoors within multiple lanes of traffic. No mechanical ventilation was used, but wind speeds through the buildings were relatively strong and consistent. CO was measured at breathing-zone height throughout the clinic sessions using direct-reading instruments. RESULTS: CO levels remained below detection for the majority of the clinic sessions. Short-term, high CO exposures, however, were found to be associated with a small number of individual vehicles that were in apparent disrepair. CONCLUSIONS: The findings from this study indicate that CO exposures may be minimized by identifying and separately processing problematic vehicles before they enter the clinic. Direct reading CO monitors can help to identify these vehicles.

A simple and inexpensive method for determining the effective ventilation rate in a negatively pressurized room using airborne particles as a tracer.

The ventilation rate within a negatively pressurized room is usually determined by measuring the exhaust air flow rate. This method does not account for air mixing factors and gives limited information on ventilation efficiency within the room. Effective ventilation rates have been determined using tracer gases such as sulfur hexafluoride (SF6). The objective of this study was to determine whether artificially generated airborne particles could be used as a tracer to directly measure ventilation efficiency. We monitored the decay of artificially generated particles within negatively pressurized rooms. Separate trials were conducted at air exhaust rates ranging from about 6 to 20 room air changes per hour. Particles were generated to a minimum of 20 times the ambient concentration using a simple ventilation smoke bottle and measured with handheld light-scattering airborne particle counters. Data were obtained for aerodynamic particle size ranges of: 0.5 micron (microM) and larger, and 1.0 microM and larger. The time rate of decay of particles was plotted after subtracting the background concentrations. Results were compared with simultaneously conducted tracer gas decay analyses (ASTM method E741-95) using SF6. Particle concentrations followed an exponential decay (R2 = 0.98-0.99+) and mirrored the decay curve of the tracer gas. The air change rates predicted by the particle count procedure differed from the tracer gas results by a mean of 4.0 percent (range 0%-12%). The particle count procedure was substantially simpler and less expensive than the SF6 tracer gas method. Additional studies are needed to further refine this procedure and to explore its range of applicability.