Physiological evaluation of air-fed ensembles.

The goal of this study was to evaluate the respiratory and metabolic stresses of air-fed ensembles used by workers in the nuclear, chemical, and pharmaceutical industries during rest, low-, and moderate-intensity treadmill exercise. Fourteen men and six women wore two different air-fed ensembles (AFE-1 and AFE-2) and one two-piece supplied-air respirator (SA) at rest (REST) and while walking for 6min at oxygen consumption (V.O2) rates of 1.0 (LOW) and 2.0 l min(-1) (MOD). Inhaled CO2 (FICO2), inhaled O2 (FIO2), pressure, and temperature were measured continuously breath-by-breath. For both LOW and MOD, FICO2 was significantly lower (P < 0.03) and FIO2 was significantly greater (P < 0.008) for SA compared with AFE-1 and AFE-2 in women, while in men, similar trends were observed. Significantly lower FICO2 (P < 0.009) and significantly greater FIO2 (P < 0.04) were consistently observed in AFE-1 compared with AFE-2 in men during LOW and MOD. For both men and women, average FICO2 exceeded 2.0% in AFE-2 during MOD. During LOW and MOD, average FIO2 in AFE-1 and AFE-2 dropped <19.5% in men and women. For men and women, average inhalation pressures (PIave) were significantly greater in both air-fed ensembles than SA (P < 0.001) during REST, LOW, and MOD. Inhaled gas temperature was significantly lower in SA than in either air-fed ensemble (P < 0.001). When the air supply was shut off during walking, the time taken for minimum FICO2 to reach 2.0% was <38 s for all three ensembles in both men and women, an observation that has implications for the design of emergency escape protocols for air-fed ensemble wearers. Results show that inhaled gas concentrations may reach physiologically stressful levels in air-fed ensembles during moderate-intensity treadmill walking.

Pilot study of aromatic hydrocarbon adsorption characteristics of disposable filtering facepiece respirators that contain activated carbon.

Disposable filtering facepiece respirators (FFRs) used by health care workers are not designed to reduce the inhalation of volatile organic compounds (VOCs). Smoke-generating surgical procedures release VOCs and have been associated with the following complaints: foul smell, headaches, nausea, irritated throat and lungs, and asthma. Organic vapor FFRs that contain activated carbon are used by industrial workers to provide odor relief. These respirators remove irritating odors but are not marketed as respirators that provide respiratory protection against a gas or vapor. This study investigated the aromatic hydrocarbon adsorption capabilities of nuisance organic vapor (OV) FFRs. Three OV FFR models were tested to determine the 10% breakthrough time of three aromatic hydrocarbons at ambient room temperature and relative humidity. All respirator models were exposed to each vapor separately in three duplicate tests (n = 27). The respirator was sealed with silicone to an AVON-ISI headform that was placed in a chamber and exposed to VOC-laden air (20 ppm, 37 L/min). Periodically, gas samples were directed to an SRI gas chromatograph (Model 8610C) for analysis. All respirators performed similarly. The average 10% breakthrough values for all tests were at least 64 min, 96 min, and 110 min for benzene, toluene, and xylene, respectively. Respirators were tested with challenge concentrations at nuisance levels (20 ppm) and did not exceed 10% breakthrough values for at least 61 min. While the results of this pilot study hold promise, there is a need for further investigation and validation to determine the effectiveness of nuisance FFRs in mitigating organic vapors such as benzene, toluene, and xylene.

Impact of three biological decontamination methods on filtering facepiece respirator fit, odor, comfort, and donning ease.

The objective of this study was to determine if ultraviolet germicidal irradiation (UVGI), moist heat incubation (MHI), or microwave-generated steam (MGS) decontamination affects the fitting characteristics, odor, comfort, or donning ease of six N95 filtering facepiece respirator (FFR) models. For each model, 10 experienced test subjects qualified for the study by passing a standard OSHA quantitative fit test. Once qualified, each subject performed a series of fit tests to assess respirator fit and completed surveys to evaluate odor, comfort, and donning ease with FFRs that were not decontaminated (controls) and with FFRs of the same model that had been decontaminated. Respirator fit was quantitatively measured using a multidonning protocol with the TSI PORTACOUNT Plus and the N95 Companion accessory (designed to count only particles resulting from face to face-seal leakage). Participants' subjective appraisals of the respirator's odor, comfort, and donning ease were captured using a visual analog scale survey. Wilcoxon signed rank tests compared median values for fit, odor, comfort, and donning ease for each FFR and decontamination method against their respective controls for a given model. Two of the six FFRs demonstrated a statistically significant reduction (p < 0.05) in fit after MHI decontamination. However, for these two FFR models, post-decontamination mean fit factors were still ≥ 100. One of the other FFRs demonstrated a relatively small though statistically significant increase (p < 0.05) in median odor response after MHI decontamination. These data suggest that FFR users with characteristics similar to those in this study population would be unlikely to experience a clinically meaningful reduction in fit, increase in odor, increase in discomfort, or increased difficulty in donning with the six FFRs included in this study after UVGI, MHI, or MGS decontamination. Further research is needed before decontamination of N95 FFRs for purposes of reuse can be recommended.

Opportunities to bridge gaps between respiratory protection guidance and practice in US health care.

Healthcare organizations are required to provide workers with respiratory protection (RP) to mitigate hazardous airborne inhalation exposures. This study sought to better identify gaps that exist between RP guidance and clinical practice to understand issues that would benefit from additional research or clarification.

Best practices: understanding nurses' perspectives.

Understanding the perspectives of nurses is a critical, initial step in developmental efforts targeting the integration of evidence into practice. The authors discuss the outcomes of a study that assessed nurses' views of best practice, including organizational supports, barriers, and recommended strategies to successfully navigate practice changes in demanding work environments.

Prevalence of Respiratory Protective Devices in U.S. Health Care Facilities: Implications for Emergency Preparedness.

An online questionnaire was developed to explore respiratory protective device (RPD) prevalence in U.S. health care facilities. The survey was distributed to professional nursing society members in 2014 and again in 2015 receiving 322 and 232 participant responses, respectively. The purpose of this study was to explore if the emergency preparedness climate associated with Ebola virus disease changed the landscape of RPD use and awareness. Comparing response percentages from the two sampling time frames using bivariate analysis, no significant changes were found in types of RPDs used in health care settings. N95 filtering facepiece respirators continue to be the most prevalent RPD used in health care facilities, but powered air-purifying respirators are also popular, with regional use highest in the West and Midwest. Understanding RPD use prevalence could ensure that health care workers receive appropriate device trainings as well as improve supply matching for emergency RPD stockpiling.

Differences in Hospital Managers', Unit Managers', and Health Care Workers' Perceptions of the Safety Climate for Respiratory Protection.

This article compares hospital managers' (HM), unit managers' (UM), and health care workers' (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers' safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management's supervision of HCWs' respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs' inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices.

Hospital respiratory protection practices in 6 U.S. states: a public health evaluation study.

BACKGROUND: Lessons learned from the influenza A (H1N1) virus revealed a need to better understand hospitals' respiratory protection programmatic practice gaps. This article reports findings from a multistate assessment of hospitals' adherence to the Occupational Safety and Health Administration's respiratory protection program (RPP) requirements and the Centers for Disease Control and Prevention's infection control guidance. METHODS: Onsite surveys were conducted in 98 acute care hospitals in 6 U.S. states, including >1,500 hospital managers, unit managers, and health care workers. Descriptive statistics were used to assess hospital adherence. RESULTS: Most acute care hospitals adhere to requirements for initial medical evaluations, fit testing, training, and recommended respiratory protection when in close contact with patients who have suspected or confirmed seasonal influenza. Low hospital adherence was found for respiratory protection with infectious diseases requiring airborne precautions, aerosol-generating procedures with seasonal influenza, and checking of the respirator's user seal. Hospitals' adherence was also low with follow-up program evaluations, medical re-evaluations, and respirator maintenance. CONCLUSION: Efforts should be made to closely examine ways of strengthening hospitals' RPPs to ensure the program's ongoing effectiveness and workers' proper selection and use of respiratory protection. Implications for improved RPPs and practice are discussed.

Occupational health nurses' achievement of competence and comfort in respiratory protection and preferred learning methods results of a nationwide survey.

Additional findings are presented from a 2012 nationwide survey of 2,072 occupational health nurses regarding how they achieved competence in respiratory protection, their preferred methods of learning, and how they motivated employees to use respiratory protection. On-the-job training, taking a National Institute for Occupational Safety and Health spirometry course, or attending professional conferences were the primary ways occupational health nurses gained respiratory protection knowledge. Attending professional conferences was the preferred method of learning, varying by type of industry and years of occupational health nurse experience. Employee motivational strategies were not widely used; the most common strategy was to tailor respiratory protection training to workplace culture. Designing training methods that match learning preferences, within the context of the organization's safety and quality improvement culture, is a key recommendation supported by the literature and these findings. Including respiratory protection content and competencies in all levels of academic nursing education is an additional recommendation. Additional research is needed to link training strategies with consistent and correct use of respiratory protection by employees.

Proper use of surgical n95 respirators and surgical masks in the OR.

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.

Evaluation of respiratory protection programs and practices in California hospitals during the 2009-2010 H1N1 influenza pandemic.

BACKGROUND: Emergence of the novel 2009 influenza A H1N1 virus in California led to an evaluation of hospital respiratory protection programs (RPPs) and practices by the California Department of Public Health during the 2009-2010 influenza season. METHODS: Onsite evaluation of 16 hospitals consisted of interviews with managers and health care workers about RPPs and practices, review of written RPPs, and limited observations of personnel using respirators. Data were analyzed using descriptive statistics. RESULTS: All hospitals had implemented policies requiring the minimum use of N95 filtering facepiece respirators when working with patients with H1N1 virus infection; 95.5% of health care workers (n = 199) reported they would wear at least this level of protection when in close contact with a patient with confirmed or suspected H1N1 virus infection. However, evaluation of written RPPs indicated deficiencies in required areas, most commonly in recordkeeping, designation of a program administrator, program evaluation, employee training, and fit testing procedures. CONCLUSIONS: Health care workers were aware of respiratory protection required when providing care for patients with confirmed or suspected H1N1 virus infection. Hospitals should improve written RPPs, fully implement written procedures, and conduct periodic program evaluation to ensure effectiveness of respirator use for health care worker protection. Increased accessibility of resources tailored for hospital respirator program administrators may be helpful.

Perceived competence and comfort in respiratory protection: results of a nationwide survey of occupational health nurses.

In response to the Institute of Medicine (2011) report Occupational Health Nurses and Respiratory Protection: Improving Education and Training, a nationwide survey was conducted in May 2012 to assess occupational health nurses' educational preparation, roles, responsibilities, and training needs in respiratory protection. More than 2,000 occupational health nurses responded; 83% perceived themselves as competent, proficient, or expert in respiratory protection, reporting moderate comfort with 12 respiratory program elements. If occupational health nurses had primary responsibility for the respiratory protection program, they were more likely to perceive higher competence and more comfort in respiratory protection, after controlling for occupational health nursing experience, highest education, occupational health nursing certification, industry sector, Association of Occupational Health Professionals in Healthcare membership, taking a National Institute for Occupational Safety and Health spirometry course in the prior 5 years, and perceiving a positive safety culture at work. These survey results document high perceived competence and comfort in respiratory protection. These findings support the development of targeted educational programs and interprofessional competencies for respiratory protection.