Behind the mask: Determinants of nurse's adherence to facial protective equipment

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.

Current practices and barriers to the use of facemasks and respirators among hospital-based health care workers in Vietnam

Background

This study aimed to examine the knowledge, attitudes, and practices towards the use of facemasks among hospital-based health care workers (HCWs) in Hanoi, Vietnam.

Methods

A qualitative study incorporating 20 focus groups was conducted between August 2010 and May 2011. HCWs from 7 hospitals in Vietnam were invited to participate.

Results

Issues associated with the availability of facemasks (medical and cloth masks) and respirators was the strongest theme to emerge from the discussion. Participants reported that it is not unusual for some types of facemasks to be unavailable during nonemergency periods. It was highlighted that the use of facemasks and respirators is not continuous, but rather is limited to selected situations, locations, and patients. Reuse of facemasks and respirators is also common in some settings. Finally, some participants reported believing that the reuse of facemasks, particularly cloth masks, is safe, whereas others believed that the reuse of masks put staff at risk of infection.

Conclusions

In low and middle-income countries, access to appropriate levels of personal protective equipment may be restricted owing to competing demands for funding in hospital settings. It is important that issues around reuse and extended use of medical masks/respirators and decontamination of cloth masks are addressed in policy documents to minimize the risk of infection.

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Knowledge, attitudes, and practices around the use of facemasks and respirators were examined.

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Views were mixed regarding the protection afforded by various types of facemasks.

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The availability of products was the main issue highlighted by participants.

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Facemask use is limited to selected situations, locations, and types of patients.

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Extended use and reuse of facemasks is a common practice in low-resource settings.

Respiratory protection competencies for the occupational health nurse

Approximately 5 million workers employed at 1.3 million work settings are required to wear some form of respiratory protection as part of their jobs. Occupational health nurses can protect the respiratory health of America's workforce. In 2012, the American Association of Occupational Health Nurses Grants Committee Working Group conducted a nationwide survey of occupational health nurses to assess their knowledge, comfort, skills, and abilities relative to respiratory protection. The Working Group used the survey findings as a foundation for the development of respiratory protection competencies for occupational health nurses and a guide for the development of educational modules.

Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses

BACKGROUND

Long-term use of respiratory protection may be necessary, but compliance may be low, and physiologic effects have not been well evaluated.

METHODS

Ten nurses participated; physiologic effects, subjective symptoms, and compliance with wearing an N95 alone or with a surgical mask overlay were assessed. Longitudinal analysis based on multivariate linear regression models assessed changes in outcome variables (CO2, O2, heart rate, perceived comfort items, compliance measures, and others). Analyses compared changes over time, and compared wearing only an N95 to wearing an N95 with a surgical mask overlay.

RESULTS

Most nurses (90%, n = 9) tolerated wearing respiratory protection for two 12-hour shifts. CO(2) levels increased significantly compared with baseline measures, especially when comparing an N95 with a surgical mask to only an N95, but changes were not clinically relevant. Perceived exertion; perceived shortness of air; and complaints of headache, lightheadedness, and difficulty communicating also increased over time. Almost one-quarter (22%) of respirator removals were due to reported discomfort. N95 adjustments increased over time, but other compliance measures did not vary by time. Compliance increased on day 2, except for adjustments, touching under the N95, and eye touches.

CONCLUSION

Long-term use of respiratory protection did not result in any clinically relevant physiologic burden for health care personnel, although many subjective symptoms were reported. N95 compliance was fairly high.

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.

Sequential compression devices in postoperative urologic patients: an observational trial and survey study on the influence of patient and hospital factors on compliance

Background

Sequential compression devices (SCDs) are commonly used for thromboprophylaxis in postoperative patients but compliance is often poor. We investigated causes for noncompliance, examining both hospital and patient related factors.

Methods

100 patients undergoing inpatient urologic surgery were enrolled. All patient had SCD sleeves placed preoperatively. Postoperative observations determined SCD compliance and reasons for non-compliance. Patient demographics, length of stay, inpatient unit type, and surgery type were recorded. At discharge, a patient survey gauged knowledge and attitudes regarding SCDs and bother with SCDs. Statistical analysis was performed to correlate SCD compliance with patient demographics; patient knowledge and attitudes regarding SCDs; and patient self-reported bother with SCDs.

Results

Observed overall compliance was 78.6%. The most commonly observed reasons for non-compliance were SCD machines not being initially available on the ward (71% of non-compliant observations on post-operative day 1) and SCD use not being restarted promptly after return to bed (50% of non-compliant observations for entire hospital stay). Mean self-reported bother scores related to SCDs were low, ranging from 1–3 out of 10 for all 12 categories of bother assessed. Patient demographics, knowledge, attitudes and bother with SCD devices were not significantly associated with non-compliance.

Conclusions

Patient self-reported bother with SCD devices was low. Hospital factors, including SCD machine availability and timely restarting of devices by nursing staff when a patient returns to bed, played a greater role in SCD non-compliance than patient factors. Identifying and addressing hospital related causes for poor SCD compliance may improve postoperative urologic patient safety.