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Bray C, Vanberkel PT. A framework for comparing N95 and elastomeric facepiece respirators on cost and function for healthcare use during a pandemic- A literature review. Health Policy 2023; 134:104857. [PMID: 37336164 DOI: 10.1016/j.healthpol.2023.104857] [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: 06/29/2021] [Revised: 05/16/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023]
Abstract
SARS-CoV-2 has posed implications for personal protective equipment supply. In this literature review we examine if elastomeric facepiece respirators (EFRs) are effective substitutes for N95 respirators through comparing their functionality and cost. We reviewed 30 articles which researched the advantages and disadvantages of each respirator. We compiled the reported results and found, among other things, that users favour N95 respirators for comfort but prefer EFRs for protection. EFRs are more cost effective when N95s are used as designed (single use) but mixed strategies minimize costs when N95s are reused (as practiced during shortages). Future research is needed on multicriteria analyses and to incorporate SARS-CoV-2 specific data to support future pandemic planning.
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Affiliation(s)
- Ceilidh Bray
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada
| | - Peter T Vanberkel
- Dalhousie University, Industrial Engineering, PO BOX 15000, Halifax, NS B3H 4R2, Canada.
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Reusable respirators as personal protective equipment in clinical practice : User experience in times of a pandemic. Wien Klin Wochenschr 2022; 134:522-528. [PMID: 35412049 PMCID: PMC9001817 DOI: 10.1007/s00508-022-02022-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 01/25/2023]
Abstract
Background The novel strain of severe acute respiratory syndrome coronavirus 2 is highly contagious; therefore, special emphasis must be given to personal protective equipment for healthcare workers. Reusable elastomeric respirators were previously used in intensive care units (ICU). These respirators include full or half masks and devices modified to accommodate a filter. Although the general comfort of masks used in the ICU has been studied, data comparing multiple types of masks during a pandemic are missing. Methods A prospective randomized trial was conducted in an ICU. After standardized training, participants were randomized to use one of three mask types (full, half or snorkelling mask), each fitted with a filter equivalent to a class 3 particle-filtering half mask (FFP3) during one shift. The main outcomes were characteristics of using the mask itself (donning/doffing, quality of seal, cleaning), working conditions with the mask (vision, comfort, perceived safety, communication) and a subjective comparison to single-use FFP2/3 masks. Results A total of 30 participants were included in the trial, randomized to 10 participants per group. The masks were worn 6.4 (4.5) times (mean SD) for a total duration of 132 (66) min per shift. The tested masks were rated 7 (2.6) (mean SD) in comparison to FFP2/3 on a Likert scale (0: worst, 10: best). Significant differences between the masks were found in respect to comfort (7/4/8), donning (8/7/9), overall rating (8/5/8) and comparison to single-use FFP2/3 masks (9/7/9; full-, half, snorkelling mask). Conclusion Using reusable elastomeric masks is feasible in clinical practice. Full face masks were significantly better in terms of comfort, donning, overall rating and in comparison to single-use FFP2/3 masks.
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Hines SE, Brown CH, Oliver M, Gucer P, Frisch M, Hogan R, Roth T, Chang J, McDiarmid M. Cleaning and Disinfection Perceptions and Use Practices Among Elastomeric Respirator Users in Health care. Workplace Health Saf 2020; 68:572-582. [PMID: 32812845 DOI: 10.1177/2165079920938618] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reusable elastomeric respirator use in health care may represent one solution to address N95 respirator shortages experienced during infectious disease outbreaks, but cleaning and disinfection requirements may limit their utility. Evidence of respirator cleaning and disinfection behaviors and practices by health care workers may inform guidance on reusable respirator use. METHODS Medical system elastomeric respirator users were surveyed about respirator cleaning and disinfection practices and perceptions via an electronic survey. Respondents were subsequently classified based on reported compliance with their assigned respirator use. To explore whether respirator cleaning and disinfection issues affected compliance with assigned device use, responses were compared between user groups and adjusted for covariates. RESULTS A total of 432 of 2,024 (21%) eligible elastomeric respirator users completed the survey. Most (>90%) reported that their respirator was clean, but only 52% reported that they always disinfect their respirators after use according to the hospital's expected practice. Only 40 respondents (9%) reported regularly cleaning the respirator with soap and water, in accordance with manufacturer recommendations. Reporting of suboptimal decontamination practice was not associated with assigned device compliance, however, except among providers and respiratory therapists. CONCLUSION/APPLICATION TO PRACTICE Although perceptions of cleanliness and adherence to expected decontamination practices during routine use did not appear to influence compliance with assigned respirator use overall, this did predict compliance among providers and respiratory therapists, both of whom have nonfixed workstations. Practical and effective strategies to assure easy access to and availability of clean reusable respiratory protective devices are needed to facilitate their use in health care respiratory protection programs.
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Affiliation(s)
| | | | | | | | | | | | - Tracy Roth
- University of Maryland School of Medicine
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Hines SE, Brown C, Oliver M, Gucer P, Frisch M, Hogan R, Roth T, Chang J, McDiarmid M. Storage and Availability of Elastomeric Respirators in Health Care. Health Secur 2020; 17:384-392. [PMID: 31593514 DOI: 10.1089/hs.2019.0039] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Use of reusable respirators, such as elastomeric half-face respirators (EHFRs), may serve as one solution to combating the problem of N95 respirator shortages experienced during infectious disease emergencies. To clarify whether logistical issues like respirator storage and availability are barriers to implementation of healthcare respiratory protection strategies that include EHFRs, this study aimed to evaluate the availability, storage, and respirator and filter replacement practices of EHFRs used in healthcare settings under routine use. Healthcare workers using EHFRs were surveyed about their use practices. To explore whether issues related to storage and availability of EHFRs affected compliance with assigned respirator use, responses were compared between concordant users and EHFR users who were assigned to use EHFRs but currently use different respirators ("discordant users"). Most concordant EHFR users reported that their respirator was always available when needed (63.8%). Almost two-thirds of concordant but only half of discordant users reported storing their EHFRs conveniently in the patient care area (p = <0.001). Among mobile workers, discordant users had higher odds (aOR = 3.2, 95% CI [1.4,7.5]) of reporting that their respirator was not stored in the patient care area, suggesting that storage location has a significant impact on compliance with expected practice, particularly in this group. Storage and access are barriers to optimal elastomeric respirator use in healthcare. Strategies to assure ready availability and storage of respirators will permit EHFR inclusion in pandemic and routine respiratory protection programs.
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Affiliation(s)
- Stella E Hines
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
| | - Clayton Brown
- Clayton Brown, PhD, is Professor, Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, School of Medicine, University of Maryland-Baltimore
| | - Marc Oliver
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
| | - Patricia Gucer
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
| | - Melissa Frisch
- Melissa Frisch, MD, MPH, is an Occupational and Environmental Medicine physician; Regina Hogan, RN, MS, is Manager, Employee Health Services; and James Chang, CIH, is Safety Officer; all at the University of Maryland Medical Center, Baltimore, MD
| | - Regina Hogan
- Melissa Frisch, MD, MPH, is an Occupational and Environmental Medicine physician; Regina Hogan, RN, MS, is Manager, Employee Health Services; and James Chang, CIH, is Safety Officer; all at the University of Maryland Medical Center, Baltimore, MD
| | - Tracy Roth
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
| | - James Chang
- Melissa Frisch, MD, MPH, is an Occupational and Environmental Medicine physician; Regina Hogan, RN, MS, is Manager, Employee Health Services; and James Chang, CIH, is Safety Officer; all at the University of Maryland Medical Center, Baltimore, MD
| | - Melissa McDiarmid
- Stella E. Hines, MD, MSPH, is Assistant Professor; Marc Oliver, RN, MPH, MBA, is a Research Nurse; Patricia Gucer, PhD, is Assistant Professor; Tracy Roth, RN, is a Research Nurse; and Melissa McDiarmid, MD, MPH, DABT, is Director; all in the Division of Occupational and Environmental Medicine, Department of Medicine, School of Medicine, University of Maryland-Baltimore, Baltimore, MD
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Hines SE, Brown C, Oliver M, Gucer P, Frisch M, Hogan R, Roth T, Chang J, McDiarmid M. User acceptance of reusable respirators in health care. Am J Infect Control 2019; 47:648-655. [PMID: 30638674 PMCID: PMC7115316 DOI: 10.1016/j.ajic.2018.11.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 11/28/2018] [Accepted: 11/28/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Inclusion of reusable respirators, such as elastomeric half-face respirators (EHFRs) and powered air-purifying respirators (PAPRs), in hospital respiratory protection inventories may represent 1 solution to the problem of N95 respirator shortages experienced during pandemics. User acceptance of these devices is 1 potential barrier to implementing such a strategy in respiratory protection programs. METHODS To assess user attitudes toward various respirators, health care workers enrolled in respiratory protection programs in a medical system using EHFRs, N95s, and PAPRs and completed an online questionnaire that addressed attitudes, beliefs, and respirator preferences under different risk scenarios. Responses were compared between user groups. RESULTS Of 1,152 participants, 53% currently used N95s, 24% used EHFRs, and 23% used PAPRs. N95 users rated their respirators more favorably compared with EHFR and PAPR users (P < .001) regarding comfort and communication, however, EHFR users rated their respirators much more highly regarding sense of protection (P < .001). For all user groups, reusable respirators were significantly more likely (odds ratios 2.3-7.7) to be preferred over N95 filtering facepiece respirators in higher risk scenarios compared to "usual circumstance" scenarios. CONCLUSIONS Despite somewhat less favorable ratings on comfort and communication, experienced EHFR and PAPR users still prefer reusable respirators over N95s in certain higher risk scenarios. This suggests that reusable respirators are an acceptable alternative to N95 respirators in health care and offer 1 viable solution to prevent pandemic-generated respirator shortages.
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Affiliation(s)
- Stella E Hines
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD.
| | - Clayton Brown
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Marc Oliver
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Patricia Gucer
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Melissa Frisch
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Regina Hogan
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Tracy Roth
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - James Chang
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
| | - Melissa McDiarmid
- Department of Medicine, Division of Occupational and Environmental Medicine, The University of Maryland-Baltimore, School of Medicine, Baltimore, MD
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