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Lane M, Pompeii L, Rios J, Benavides E, Kasbaum M, Patlovich S, Ostrosky-Zeichner L, Hornbeck A, McClain C, Fernando R, Sietsema M, Kraft C. Provider experiences with daily use of elastomeric half-mask respirators in health care. Am J Infect Control 2024; 52:745-750. [PMID: 38278304 DOI: 10.1016/j.ajic.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND During public health emergencies, demand for N95 filtering facepiece respirators (N95 FFRs) can outpace supply. Elastomeric half-mask respirators (EHMRs) are a potential alternative that are reusable and provide the same or higher levels of protection. This study sought to examine the practical aspects of EHMR use among health care personnel (HCP). METHODS Between September and December 2021, 183 HCPs at 2 tertiary referral centers participated in this 3-month EHMR deployment, wearing the EHMR whenever respiratory protection was required according to hospital protocols (ie, when an N95 FFR would typically be worn) and responding to surveys about their experience. RESULTS Participants wore EHMRs typically 1 to 3 hours per shift, reported disinfecting the respirator after 85% of the removals, and reported high confidence in using the EHMR following the study. EHMRs caused minimal interference with patient care tasks, though they did inhibit communication. DISCUSSION HCP who had not previously worn an EHMR were able to wear it as an alternative to an N95 FFR without much-reported interference with their job tasks and with high disinfection compliance. CONCLUSIONS This study highlights the feasibility of the deployment of EHMRs during a public health emergency when an alternative respirator option is necessary.
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Affiliation(s)
- Morgan Lane
- Department of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA.
| | - Lisa Pompeii
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Janelle Rios
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX
| | - Elisa Benavides
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX
| | - Marie Kasbaum
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Scott Patlovich
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX
| | - Luis Ostrosky-Zeichner
- Department of Epidemiology, Genetics, and Environmental Sciences, University of Texas Health Sciences Center, School of Public Health, Houston, TX
| | - Adam Hornbeck
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - Caitlin McClain
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - Rohan Fernando
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - Margaret Sietsema
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, PA
| | - Colleen Kraft
- Department of Infectious Diseases, School of Medicine, Emory University, Atlanta, GA
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Haas EJ, Furek A, Greenawald LA. Identifying leadership practices to support the uptake of reusable elastomeric half mask respirators in health delivery settings. Healthc Manage Forum 2024; 37:230-236. [PMID: 38243776 PMCID: PMC11273238 DOI: 10.1177/08404704241226698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
An increase in reusable Elastomeric Half Mask Respirators (EHMRs) among healthcare personnel has been documented during pandemic emergencies; however, research has not detailed leadership practices to support their use. Forty-three organizations implemented EHMRs received from the United States federal government which prompted interviews with 73 individuals who managed respirator distribution and fit testing between October 2021 and November 2022. Interview data was qualitatively analyzed. Themes around organizational culture and leadership practices emerged when discussing how elastomeric half mask respirators were integrated into health delivery settings including communication and outreach methods to aid worker support. Example included on-line and hands-on training, peer support, leadership support, and a culture that supports respirator use. To support a shift to reusable respiratory protection being procured and implemented, organizational- and individual-level perspectives are needed. Employee engagement, respirator champions, and updated verbal and written communication mechanisms are important takeaways for leaders to consider during any routine or emergency scenario.
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Affiliation(s)
- Emily J. Haas
- National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, Pennsylvania, USA
| | - Alexa Furek
- National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, Pennsylvania, USA
| | - Lee A. Greenawald
- National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, Pennsylvania, USA
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Pompeii L, Rios J, Kraft CS, Kasbaum M, Benavides E, Patlovich SJ, Ostrosky-Zeichner L, Hornbeck A, McClain C, Fernando RD, Sietsema M, Lane M. Health Care Workers' Comfort Ratings for Elastomeric Half-Mask Respirators Versus N95 ® Filtering Facepiece Respirators During the COVID-19 Pandemic. Workplace Health Saf 2024; 72:261-272. [PMID: 38587354 PMCID: PMC11283741 DOI: 10.1177/21650799241238755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Reusable elastomeric half-mask respirators (EHMR) are an alternative to address shortages of disposable respirators. While respirator discomfort has been noted as a barrier to adherence to wearing an N95 filtering facepiece respirator (FFR) among health care personnel (HCP), few have examined EHMR comfort while providing patient care, which was the purpose of this study. METHOD Among a cohort of 183 HCP, we prospectively examined how HCP rated EHMR tolerability using the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI) questionnaire at Study Week 2 and Week 10. At the completion of the study (Week-12), HCP compared EHMR comfort with their prior N95 FFR use. Overall R-COMFI scores and three subscales (comfort, wear experience, and function) were examined as well as individual item scores. FINDINGS The HCP reported an improved overall R-COMFI score (lower score more favorable, 30.0 vs. 28.7/47, respectively) from Week 2 to Week 10. Many individual item scores improved or remained low over this period, except difficulty communicating with patients and coworkers. The overall R-COMFI scores for the EHMR were more favorable than for the N95 FFR (33.7 vs. 37.4, respectively), with a large proportion of workers indicating their perception that EHMR fit better, provided better protection, and they preferred to wear it in pandemic conditions compared with the N95 FFR. CONCLUSION/APPLICATION TO PRACTICE Findings suggest that the EHMR is a feasible respiratory protection device with respect to tolerance. EHMRs can be considered as a possible alternative to the N95 FFR in the health care setting. Future work is needed in the EHMR design to improve communication.
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Affiliation(s)
- Lisa Pompeii
- Cincinnati Children’s Hospital Medical Center
- Baylor College of Medicine
- The University of Texas Health Science Center at Houston
| | - Janelle Rios
- The University of Texas Health Science Center at Houston
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Bryant RA, Smith JM, Tervola NK, Smith C, Hoyt C, Dawud B, Dugan S, St. Hill CA. Use of Elastomeric Half-Mask Respirator in the Clinical Care Environment: Health Care Worker Perceptions. J Nurs Care Qual 2024; 39:37-43. [PMID: 37256675 PMCID: PMC10655906 DOI: 10.1097/ncq.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Elastomeric half-mask respirators (EHMR) reduce health care workers' exposure to airborne hazards including bioaerosols but have primarily been used in the industrial setting. PURPOSE To assess health care workers' perceptions, attitudes, and experiences wearing EHMRs in a clinical environment. METHODS Employees within a single health care system who wore the EHMR continuously during their shift completed an investigator developed survey. Descriptive statistics and thematic analysis were used. RESULTS Of the 8273 EHMR "fit-tested" eligible employees, 1478 met inclusion criteria and participated. Respondents reported that they felt well protected with the EHMR and confident in their care and maintenance of the EHMR. Although skin changes developed, they were primarily managed by adjusting the straps. Clarity of communication was a concern across all respondents and disciplines. CONCLUSIONS The EHMR was preferred over reusing the N95 although clarity in communication was challenging.
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Affiliation(s)
- Ruth A. Bryant
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Justin M. Smith
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Ned K. Tervola
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Claire Smith
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Cecely Hoyt
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Barite Dawud
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Siobhán Dugan
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
| | - Catherine A. St. Hill
- Nursing Research, Abbott Northwestern Hospital, Minneapolis, Minnesota (Dr Bryant); Department of Nursing, Mayo Clinic, Center for Digital Health, Rochester, Minnesota (Dr Smith); Allina Health Orthopedic Research, Allina Health, Minneapolis, Minnesota (Mr Tervola); Research Informatics, Allina Health, Minneapolis, Minnesota (Ms Smith); Research in Action, Minneapolis, Minnesota (Ms Hoyt); Amherst H. Wilder Foundation, Saint Paul, Minnesota (Ms Dawud); and Industrial Hygiene Quality and Safety (Dr Dugan) and Care Delivery Research (Dr Hill), Allina Health, Minneapolis, Minnesota (Drs Dugan and St. Hill)
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5
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Hines SE, Thurman P, Zhuang E, Chen H, McDiarmid M, Chalikonda S, Angelilli S, Waltenbaugh H, Napoli M, Haas E, McClain C, Sietsema M, Fernando R. Elastomeric half-mask respirator disinfection practices among healthcare personnel. Am J Ind Med 2023; 66:1056-1068. [PMID: 37755824 DOI: 10.1002/ajim.23538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Disposable N95 respirator shortages during the COVID-19 and 2009 H1N1 influenza pandemics highlighted the need for reusable alternatives, such as elastomeric half-mask respirators (EHMRs). Two US medical organizations deployed reusable EHMRs during the COVID-19 response. In addition to wipe-based disinfection following patient care episodes expected per local policies at both organizations, postshift centralized cleaning and disinfection (C&D) was expected at one site (A), permitting shared-pool EHMR use, and optional at the other (Site B), where EHMRs were issued to individuals. Using a survey, we evaluated disinfection practices reported by EHMR users and predictors of disinfection behaviors and perceptions. METHODS Surveys assessed EHMR disinfection practices, occupational characteristics, EHMR use frequency, training, and individual-issue versus shared-pool EHMR use. RESULTS Of 1080 EHMR users completing the survey, 76% reported that they disinfect the EHMR after each patient encounter, which was the expected practice at both sites. Increasing EHMR use, recall of disinfection training, and work in intensive care or emergency settings significantly influenced higher reporting of this practice. 36% of respondents reported using centralized C&D, although reporting was higher at the site (A) where this was expected (53%). Confidence in cleanliness of the EHMR following centralized C&D was not influenced by individual versus shared-pool EHMR issue. CONCLUSIONS Most EHMR users reported adherence with expected post-care individual-based disinfection of EHMRs but did not necessarily use standardized, centralized C&D. Future efforts to limit reliance on behavior related to respirator disinfection may improve EHMR implementation in healthcare to avert dependence on single-use, disposable N95 respirators.
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Affiliation(s)
- Stella E Hines
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Paul Thurman
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Eileen Zhuang
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Hegang Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Melissa McDiarmid
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | | | - Meghan Napoli
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Emily Haas
- National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Caitlin McClain
- National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Margaret Sietsema
- National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
| | - Rohan Fernando
- National Personal Protective Technology Laboratory, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, USA
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6
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Harber P, Beckett WS. Health effects of filtering facepiece respirators: Research and clinical implications of comfort, thermal, skin, psychologic, and workplace effects. Am J Ind Med 2023; 66:1017-1032. [PMID: 37702368 DOI: 10.1002/ajim.23535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 09/14/2023]
Abstract
Filtering facepiece respirators (FFR's) such as N95s have become widely used in appropriate settings for personal respiratory protection and are increasingly used beyond workplace settings. Concerns about possible adverse effects have appeared in many publications, particularly since the COVID-19 pandemic led to much more widespread use. This paper synthesizes known effects based upon review of publications in PubMed since 1995, addressing effects other than pulmonary and cardiovascular (reviewed elsewhere). Findings: (1) Subjective discomfort is very frequently reported; this includes general discomfort or organ-system-specific complaints such as respiratory, headache, dermatologic, and heat. Research methods are widely divergent, and we propose a taxonomy to classify such studies by methodology, study population (subjects, experimental vs. observational methodology, comparator, specificity, and timeframe) to facilitate synthesis. (2) Objective measures of increased heat and humidity within the mask are well documented. (3) Frequency and characteristics of dermatologic effects have been insufficiently evaluated. (4) Physical mask designs are varied, making generalizations challenging. (5) More studies of impact on work performance and communication are needed. (6) Studies of effect of FFR design and accompanying training materials on ease and consistency of use are needed.
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Affiliation(s)
- Philip Harber
- Environmental Health Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - William S Beckett
- Mount Auburn Hospital (Emeritus Status), Cambridge, Massachusetts, USA
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7
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Figueroa M, McMullen KM, Kruger E, Peterson AV, Johnson C, Line W. Respiratory Protection: Lessons Learned from a Global Pandemic. Risk Manag Healthc Policy 2023; 16:1693-1702. [PMID: 37670731 PMCID: PMC10476861 DOI: 10.2147/rmhp.s417979] [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: 04/20/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023] Open
Abstract
The COVID-19 pandemic exposed the limitations of global health systems' abilities to manage the rapid spread of a novel infectious disease, which was exacerbated by shortages of respiratory protective devices and other critical personal protective equipment (PPE). An advisory panel of experienced health-care professionals with backgrounds in Occupational and Environmental Health and Safety (OEHS), Infection Prevention, Nursing, and Clinical Application Specialists convened to discuss challenges and strategies associated with the selection and use of respiratory protective devices as experienced during the first year of the COVID-19 pandemic. This discussion led to the following recommendations: 1) the need for clear communication of alternative respiratory protection selection and use recommendations in accordance with US regulatory and agency guidance; 2) the need for collaboration between Infection Prevention, OEHS, clinical staff, supply chain/materials management, emergency preparedness, executive leadership, and finance; 3) the need for adequate stockpiling, inventory rotation, and diverse respiratory protection options to accommodate the majority of health-care workers; 4) the need for efficient and innovative strategies to communicate evolving regulatory, agency, and facility recommendations and to deliver appropriate training on respiratory protection; and 5) the need for additional research on respiratory protection use - involving filtering facepiece respirators (FFRs) as well as other respirator types designed to be reused - to balance infection prevention best practices with a sustainable process. In conclusion, these considerations may offer guidance and identify areas for research on preparedness, communication, education, and training to enhance the preparation of health-care facilities including community-based health-care organizations for unexpected public health events.
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Affiliation(s)
- Marta Figueroa
- Environmental Health and Safety, NYU Langone Health, New York, NY, USA
| | - Kathleen M McMullen
- Infection Prevention, Christian Hospital and Northwest Healthcare, St. Louis, MO, USA
| | - Elizabeth Kruger
- Home Infusion and Infection Prevention, Park Nicollet Health Services, St. Louis Park, MN, USA
| | | | | | - Whitney Line
- Medical Solutions Division, 3M Company, St. Paul, MN, USA
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Montazeri NX, Sandbrink JB. Innovate and Stockpile: Respiratory Protection for Essential Workers in a Catastrophic Pandemic. Health Secur 2023; 21:266-271. [PMID: 37196202 PMCID: PMC10357109 DOI: 10.1089/hs.2022.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Affiliation(s)
- Nadia X. Montazeri
- Nadia X. Montazeri, MD, is a Research Affiliate, Center for International Security and Cooperation, Stanford University, Stanford, CA
| | - Jonas B. Sandbrink
- Jonas B. Sandbrink is a Doctoral Researcher, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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9
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Strickland KT, Bergman MS, Xu S, Zhuang Z. A manikin-based assessment of loose-fitting powered air-purifying respirator performance at variable flow rates and work rates. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:279-288. [PMID: 37084405 PMCID: PMC10527853 DOI: 10.1080/15459624.2023.2205481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Loose-fitting powered air-purifying respirators (PAPRs) are used in healthcare settings, although barriers to routine, everyday usage remain, including usability concerns and potential interference with work activities. Loose-fitting PAPRs are approved by the National Institute for Occupational Safety and Health (NIOSH) and must meet minimum performance requirements, including a minimum airflow requirement of 170 L/min. One course of action to address usability concerns is to allow for the use of PAPRs designed with reduced airflow rates. The primary objective of this study was to assess the effect of PAPR flow rate and user work rate on PAPR performance, using a manikin-based assessment method. PAPR performance was quantified using the "Manikin Fit Factor" (mFF), a ratio of the challenge aerosol concentration to the in-facepiece concentration. Flow rates from 50-215 L/min and low, moderate, and high work rates were tested. Two models of NIOSH Approved loose-fitting facepiece PAPRs were tested, both having an Occupational Safety and Health Administration Assigned Protection Factor (APF) or expected level of protection, of 25. A two-way analysis of variance with an effect size model was run for each PAPR model to analyze the effects of work rate and flow rate on PAPR performance. Flow rate and work rate were found to be significant variables impacting PAPR performance. At low and moderate work rates and flow rates below the NIOSH minimum of 170 L/min, mFF was greater than or equal to 250, which is 10 times the OSHA APF of 25 for loose-fitting facepiece PAPRs. At high work rates and flow rates below 170 L/min, mFF was not greater than or equal to 250. These results suggest that some loose-fitting facepiece PAPRs designed with a flow rate lower than the current NIOSH requirement of 170 L/min may provide respirator users with expected protection at low and moderate work rates. However, when used at high work rates, some loose-fitting facepiece PAPRs designed with lower flow rates may not provide the expected level of protection.
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Affiliation(s)
- Kevin T Strickland
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania
| | - Michael S Bergman
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania
| | - Susan Xu
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania
| | - Ziqing Zhuang
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania
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10
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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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11
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Edirisooriya M, Haas EJ. Examining the Roles of Training, Fit Testing, and Safety Climate on User Confidence in Respiratory Protection: A Case Example with Reusable Respirators in Health Delivery Settings. SUSTAINABILITY 2023; 15:10.3390/su151712822. [PMID: 39070029 PMCID: PMC11274855 DOI: 10.3390/su151712822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
A lack of confidence in the efficacy of respiratory protection can contribute to uncertainty among workers and cast doubt on workplace safety. To date, no research has been conducted to study and understand the introduction of elastomeric half-mask respirators (EHMRs)-without exhalation valves (EVs) or with exhalation valve filters (EVFs), both representing new designs that address source control-in the workplace. To study this issue, researchers collaborated with partners at 32 health delivery settings that received EHMRs from the Strategic National Stockpile during the COVID-19 pandemic. EHMR users (n = 882) completed an online survey between October 2021 and September 2022. Analyses demonstrated that employees were statistically significantly more confident in the efficacy of EHMRs with no EV/with an EVF (including the efficacy in protecting the user from COVID-19) if they had been fit tested and received training. Respondents were also statistically significantly more confident in the efficacy of their EHMR if they had a more positive perception of their organization's safety climate. The results provide insights for tailored fit testing and training procedures as manufacturers continue to improve respirator models to enhance worker comfort and use. Results also show that, even during a public health emergency, the role of safety climate cannot be ignored as an organizational factor to support worker knowledge, attitudes, and participation in health and safety behaviors specific to respirator use.
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Affiliation(s)
- Mihili Edirisooriya
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA 15236, USA
| | - Emily J. Haas
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA 15236, USA
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12
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Sietsema M, Hamza H, Brosseau LM. Simulated workplace protection factor study of a quarter-facepiece elastomeric respirator. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:33-39. [PMID: 36416662 DOI: 10.1080/15459624.2022.2145014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The assigned protection factor (APF) for quarter-facepiece respirators is currently 5, based on fit test data from the 1970s with models no longer commercially available. The goal of this project was to evaluate the respirator fit capability of a NIOSH-approved N95 quarter-facepiece elastomeric respirator with a gel-based facial seal design (Envo Mask by Sleepnet Corporation). Human subjects were recruited from healthcare and the general population to satisfy a 25-member NIOSH bivariate panel. Subjects were fit tested with a fast fit protocol using a TSI Portacount Model 8038 in the N95 mode. Second-by-second measures of fit were then collected while subjects performed a 30-min series of simulated healthcare activities. Subjects completed a short comfort questionnaire. The median (5th, 95th percentile) fit factor was 188 (48, 201). Simulated workplace protection factors (SWPFs) had a median (5th, 95th percentile) of 181 (94, 199) (data truncated at 200) and 570 (153, 1508) (non-truncated data). Subjects ranked inhalation and exhalation as "easy" with average scores of 5.0/6.0 and 5.2/6.0, respectively. The facepiece was ranked between slightly comfortable and comfortable (4.8/6.0) and the harness as comfortable (5.0/6.0). Most users agreed (5.2/6.0) that the mask was stable on their faces. The 5th percentile SWPF of 95 supports an APF of at least 10 for this quarter-facepiece elastomeric respirator, similar to the APF for half-facepiece respirators. This study supports increasing the APF for quarter-facepiece respirators, a class that has been largely ignored by manufacturers for the past 40 years. A lightweight, low profile, reusable quarter-facepiece respirator is an effective option for healthcare and other worker protection during a pandemic and similar situations.
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Affiliation(s)
- Margaret Sietsema
- Environmental and Occupational Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois
| | - Hamed Hamza
- Environmental and Occupational Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, Illinois
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Flow-Shop Scheduling Problem Applied to the Planning of Repair and Maintenance of Electromedical Equipment in the Hospital Industry. Processes (Basel) 2022. [DOI: 10.3390/pr10122679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In the literature, several approaches have been proposed to integrate and optimize product supply and construction processes associated with demand management. However, in Industry 4.0, there needs to be more studies related to applying techniques that directly affect the programming and reprogramming process that integrates the industries at the operational level. This document proposes a flow-shop scheduling procedure to address the problem of planning the repair of medical equipment in public hospitals whose main objective is to eliminate downtime and minimize total production time. The research stems from the practical problem of responding to clinical users who make use of critical equipment, such as mechanical respirators, due to COVID-19, and the limited quantity of this equipment, which makes it necessary to have repair planning processes that seek to keep the equipment in operation for the most extended amount of time. The novelty of this study is that it was applied to a critical and real problem in the industry with a high economic and social impact, which has not been explored previously. The results show improvements in the overall planning and execution of electro-medical equipment repair. Several improvements to the applied methods were identified as future work, such as the need to consider work interruptions and psychosocial effects on workers due to the stricter planning of execution times.
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Price A, Lin YL, Levin AS, Tumietto F, Almeida R, Almeida A, Ciofi-Silva CL, Fontana L, Oliveira N, Parisi NF, Mainardi GM, Cordeiro L, Roselli M, Shepherd P, Morelli L, Mehrabi N, Price K, Chan W, Srinivas S, Harrison TK, Chu M, Padoveze MC, Chu L. Perceived Workload Using Separate (Filtering Facepiece Respirator and Face Shield) and Powered Air-Purifying Respirator and Integrated Lightweight Protective Air-Purifying Respirator: Protocol for an International Multisite Human Factors Randomized Crossover Feasibility Study. JMIR Res Protoc 2022; 11:e36549. [PMID: 36454625 PMCID: PMC9756122 DOI: 10.2196/36549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/26/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences. OBJECTIVE This study will assess whether the L-PAPR improves health care professionals' comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs. METHODS This is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user's perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types. RESULTS We expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time. CONCLUSIONS The design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/36549.
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Affiliation(s)
- Amy Price
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | | | - Anna S Levin
- Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Fabio Tumietto
- Unit of Antimicrobial Stewardship, Local Health Authority, City of Bologna, Bologna, Italy
| | | | - Ana Almeida
- Federal University of Itajubá, Minas Gerais, Brazil
| | | | | | - Naila Oliveira
- School of Nursing, University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Paul Shepherd
- Animation and Media Arts Concentration, Academy of Film, Hong Kong Baptist University, Hong Kong, China
| | | | | | - Kathleen Price
- College of Health Sciences and Technology, St Thomas University, Miami, FL, United States
| | - Whitney Chan
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Shrinidhy Srinivas
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - May Chu
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | | | - Larry Chu
- Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Palo Alto, CA, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
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Zhuang E, Chen HH, Kolesnik O, Hines SE. Tolerability, User Acceptance and Preference for a Novel Reusable Respirator Among Healthcare Workers. Am J Infect Control 2022:S0196-6553(22)00673-3. [PMID: 36122632 DOI: 10.1016/j.ajic.2022.09.006] [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: 07/26/2022] [Revised: 09/06/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The CleanSpace Technology Halo respirator combines a clear face mask and a powered air supply, without belts or hoses. Although providing higher protection than other respirators used in healthcare, user acceptance of this device has not been assessed with validated tools. METHODS We surveyed healthcare workers (HCWs) within a US medical system using Halo respirators in 2021. Subjects completed three surveys over eight weeks, which included the Respirator Comfort, Wearing Experience, and Function Instrument (R-COMFI), a validated tool to assess respirator tolerability. The survey included additional questions about user acceptability and respirator preference. Responses were evaluated for change over time and for significant predictors. RESULTS Of 113 HCWs who completed the initial survey (29% response rate), mean ± SD R-COMFI score was 9.1± 5.1, (scale 0-47, lower = more tolerable) and did not change over time (p = 0.42). Fewer years in healthcare significantly predicted better R-COMFI score (p=0.01). Many users preferred Halo in both usual care (45-52%) and care of patients with COVID-19 (60-64%). DISCUSSION Halo respirators received favorable tolerability scores by HCWs, who often preferred them, especially during care of patients with COVID-19. CONCLUSIONS Given demand for respirator use in healthcare, the innovative design provides higher protection than other respirators with a favorable user experience.
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Affiliation(s)
- Eileen Zhuang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA
| | - Hegang H Chen
- Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Howard Hall, Suite 109, 660 W. Redwood Street, Baltimore, MD, 21201, USA
| | - Olga Kolesnik
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA
| | - Stella E Hines
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, 110 S. Paca Street #200, Baltimore, MD, 21201, USA; Department of Medicine, Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, 11 S. Paca Street #200, Baltimore, MD, 21201, USA.
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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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Roche AD, McConnell AC, Donaldson K, Lawson A, Tan S, Toft K, Cairns G, Colle A, Coleman AA, Stewart K, Digard P, Norrie J, Stokes AA. Personalised 3D printed respirators for healthcare workers during the COVID-19 pandemic. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:963541. [PMID: 35982716 PMCID: PMC9380470 DOI: 10.3389/fmedt.2022.963541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
Widespread issues in respirator availability and fit have been rendered acutely apparent by the COVID-19 pandemic. This study sought to determine whether personalized 3D printed respirators provide adequate filtration and function for healthcare workers through a Randomized Controlled Trial (RCT). Fifty healthcare workers recruited within NHS Lothian, Scotland, underwent 3D facial scanning or 3D photographic reconstruction to produce 3D printed personalized respirators. The primary outcome measure was quantitative fit-testing to FFP3 standard. Secondary measures included respirator comfort, wearing experience, and function instrument (R-COMFI) for tolerability, Modified Rhyme Test (MRT) for intelligibility, and viral decontamination on respirator material. Of the 50 participants, 44 passed the fit test with the customized respirator, not significantly different from the 38 with the control (p = 0.21). The customized respirator had significantly improved comfort over the control respirator in both simulated clinical conditions (p < 0.0001) and during longer wear (p < 0.0001). For speech intelligibility, both respirators performed equally. Standard NHS decontamination agents were able to eradicate 99.9% of viral infectivity from the 3D printed plastics tested. Personalized 3D printed respirators performed to the same level as control disposable FFP3 respirators, with clear communication and with increased comfort, wearing experience, and function. The materials used were easily decontaminated of viral infectivity and would be applicable for sustainable and reusable respirators.
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Affiliation(s)
- Aidan D. Roche
- Deanery of Clinical Sciences, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Alistair C. McConnell
- School of Engineering, Institute for Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh, United Kingdom
| | - Karen Donaldson
- School of Engineering, Institute for Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh, United Kingdom
- *Correspondence: Karen Donaldson
| | - Angus Lawson
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, United Kingdom
| | - Spring Tan
- Roslin Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kate Toft
- Department of Speech and Language Therapy, St John's Hospital, Livingston, United Kingdom
| | - Gillian Cairns
- Department of Speech and Language Therapy, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Alexandre Colle
- School of Engineering, Institute for Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh, United Kingdom
| | | | - Ken Stewart
- Deanery of Clinical Sciences, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Digard
- Roslin Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, United Kingdom
| | - Adam A. Stokes
- School of Engineering, Institute for Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh, United Kingdom
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18
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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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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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Hines SE, Gaitens J, Mueller NM, Molina Ochoa D, Fernandes E, McDiarmid MA. Respiratory Protection Perceptions among Malian Health Workers: Insights from the Health Belief Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19053028. [PMID: 35270723 PMCID: PMC8909975 DOI: 10.3390/ijerph19053028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/10/2022] [Accepted: 02/25/2022] [Indexed: 12/10/2022]
Abstract
Reusable respiratory protective devices called elastomeric respirators have demonstrated their effectiveness and acceptability in well-resourced healthcare settings. Using standard qualitative research methods, we explored the feasibility of elastomeric respirator use in low- and middle-income countries (LMIC). We conducted interviews and focus groups with a convenience sample of health workers at one clinical center in Mali. Participants were users of elastomeric and/or traditional N95 respirators, their supervisors, and program leaders. Interview transcripts of participants were analyzed using a priori constructs from the Health Belief Model (HBM) and a previous study about healthcare respirator use. In addition to HBM constructs, the team identified two additional constructs impacting uptake of respirator use (system-level factors and cultural factors). Together, these framed the perceptions of Malian health workers and highlighted both facilitators of and barriers to respirator use uptake. As needs for respiratory protection from airborne infectious hazards become more commonly recognized, elastomeric respirators may be a sustainable and economic solution for health worker protection in LMIC.
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Affiliation(s)
- Stella E. Hines
- Division of Occupation and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (J.G.); (M.A.M.)
- Correspondence:
| | - Joanna Gaitens
- Division of Occupation and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (J.G.); (M.A.M.)
| | - Nora M. Mueller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MD 02115, USA;
| | | | - Eseosa Fernandes
- Department of Preventative Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA;
| | - Melissa A. McDiarmid
- Division of Occupation and Environmental Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA; (J.G.); (M.A.M.)
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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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Zhuang E, Thurman P, Chen HH, McDiarmid MA, Hines SE. Physiological Impacts of Surgical Mask Coverage of Elastomeric Half-mask Respirator Exhalation Valves in Healthcare Workers. Ann Work Expo Health 2022; 66:233-245. [PMID: 34585722 PMCID: PMC8500049 DOI: 10.1093/annweh/wxab069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/23/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Elastomeric half-mask respirator (EHMR) use in healthcare increased significantly during the COVID-19 pandemic. Concern for potential release of infectious aerosols from EHMR exhalation valves prompted recommendations to cover them with surgical masks (SMs), thereby improving source control. The physiological and subjective effects of wearing a SM over the exhalation valve of an EHMR, however, are unknown. METHODS Twelve healthy healthcare worker volunteers completed a 30-min series of simulated healthcare-related tasks, including resting, talking, walking, and bending, proning and supinating a weighted manikin, and performing cardiopulmonary resuscitation. This series recurred three times with different mask configurations-SM only, EHMR only, or EHMR with SM covering the exhalation valve. A transcutaneous sensor continuously measured carbon dioxide (tcPCO2), oxygen saturation (SpO2), and heart rate (HR) from each subject. Subjects scored their rates of perceived exertion (RPE) and levels of discomfort after each round. Physiological parameters and subjective scores were analyzed using mixed linear models with a fixed effect for mask type, activity, age, body mass index (BMI), and gender. Analysis also tested for interaction between mask type and activity. RESULTS Physiological parameters remained within normal ranges for all mask configurations but varied by task. Statistically significant but small decreases in mean tcPCO2 (37.17 versus 37.88 mmHg, P < 0.001) and SpO2 (97.74 versus 97.94%, P < 0.001) were associated with wearing EHMR with SM over the exhalation valve compared with EHMR alone. Mean HR did not differ between these mask configurations. Wearing SM only was associated with lower RPE and level of discomfort compared with EHMR, but these subjective scores did not differ when comparing EHMR with SM to EHMR only. Age, BMI, and gender had no significant effect on any outcomes. CONCLUSIONS Wearing a SM over an EHMR did not produce clinically significant changes in tcPCO2, SpO2, or HR compared with uncovered EHMR during healthcare-related tasks. Covered EHMR use also did not affect perceived exertion or discomfort compared with uncovered EHMR use. Covering the exhalation valve of an EHMR with a SM for source control purposes can be done safely.
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Affiliation(s)
- Eileen Zhuang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Paul Thurman
- R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Hegang H Chen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Melissa A McDiarmid
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Suite 200, Baltimore, MD, USA
| | - Stella E Hines
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, Division of Occupational and Environmental Medicine, University of Maryland School of Medicine, Suite 200, Baltimore, MD, USA
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Elastomeric Respirators for COVID-19 and the Next Respiratory Virus Pandemic: Essential Design Elements. Anesthesiology 2021; 135:951-962. [PMID: 34666348 DOI: 10.1097/aln.0000000000004005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Respiratory viruses are transmitted via respiratory particles that are emitted when people breath, speak, cough, or sneeze. These particles span the size spectrum from visible droplets to airborne particles of hundreds of nanometers. Barrier face coverings ("cloth masks") and surgical masks are loose-fitting and provide limited protection from airborne particles since air passes around the edges of the mask as well as through the filtering material. Respirators, which fit tightly to the face, provide more effective respiratory protection. Although healthcare workers have relied primarily on disposable filtering facepiece respirators (such as N95) during the COVID-19 pandemic, reusable elastomeric respirators have significant potential advantages for the COVID-19 and future respiratory virus pandemics. However, currently available elastomeric respirators were not designed primarily for healthcare or pandemic use and require further development to improve their suitability for this application. The authors believe that the development, implementation, and stockpiling of improved elastomeric respirators should be an international public health priority.
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Safi S, Danzer G, Raha S, Nassar E, Hufert FT, Schmailzl KJG. Does Being Ill Improve Acceptance of Medical Technology?-A Patient Survey with the Technology Usage Inventory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179367. [PMID: 34501957 PMCID: PMC8431124 DOI: 10.3390/ijerph18179367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Acceptance of new medical technology may be influenced by social conditions and an individual’s background and particular situation. We studied this acceptance by hypothesizing that current and former COVID-19 patients would be more likely to accept an electrocardiogram (ECG) “patch” (attached to the chest) that allows continuous monitoring of the heart than individuals who did not have the disease and thus the respective experience. Currently infected COVID-19 patients, individuals who had recovered from COVID-19, and a control group were recruited online through Facebook (and Instagram) and through general practitioners (GPs). Demographic information and questions tailored to the problem were collected via an online questionnaire. An online survey was chosen in part because of the pandemic conditions, and Facebook was chosen because of the widespread discussions of health topics on that platform. The results confirmed the central hypothesis that people who had experienced a disease are more willing to accept new medical technologies and showed that curiosity about new technologies and willingness to use them were significantly higher in the two groups currently or previously affected by COVID-19, whereas fears of being “monitored” (in the sense of surveillance) were significantly higher among people who had not experienced the disease and threat. Experiencing a serious disease (“patient experience”) promotes acceptance of new medical technologies.
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Affiliation(s)
- Sabur Safi
- Fakultät Humanwissenschaften, Medical School Hamburg, Am Kaiserkai 1, 20457 Hamburg, Germany
- Correspondence: ; Tel.: +49-17-8666-6187
| | - Gerhard Danzer
- Fachbereich für Innere Medizin und Psychosomatische Medizin, Allgemeine Psychologie, Medical School Brandenburg, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
| | - Solaiman Raha
- Fachbereich für Digitale Medizin und Künstliche Intelligenz, Center for Connected Health Care UG, Gartenstrasse 20, 16818 Wustrau, Germany; (S.R.); (E.N.); (K.J.G.S.)
| | - Eyyad Nassar
- Fachbereich für Digitale Medizin und Künstliche Intelligenz, Center for Connected Health Care UG, Gartenstrasse 20, 16818 Wustrau, Germany; (S.R.); (E.N.); (K.J.G.S.)
| | - Frank T. Hufert
- Fachbereich für Mikrobiologie und Virologie, Medical School Brandenburg, Fehrbelliner Str. 38, 16816 Neuruppin, Germany;
| | - Kurt J. G. Schmailzl
- Fachbereich für Digitale Medizin und Künstliche Intelligenz, Center for Connected Health Care UG, Gartenstrasse 20, 16818 Wustrau, Germany; (S.R.); (E.N.); (K.J.G.S.)
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Healthcare Workers' Experiences and Views of Using Surgical Masks and Respirators, and Their Attitudes on the Sustainability: A Semi-Structured Survey Study during COVID-19. NURSING REPORTS 2021; 11:615-628. [PMID: 34968337 PMCID: PMC8608101 DOI: 10.3390/nursrep11030059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
A universal mask use was instituted in healthcare during COVID-19 pandemic in 2020. The extensive growth in the consumption of surgical masks and respirators brought new challenges. Healthcare workers had to get accustomed to wearing the facemasks continuously, raising concerns on the patient, occupational, and environmental safety. The aim of this study is to describe frontline healthcare workers and other authorities’ views and experiences on continuous use of surgical masks and respirators (facemasks) and their attitudes towards environmental and sustainability issues. A cross-sectional web-based survey was conducted in Finland during the COVID-19 pandemic in autumn 2020. The respondents(N = 120) were recruited via social media, and the data were collected using a purpose-designed questionnaire. Descriptive statistics and inductive content analysis were used to analyze the quantitative data and qualitative data, respectively. The healthcare workers perceived their own and patient safety, and comfortability of facemasks as important, but according to their experiences, these properties were not evident with the current facemasks. They considered protection properties more important than environmental values. However, biodegradability and biobased material were seen as desired properties in facemasks. Based on the results, the current facemasks do not meet users’ expectations well enough. Especially the design, breathability, and sustainability issues should be taken more into account.
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Zhang X, Jiang X, Ni P, Li H, Li C, Zhou Q, Ou Z, Guo Y, Cao J. Association between resilience and burnout of front-line nurses at the peak of the COVID-19 pandemic: Positive and negative affect as mediators in Wuhan. Int J Ment Health Nurs 2021; 30:939-954. [PMID: 33893718 PMCID: PMC8251287 DOI: 10.1111/inm.12847] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/31/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) is having a dramatic effect on the mental health of healthcare workers (HCWs). Upon the emergence of the COVID-19 pandemic, the Chinese government dispatched about 42 000 HCWs to Wuhan City and Hubei Province to fight this pandemic. This study briefly examines front-line nurses who experienced burnout, with the main objective of investigating the mediating roles of positive and negative affect in the relationship between resilience and burnout in Wuhan hospitals at the peak of the COVID-19 pandemic. A total of 180 front-line nurses voluntarily participated via a social media group. They completed the online questionnaires, including the Maslach Burnout Inventory-General Survey (MBI-GS), the Positive and Negative Affect Schedule (PANAS), the Connor-Davidson Resilience Scale (CD-RISC), demographics, and work-related characteristics. Structural equation modelling (SEM) analysis was used to examine the mediating effect of positive and negative affect on the relationship between resilience and burnout. The total prevalence of burnout was 51.7%, of which 15.0% were severe burnout. These preliminary results revealed that positive and negative affect fully mediated the effects of resilience on burnout, emotional exhaustion, depersonalization, and reduced personal accomplishment of front-line nurses. It is necessary to know the impact of resilience on HCWs with burnout through the positive and negative affect of individual backgrounds and situations, and how policymakers can deploy resilience interventions to support front-line HCWs.
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Affiliation(s)
- Xiaoning Zhang
- School of Nursing, Xuzhou Medical University, Xuzhou, China.,School of Nursing, Capital Medical University, Beijing, China.,Department of Neonatology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
| | - Xue Jiang
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Pingping Ni
- School of Nursing, Xuzhou Medical University, Xuzhou, China.,Department of Neonatology, Suqian First Hospital, Suqian, China
| | - Haiyang Li
- Development Planning Office, Xuzhou Medical University, Xuzhou, China
| | - Chong Li
- Graduate School, Xuzhou Medical University, Xuzhou, China
| | - Qiong Zhou
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Zhengyan Ou
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Yuqing Guo
- School of Nursing, Xuzhou Medical University, Xuzhou, China
| | - Junli Cao
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.,Jiangsu Province Key Laboratory of Anesthesia and Analgesia Application Technology, Xuzhou Medical University, Xuzhou, China
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27
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Hebenstreit T, Ho G, Tronnier A, Chu E, Benjenk I, Dangerfield P, Keneally R, Liu T, Sherman M. Overcoming Communication Barriers: An evaluation of communication devices for healthcare providers wearing powered air-purifying respirators (PAPRs). PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2021; 23:100163. [PMID: 36568711 PMCID: PMC9764430 DOI: 10.1016/j.pcorm.2021.100163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/01/2021] [Accepted: 03/06/2021] [Indexed: 12/27/2022]
Abstract
Introduction The COVID-19 pandemic has resulted in an increased use of Powered Air Purifying Respirators (PAPRs), by health care providers to mitigate the risk of viral transmission, especially for aerosol-generating procedures. In this study, we evaluate communication devices that could be used concurrently with PAPRs to promote improved communication. Methods We tested two devices, a Bluetooth earpiece and a throat microphone that operated over mobile networks, against a control scenario in a simulated operating room environment with participants donning PAPRs. Participants read a short paragraph to each other, transcribed short phrases, and evaluated the scenarios according to speech intelligibility, ease of use, and comfort. Results There were 30 participants of varying PAPR experience. The Bluetooth headset had the most accurate transcriptions, followed by control, and lastly the neckpiece (94.7%vs 88.4%vs 76%, p<0.001). Conclusion Communication devices have the potential to bridge but also worsen communications barriers between providers donning PAPRs.
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Affiliation(s)
- Trevor Hebenstreit
- The George Washington University School of Medicine and Health Sciences, Washington, DC, 20037, United States
| | - Geoffrey Ho
- The George Washington University, Department of Anesthesiology & Critical Care Medicine, Washington, DC, 20037, United States
| | - Amy Tronnier
- The George Washington University School of Medicine and Health Sciences, Washington, DC, 20037, United States
| | - Everett Chu
- The George Washington University, Department of Anesthesiology & Critical Care Medicine, Washington, DC, 20037, United States
| | - Ivy Benjenk
- The George Washington University, Department of Anesthesiology & Critical Care Medicine, Washington, DC, 20037, United States
| | - Paul Dangerfield
- The George Washington University, Department of Anesthesiology & Critical Care Medicine, Washington, DC, 20037, United States
| | - Ryan Keneally
- The George Washington University, Department of Anesthesiology & Critical Care Medicine, Washington, DC, 20037, United States
| | - Timothy Liu
- The George Washington University, Department of Anesthesiology & Critical Care Medicine, Washington, DC, 20037, United States
| | - Marian Sherman
- The George Washington University, Department of Anesthesiology & Critical Care Medicine, Washington, DC, 20037, United States,Corresponding author at: George Washington School of Medicine and Health Sciences, Department of Anesthesiology and Critical Care Medicine, 2300 M St NW, 7th Floor, Suite 737, Washington, DC 20037, United States
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McMahon K, Jeanmonod D, Check R, Rivard L, Balakrishnan V, Kelly B, Pester J, Jeanmonod R. The pragmatic use of industrial elastomeric facemasks in health care practice during the COVID-19 pandemic. Am J Emerg Med 2021; 48:273-275. [PMID: 34022633 PMCID: PMC8116120 DOI: 10.1016/j.ajem.2021.05.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction The COVID-19 pandemic has forced health care workers to explore alternative personal protective equipment (PPE) strategies due to traditional product shortages in the setting of increased global demand. Some physicians have chosen to use elastomeric face masks (EFMs), traditionally used in non-healthcare industries. Methods We performed a prospective cohort study of Emergency Medicine (EM) physicians working at a Level 1 Trauma Center who chose to use self-supplied EFMs for PPE. All subjects used commercial EFMs with disposable filters (N95, P95, or P100). All subjects chose their mask size independently with no input from employee health regarding appropriate fit. Per study protocol, subjects were fit tested periodically during clinical shifts over the course of the 6-week study period. All investigators performing fit testing underwent OSHA qualitative fit testing training. Data collected included mask/filters age, subjective assessment of mask seal quality, and fit test results. The data were analyzed using descriptive statistics. Results 105 fit tests were performed on physicians wearing EFMs over the course of 49 shifts. Physicians felt their fit was adequate for all tests performed. There were no fit test failures in any subjects. Conclusions EFMs have an extremely low failure rate. Physicians are able to assess the adequacy of fit and accurately choose EFM size.
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Affiliation(s)
- Kathleen McMahon
- St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, USA
| | - Donald Jeanmonod
- St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, USA
| | - Ronald Check
- St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, USA
| | - Leah Rivard
- St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, USA
| | - Vamsi Balakrishnan
- St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, USA
| | - Brian Kelly
- St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, USA
| | - Jonathan Pester
- St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, USA
| | - Rebecca Jeanmonod
- St. Luke's University Hospital and Health Network, Department of Emergency Medicine, Bethlehem, PA, USA.
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Licina A, Silvers A. Use of powered air-purifying respirator(PAPR) as part of protective equipment against SARS-CoV-2-a narrative review and critical appraisal of evidence. Am J Infect Control 2021; 49:492-499. [PMID: 33186678 PMCID: PMC7654369 DOI: 10.1016/j.ajic.2020.11.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The last 2 decades have seen an increasing frequency of zoonotic origin viral diseases leaping from animal to human hosts including Severe Acute Respiratory Syndrome Coronaviruses (SARS-CoV-2). Respiratory component of the infectious disease program against SARS-CoV-2 incorporates use of protective airborne respiratory equipment. METHODS In this narrative review, we explore the features of Powered Air Purifying Respirators (PAPR) as well as logistical and evidence-based advantages and disadvantages. RESULTS Simulation study findings support increased heat tolerance and wearer comfort with a PAPR, versus decreased communication ability, mobility, and dexterity. Although PAPRs have been recommended for high-risk procedures on suspected or confirmed COVID-19 patients, this recommendation remains controversial due to lack of evidence. Guidelines for appropriate use of PAPR during the current pandemic are sparse. International regulatory bodies do not mandate the use of PAPR for high-risk aerosol generating procedures in patients with SARS-CoV-2. Current reports of the choice of protective respiratory technology during the SARS-CoV-2 pandemic are disparate. Patterns of use appear to be related to geographical locations. DISCUSSION Field observational studies do not indicate a difference in healthcare worker infection utilizing PAPR devices versus other compliant respiratory equipment in healthcare workers performing AGPs in patients with SARS-CoV-2. Whether a higher PAPR filtration factor translates to decreased infection rates of HCWs remains to be elucidated. Utilization of PAPR with high filtration efficiency may represent an example of "precautionary principle" wherein action taken to reduce risk is guided by logistical advantages of PAPR system.
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Affiliation(s)
- Ana Licina
- VMO Anaesthesia, Austin Health, Melbourne, Victoria, Australia.
| | - Andrew Silvers
- VMO Anaesthesia, Monash Medical Centre, Adjunct Senior Lecturer, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.
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Anwari V, Ng WCK, Mbadjeu Hondjeu AR, Xiao Z, Afenu E, Trac J, Kazlovich K, Hiansen J, Mashari A. Development, manufacturing, and preliminary validation of a reusable half-face respirator during the COVID-19 pandemic. PLoS One 2021; 16:e0247575. [PMID: 33730106 PMCID: PMC7968700 DOI: 10.1371/journal.pone.0247575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The COVID-19 pandemic has led to widespread shortages of N95 respirators and other personal protective equipment (PPE). An effective, reusable, locally-manufactured respirator can mitigate this problem. We describe the development, manufacture, and preliminary testing of an open-hardware-licensed device, the “simple silicone mask” (SSM). Methods A multidisciplinary team developed a reusable silicone half facepiece respirator over 9 prototype iterations. The manufacturing process consisted of 3D printing and silicone casting. Prototypes were assessed for comfort and breathability. Filtration was assessed by user seal checks and quantitative fit-testing according to CSA Z94.4–18. Results The respirator originally included a cartridge for holding filter material; this was modified to connect to standard heat-moisture exchange (HME) filters (N95 or greater) after the cartridge showed poor filtration performance due to flow acceleration around the filter edges, which was exacerbated by high filter resistance. All 8 HME-based iterations provided an adequate seal by user seal checks and achieved a pass rate of 87.5% (N = 8) on quantitative testing, with all failures occurring in the first iteration. The overall median fit-factor was 1662 (100 = pass). Estimated unit cost for a production run of 1000 using distributed manufacturing techniques is CAD $15 in materials and 20 minutes of labor. Conclusion Small-scale manufacturing of an effective, reusable N95 respirator during a pandemic is feasible and cost-effective. Required quantities of reusables are more predictable and less vulnerable to supply chain disruption than disposables. With further evaluation, such devices may be an alternative to disposable respirators during public health emergencies. The respirator described above is an investigational device and requires further evaluation and regulatory requirements before clinical deployment. The authors and affiliates do not endorse the use of this device at present.
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Affiliation(s)
- Vahid Anwari
- Joint Department of Medical Imaging, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- The Lynn and Arnold Irwin Advanced Perioperative Imaging Lab, Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - William C. K. Ng
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Anaesthesia and Pain Management, The Hospital for Sick Children, Toronto, Ontario, Canada
- * E-mail:
| | - Arnaud Romeo Mbadjeu Hondjeu
- Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Zixuan Xiao
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Edem Afenu
- School of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Trac
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kate Kazlovich
- The Lynn and Arnold Irwin Advanced Perioperative Imaging Lab, Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Ontario, Canada
| | - Joshua Hiansen
- The Lynn and Arnold Irwin Advanced Perioperative Imaging Lab, Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Azad Mashari
- The Lynn and Arnold Irwin Advanced Perioperative Imaging Lab, Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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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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Greenawald LA, Haas EJ, D’Alessandro MM. Elastomeric Half Mask Respirators: An Alternative to Disposable Respirators and a Solution to Shortages during Public Health Emergencies. JOURNAL OF THE INTERNATIONAL SOCIETY FOR RESPIRATORY PROTECTION 2021; 38:74-91. [PMID: 36789352 PMCID: PMC9924972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
During public health emergencies such as an influenza pandemic, disposable filtering facepiece respirator (FFR) shortages have a significant impact on the national response, affecting many types of workplaces that rely on respiratory protection. During the COVID-19 pandemic, severe FFR shortages led the CDC to publish strategies for optimizing the supply of N95 FFRs. These strategies included the extended use and limited reuse of FFRs, wearing decontaminated FFRs, wearing respirators that meet an international respirator standard, or wearing FFRs that were past their manufacturer-designated shelf life. An additional strategy to mitigate supply shortages that was highlighted during the COVID-19 pandemic was to wear reusable respirators, such as elastomeric half mask respirators (EHMRs), or powered air-purifying respirators, which can be cleaned, disinfected, and reused. A decade of nationwide initiatives to increase the utility of EHMRs in healthcare settings were realized during the COVID-19 pandemic as EHMRs became more well-known and were used in healthcare settings for respiratory protection. This expanded use of EHMRs led to an increase in federal procurement, research, guidance, and private sector research and development of innovative EHMR designs by manufacturers to respond to workers' needs for both respiratory protection and source control. This paper describes the role of reusable EHMRs before and during the COVID-19 pandemic, and reviews past and current research, to inform successful EHMR implementation in healthcare and first responder settings.
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Self-reported impact of respirator use on health care worker ability to perform patient care. Am J Infect Control 2020; 48:1556-1558. [PMID: 32534121 PMCID: PMC7286820 DOI: 10.1016/j.ajic.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/23/2022]
Abstract
In a study of 1,152 health care workers surveyed prior to the COVID-19 pandemic, most disagreed that respiratory protective equipment use interferes with patient care but reported that it would affect respirator use compliance if it did. A patient's fear reaction variably influenced self-reported health care worker compliance with respirator use. Strategies to improve protective equipment design may remove potential barriers to respirator use and allow better health care worker-patient relationships.
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Kirubarajan A, Khan S, Got T, Yau M, Bryan JM, Friedman SM. Mask shortage during epidemics and pandemics: a scoping review of interventions to overcome limited supply. BMJ Open 2020; 10:e040547. [PMID: 33247019 PMCID: PMC7703444 DOI: 10.1136/bmjopen-2020-040547] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To characterise published evidence regarding preclinical and clinical interventions to overcome mask shortages during epidemics and pandemics. DESIGN Systematic scoping review. SETTINGS All healthcare settings relevant to epidemics and pandemics. SEARCH STRATEGY English peer-reviewed studies published from January 1995 to June 2020 were included. Literature was identified using four databases (Medline-OVID, EMBASE, CINAHL, Cochrane Library), forwards-and-backwards searching through Scopus and an extensive grey literature search. Assessment of study eligibility, data extraction and evidence appraisal were performed in duplicate by two independent reviewers. RESULTS Of the 11 220 database citations, a total of 47 articles were included. These studies encompassed six broad categories of conservation strategies: decontamination, reusability of disposable masks and/or extended wear, layering, reusable respirators, non-traditional replacements or modifications and stockpiled masks. Promising strategies for mask conservation in the context of pandemics and epidemics include use of stockpiled masks, extended wear of disposable masks and decontamination. CONCLUSION There are promising strategies for overcoming face mask shortages during epidemics and pandemics. Further research specific to practical considerations is required before implementation during the COVID-19 pandemic.
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Affiliation(s)
- Abirami Kirubarajan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tiffany Got
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Yau
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer M Bryan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
| | - Steven Marc Friedman
- Department of Emergency Medicine, University Health Network, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Regli A, Sommerfield A, von Ungern-Sternberg BS. The role of fit testing N95/FFP2/FFP3 masks: a narrative review. Anaesthesia 2020; 76:91-100. [PMID: 32932556 DOI: 10.1111/anae.15261] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 12/12/2022]
Abstract
For healthcare workers performing aerosol-generating procedures during the COVID-19 pandemic, well fitted filtering facepiece respirators, for example, N95/FFP2 or N99/FFP3 masks, are recommended as part of personal protective equipment. In this review, we evaluate the role of fit checking and fit testing of respirators, in addition to airborne protection provided by respirators. Filtering facepiece respirators are made of material with sufficient high filter capacity to protect against airborne respiratory viruses. Adequate viral protection can only be provided by respirators that properly fit the wearer's facial characteristics. Initial fit pass rates vary between 40% and 90% and are especially low in female and in Asian healthcare workers. Fit testing is recommended to ensure a proper fit of respirators for the individual healthcare worker so that alternative respirators can be selected if required. Although fit testing is required to comply with respirator standards, it is not performed consistently within all healthcare settings. Fit checking (a self-test) is recommended every time a healthcare worker dons a respirator, but is unreliable in detecting proper fit or leak. Additionally, fit testing has a high educational value and as such is best performed as part of a hospital respiratory protection programme. Whether fit checking alone, as opposed to fit tested and fit checked respirators, provides adequate airborne protection against aerosols containing the SARS-CoV-2 virus and other respiratory viruses remains unknown. While fit testing undoubtedly incurs additional costs, it is still recommended, not only to protect healthcare workers but also as it may reduce overall healthcare cost when considering the potential costs of sickness leave and the associated legal costs of compensation.
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Affiliation(s)
- A Regli
- Intensive Care Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Human Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - A Sommerfield
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Western Australia, Australia.,Peri-operative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
| | - B S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Western Australia, Australia.,Division of Emergency Medicine, Anaesthesia and Pain Medicine, University of Western Australia, Perth, Western Australia, Australia.,Peri-operative Medicine Team, Telethon Kids Institute, Perth, Western Australia, Australia
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36
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Petsonk EL, Harber P. Respiratory protection for health care workers: A 2020 COVID-19 perspective. Am J Ind Med 2020; 63:655-658. [PMID: 32496602 PMCID: PMC7300982 DOI: 10.1002/ajim.23144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/31/2022]
Abstract
As the US health care system began to respond to the coronavirus disease‐2019 pandemic, demand for respiratory personal protective equipment (PPE) increased precipitously, as did the number of users. This commentary discusses ensuing deviations from accepted respiratory PPE program practices, which potentially increased risk to health care workers. Such lapses included omitting user training and fit testing, provision of unapproved devices, and application of devices in settings and ways for which they were not intended. The temporary compromise of professionally accepted standards due to exigencies must not become the new normal. Rather, the current attention to PPE should be leveraged to enhance practice, motivate vital research, and strengthen professional, governmental, and institutional capabilities to control health care worker exposures to infectious hazards.
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Affiliation(s)
- Edward L. Petsonk
- Department of MedicineSchool of Medicine, West Virginia University Morgantown West Virginia
| | - Philip Harber
- Community, Environment & Policy DepartmentCollege of Medicine, University of Arizona Tucson Arizona
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37
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Stewart CL, Thornblade LW, Diamond DJ, Fong Y, Melstrom LG. Personal Protective Equipment and COVID-19: A Review for Surgeons. Ann Surg 2020; 272:e132-e138. [PMID: 32675516 PMCID: PMC7268841 DOI: 10.1097/sla.0000000000003991] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
: There is a long history of personal protective equipment (PPE) used by the surgeon to minimize the transmission of various pathogens. In the context of the present coronavirus disease 2019 pandemic there is significant controversy as to what forms of PPE are appropriate or adequate. This review aims to describe the pathogenic mechanism and route of spread of the causative virus, severe acute respiratory syndrome coronavirus, as it pertains to accumulated published data from experienced centers globally. The various forms of PPE that are both available and appropriate are addressed. There are options in the form of eyewear, gloves, masks, respirators, and gowns. The logical and practical utilization of these should be data driven and evolve based on both experience and data. Last, situations specific to surgical populations are addressed. We aim to provide granular collective data that has thus far been published and that can be used as a reference for optimal PPE choices in the perioperative setting for surgical teams.
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Affiliation(s)
- Camille L Stewart
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | | | - Don J Diamond
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, CA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
| | - Laleh G Melstrom
- Department of Surgery, City of Hope National Medical Center, Duarte, CA
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38
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Zhang M, Zheng H, Wang J. Strategy of using personal protective equipment during aerosol generating medical procedures with COVID-19. J Clin Anesth 2020; 66:109911. [PMID: 32473504 PMCID: PMC7247986 DOI: 10.1016/j.jclinane.2020.109911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/04/2020] [Accepted: 05/22/2020] [Indexed: 01/25/2023]
Abstract
Compared the effectiveness and cost-effectiveness between masks and respirators for the COVID-19 transmission Discussed the strategy to avoid severe nosocomial infection through aerosol-generating medical procedures Suggestions for healthcare workers to choose proper personal protective equipment
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Affiliation(s)
- Mingzhu Zhang
- Department of Anesthesia, Cancer Hospital Chinese Academy of Medical Sciences, 17 Panjiayuannanli, Chaoyang District, Beijing 100021, China
| | - Hui Zheng
- Department of Anesthesia, Cancer Hospital Chinese Academy of Medical Sciences, 17 Panjiayuannanli, Chaoyang District, Beijing 100021, China
| | - Jingping Wang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, GRJ 4-420, Boston, MA 02114, United States of America.
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39
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Pompeii LA, Kraft CS, Brownsword EA, Lane MA, Benavides E, Rios J, Radonovich LJ. Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators. JAMA 2020; 323:1849-1852. [PMID: 32211889 PMCID: PMC7097838 DOI: 10.1001/jama.2020.4806] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines the feasibility of rapidly training and fit testing health care workers to use elastomeric half-mask respirators (EHMRs), widely used in construction and manufacturing, as an alternative to N95 respirators during periods of shortage.
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Affiliation(s)
- Lisa A. Pompeii
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Colleen S. Kraft
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | | | - Morgan A. Lane
- Division of Infectious Diseases, Emory University, Atlanta, Georgia
| | - Elisa Benavides
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Janelle Rios
- Department of Epidemiology, Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston
| | - Lewis J. Radonovich
- National Institute for Occupational Safety and Health Centers for Disease Control and Prevention, Pittsburgh, Pennsylvania
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40
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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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