Respiratory protection preparedness in critical care healthcare workers: An observational audit of facial hair at a major tertiary hospital in Australia

Prospective comprehensive evaluation of an elastic-band beard cover for filtering facepiece respirators in healthcare workers

OBJECTIVE

To undertake a healthcare-based multimodal evaluation of the combination of filtering facepiece respirator (FFR) with the elastic-band beard cover technique, including quantitative fit test (QNFT) results, skills assessment, and usability assessment.

DESIGN AND SETTING

We conducted a prospective study through the Respiratory Protection Program at the Royal Melbourne Hospital from May 2022 to January 2023.

PARTICIPANTS

Healthcare workers who required respiratory protection and could not shave for religious, cultural, or medical reasons.

INTERVENTION

Online education and personal face-to-face training on the use of FFR with the elastic-band beard cover technique.

RESULTS

Among 87 participants (median beard length 38 mm; interquartile range [IQR], 20-80), 86 (99%) passed 3 QNFTs consecutively with the elastic-band beard cover under a Trident P2 respirator and 68 (78%) passed 3 QNFTs consecutively with a 3M 1870+ Aura respirator. The first QNFT pass rate and the overall fit factors were significantly higher when using the technique than without the elastic-band beard cover. Most participants displayed a high skill level in their donning, doffing, and user seal-check techniques. Of 87 participants, 83 (95%) completed the usability assessment. The overall ease of use, comfort, and overall assessment were rated highly.

CONCLUSIONS

The elastic-band beard cover technique can provide safe and effective respiratory protection for bearded healthcare workers. The technique was easily taught, comfortable, well tolerated and accepted by healthcare workers, potentially allowing them full participation in the workforce during pandemics with airborne transmission. We recommend further research and evaluation of this technique in a broader health workforce.

Striving to be the fittest: quantitative P2/N95 respirator fit test results among hospital staff during the COVID-19 pandemic

Objective

To provide fit rates for specific P2/N95 respirators and compare these results by age, sex, clean-shaven status, and fit tester experience.

Design

Exploratory audit involving secondary analysis of existing quantitative fit testing data.

Setting

In response to the COVID-19 pandemic, healthcare services across Australia implemented respiratory protection protocols. This study details healthcare workers' (HCWs) fit testing results from a large Victorian public health service.

Participants

Fit-tested employees of a large tertiary public health network.

Methods

Fit rates for ten individual P2/N95 respirators were calculated, and the effect of age, sex, clean-shaven status, and fit tester experience was examined via logistic regression.

Results

4593 employees were included, with 97.98% successfully fitting at least one respirator. Males were found to have significantly increased odds of achieving fit success compared to females (OR 11.61 95%CI 1.60-84.10). Fit rates dropped by 4% with each 1-year age increase (OR 0.96 95%CI 0.94-0.98). Clean-shaven individuals were also more likely to achieve a fit compared to non-clean-shaved individuals (OR 79.23 95%CI 10.21-614.62). More experienced fit testers also yielded significantly higher fit rates (OR 3.95, 95%CI 2.34-6.67).

Conclusions

98% of staff achieved a successful fitting of at least one respirator, with three-panel flat fold models (Industree Trident, 3M Aura 9320A+, and 3M Aura 1870+) performing the most consistently. An individual's ability to achieve a successful fit was associated with; male sex, younger age, clean-shaven status, and fit tester experience.

Protocol of a prospective comprehensive evaluation of an elastic band beard cover for filtering facepiece respirators in healthcare

Individuals who are unable to be clean shaven for religious, medical or cultural reasons are unable to wear a filtering facepiece respirator (FFR), as the respirator cannot provide adequate protection against aerosol-transmissible diseases. There is currently a paucity of validated techniques to ensure the safe inclusion of bearded healthcare workers in the pandemic workforce. We propose to undertake a healthcare-based multi-modal evaluation study on the elastic band beard cover for FFR technique, examining the quantitative fit test (QNFT) results, usability and skill level of participants with repeated assessments over time. This is a prospective study conducted through the Respiratory Protection Program at the Royal Melbourne Hospital. Healthcare workers are invited to participate if they require respiratory protection and cannot shave for religious, cultural or medical reasons. An online education package on the use of respiratory protective equipment and the elastic band beard cover for FFR technique is provided. This is followed by a face-to-face session, where the participant will receive: one-on-one training; undergo a skill assessment on their donning, doffing and user seal check techniques; complete QNFTs and a usability survey. Participants will be invited to repeat the assessment within 3 months of the first session and at 12 months. This study involves multimodal and repeated assessments of an elastic band beard cover for FFRs. The findings of this study will provide information on: whether this simple technique can provide safe, consistent and effective respiratory protection; whether it will interfere with occupational activities; and whether it is comfortable and tolerable for the duration of wear. This is of significant importance to the health workforce around the world, who cannot shave but require access to respiratory protective equipment during the COVID-19 pandemic.