Respirator Selection Factors and User Acceptance in Healthcare Workers; What Elastomeric Users Are Saying

Details

• Personal Author:
  Frisch M ; Gucer P ; Hines SE ; Hogan R ; McDiarmid, Melissa A. ; Oliver M ; Roth T
• Description:
  Background: Prior pandemic emergencies have repeatedly led to shortages of N95-filtering facepiece respirators (N95-FFRs), the most conventional respirator used in healthcare. One solution to providing respirators for healthcare workers (HCWs) during N95-FFR shortages may be to utilize reusable elastomeric respirators (ERs) instead. Many hypothetical barriers to implementation exist, calling into question whether this approach is feasible and acceptable to respirator users. We drew on real-life experience of a medical center that has continuously used ERs since 2009 to determine whether ERs represent a feasible and desirable practical solution to address N95-FFR shortages in healthcare. Methods: To assess feasibility of ER use as an alternative to N95-FFR use in healthcare we performed key informant interviews of respiratory protection program (RPP) "decision makers" (DMs) to inform questionnaire content, and then administered online questionnaires to a larger body of RPP DMs at five participating institutions within a medical system. To determine user acceptance, we interviewed HCWs who participated in a focus group interview to design an online questionnaire, which was deployed to over 9000 HCWs at five institutions. Results: We learned from DM responses that ERs were first incorporated into one medical center's RPP due to two key factors: a) N95-FFR shortages during 2009's H1N1 pandemic, and b) safety leadership's familiarity with ERs from previous employment in industry. Ongoing ER use has faced scrutiny regarding adequate cleaning, storage, and consistency of use. From the survey of 1152 HCWs, we learned that approximately 40% of ER users do not store their respirators in a conveniently accessible location or in a correct manner. Up to 30% of users did not report regularly disinfecting their masks, and very few ever washed their masks with soap and water, the expected practice. These findings suggest that cleaning and decontamination is not assured and is a potential barrier to implementation. Although comfort and communication were consistently rated lower by ER users, comfort and interference with care duties were not rated as being of highest importance when asked to rate factors that could affect compliance with respirator use. In our survey, even when given an alternative choice to use an N95-FFR, most usual ER users chose to use an elastomeric mask, whether the hypothetical need was driven by care of a patient with suspected Tuberculosis, pandemic H1N1 or Ebola. Fear of exposure to illness was rated as the most important factor driving compliance with RPP practices. While both ER and N95-FFR users expressed confidence that their respirators would protect them, ER users believed that ERs can provide better protection than N95-FFRs. Conclusions: Our data provide the evidence base documenting that ERs can serve as a feasible and for some users, a desirable alternative to N95-FFRs in the healthcare environment during both routine care of patients on airborne precautions and during public health emergencies. Barriers to user acceptance such as comfort and communication are not newly raised here, and do not outweigh the greater sense of protection perceived among HCWs experienced with use of this form of respiratory protection. [Description provided by NIOSH]
• Subjects:
  Air Pollutants, Occupational Communicable Diseases Disaster Planning Emergencies Health Personnel Occupational Health Personal Protective Equipment Respiratory Protective Devices Safety
• Keywords:
  Airborne Particles Emergency Preparedness Equipment Reliability Health Care Workers Infection Prevention Infectious Diseases Personal Protective Equipment PPE Respirator Testing
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  Maryland ; OSHA Region 3
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-55
• NIOSHTIC Number:
  nn:20052292
• NTIS Accession Number:
  PB2018-101419
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, R21-OH-010868, 2018 Jan; :1-55
• Contact Point Address:
  Stella E. Hines, MD, MSPH; Assistant Professor, The University of Maryland-Baltimore School of Medicine, Division of Occupational and Environmental Medicine, 11 South Paca Street, Suite 200, Baltimore, MD 21201
• Email:
  shines@som.umaryland.edu
• Federal Fiscal Year:
  2018
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  University of Maryland, Baltimore
• Peer Reviewed:
  False
• Start Date:
  20140901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20170930
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:9fd40f955eb5f2a3e3fb116735ed4e50eba22d3a6411a1e67bd830c905e55bbeaab1b66e7b825cea1f34a9b29f3960777bdc8d6323aaccb69e351a30804ab6f8
• Download URL:
  https://stacks.cdc.gov/view/cdc/218696/cdc_218696_DS1.pdf
• File Type:
  [PDF - 556.18 KB ]