scholarly journals Impact on quantitative fit test results after application of prophylactic hydrocolloid dressing under N95 respirators

2021 ◽  
pp. 1-16
Author(s):  
Irene Ng ◽  
Benjamin Kave ◽  
Fiona Begg ◽  
Sarah Sage ◽  
Reny Segal ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Respiratory Protection ◽  
Test Results ◽  
Pass Rates ◽  
Hydrocolloid Dressing ◽  
Fit Testing ◽  
Pressure Injury ◽  
N95 Respirators ◽  
The Impact

Abstract Objective Discomfort and device-related pressure injury (DRPI) caused by N95 filtering facepiece respirators (FFRs) are common. The use of prophylactic hydrocolloid dressings is one of the strategies that may improve comfort and reduce DRPI. In this study, we investigated the impact of these dressings on N95 respirator fit. Methods We performed a repeat quantitative fit testing through the Respiratory Protection Program on 134 healthcare workers (HCWs), who applied hydrocolloid dressings on the bridge of their nose under the N95 FFRs that they passed the initial fit test but reported discomfort with. Results We found that the fit test pass rates, with the hydrocolloid dressings in place, for the semi-rigid cup style (3MTM 1860), the vertical flat-fold style (BYD), the duckbill style (BSN medical ProShield® and Halyard Fluidshield*), and the three-panel flat-fold style (3MTM Aura) N95 FFRs were 94% (108/115), 85% (44/52), 81% (87/108) and 100% (3/3) respectively. There was a statistically significant reduction in the overall fit factors for both the vertical flat-fold and duckbill type N95 respirators, after the application of hydrocolloid dressings. Conclusions Hydrocolloid dressings are likely to disturb the mask seal for non-rigid style N95 FFRs, in particular, the vertical flat-fold style and the duckbill style N95 FFRs. Given the risk of mask seal disturbance of N95 respirators as shown in this study, we advocate that any HCW requiring the use of prophylactic dressings should undergo repeat quantitative fit testing with the dressing in place prior to using the dressing and mask in combination.

Respirator-Fit Testing: Does It Ensure the Protection of Healthcare Workers Against Respirable Particles Carrying Pathogens?

2008 ◽  
Vol 29 (12) ◽  
pp. 1149-1156 ◽  
Author(s):  
M. C. Lee ◽  
S. Takaya ◽  
R. Long ◽  
A. M. Joffe
Keyword(s):  
Healthcare Workers ◽  
Respiratory Protection ◽  
Pass Rates ◽  
Test Protocol ◽  
Term Efficacy ◽  
Fit Testing ◽  
Observational Cohort ◽  
Short And Long Term ◽  
N95 Respirators

Objective.Respiratory protection programs, including fit testing of respirators, have been inconsistently implemented; evidence of their long-term efficacy is lacking. We undertook a study to determine the short- and long-term efficacy of training for fit testing of N95 respirators in both untrained and trained healthcare workers (HCWs).Design.Prospective observational cohort study.Methods.A group of at-risk, consenting HCWs not previously fit-tested for a respirator were provided with a standard fit-test protocol. Participants were evaluated after each of 3 phases, and 3 and 14 months afterward. A second group of previously fit-tested nurses was studied to assess the impact of regular respirator use on performance.Results.Of 43 untrained fit-tested HCWs followed for 14 months, 19 (44.2%) passed the initial fit test without having any specific instruction on respirator donning technique. After the initial test, subsequent instruction led to a pass for another 13 (30.2%) of the 43 HCWs, using their original respirators. The remainder required trying other types of respirators to acheive a proper fit. At 3 and 14 months' follow-up, failure rates of 53.5% (23 of 43 HCWs) and 34.9% (15 of 43 HCWs), respectively, were observed. Pass rates of 87.5%-100.0% were observed among regular users.Conclusions.Without any instruction, nearly 50% of the HCWs achieved an adequate facial seal with the most commonly used N95 respirator. Formal fit testing does not predict future adequacy of fit, unless frequent, routine use is made of the respirator. The utility of fit testing among infrequent users of N95 respirators is questionable.

scholarly journals Fit Testing Disposable P2/N95 Respirators during COVID-19 in Victoria, Australia: Fit Check Evaluation, Failure Rates, and a Survey of Healthcare Workers

COVID ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 83-96
Author(s):  
Jun Keat Chan ◽  
Kah Hong Yep ◽  
Sarah Magarey ◽  
Zoe Keon-Cohen ◽  
Matt Acheson
Keyword(s):  
Healthcare Workers ◽  
Primary Outcome ◽  
Respiratory Protection ◽  
Pass Rates ◽  
Tertiary Referral Centre ◽  
Department Of Health ◽  
Fit Testing ◽  
N95 Respirators ◽  
And Training ◽  
Relevant Finding

Quantitative fit testing was utilised to evaluate the Department of Health and Human Services in Victoria (DHHS) recommended fit check and determine pass/fail rates for self-selected P2/N95 respirators. Survey experience and training related to P2/N95 respirators were also obtained. This was an observational study at a specialist tertiary referral centre, Melbourne, Australia, between 29 May 2020 and 5 June 2020. The primary outcome was quantitative fit test pass/fail results, with fit check reported against fit test as a 2 × 2 contingency table. The secondary outcomes were the number of adjustments needed to pass, as well as the pass rates for available sizes and types of self-selected respirators, survey data for attitudes, experience and training for P2/N95 respirators. The fit check predicts respirator seal poorly (PPV 34.1%, 95% CI 25.0–40.5). In total, 69% (40/58) of respirators failed quantitative fit testing after initial respirator application and is a clinically relevant finding (first-up failure rate for P2/N95 respirators). Only one person failed the fit test for all three respirator fit tests. There was significant variability between each of the seven types of self-selected P2/N95 respirators, although sample sizes were small. Few participants were trained in the use of P2/N95 respirators or the fit check prior to COVID-19, with a high number of participants confident in achieving a P2/95 respirator seal following a fit test. The fit check alone was not a validated method in confirming an adequate seal for P2/N95 respirators. Quantitative fit testing can facilitate education, improve the seal of P2/N95 respirators, and needs to be integrated into a comprehensive Respiratory Protection Program (RPP).

scholarly journals More than half of front-line healthcare workers unknowingly used an N95/P2 mask without adequate airborne protection: An audit in a tertiary institution

2021 ◽  
pp. 0310057X2110078
Author(s):  
Adrian Regli ◽  
Priya Thalayasingam ◽  
Emily Bell ◽  
Aine Sommerfield ◽  
Britta S von Ungern-Sternberg
Keyword(s):  
Healthcare Workers ◽  
Pass Rate ◽  
Respiratory Protection ◽  
Pass Rates ◽  
Front Line ◽  
Tertiary Institution ◽  
Convenience Sample ◽  
Sense Of Security ◽  
False Sense ◽  
Fit Testing

Front-line staff routinely exposed to aerosol-generating procedures are at a particularly high risk of transmission of severe acute respiratory syndrome coronavirus 2. We aimed to assess the adequacy of respiratory protection provided by available N95/P2 masks to staff routinely exposed to aerosol-generating procedures. We performed a prospective audit of fit-testing results. A convenience sample of staff from the Department of Anaesthesia and Pain Medicine, who opted to undergo qualitative and/or quantitative fit-testing of N95/P2 masks was included. Fit-testing was performed following standard guidelines including a fit-check. We recorded the type and size of mask, pass or failure and duration of fit-testing. Staff completed a short questionnaire on previous N95/P2 mask training regarding confidence and knowledge gained through fit-testing. The first fit-pass rate using routinely available N95/P2 masks at this institution was only 47%. Fit-pass rates increased by testing different types and sizes of masks. Confidence ‘that the available mask will provide adequate fit’ was higher after fit-testing compared with before fit-testing; (median, interquartile range) five-point Likert-scale (4.0 (4.0–5.0) versus 3.0 (2.0–4.0); P<0.001). This audit highlights that without fit-testing over 50% of healthcare workers were using an N95/P2 mask that provided insufficient airborne protection. This high unnoticed prevalence of unfit masks among healthcare workers can create a potentially hazardous false sense of security. However, fit-testing of different masks not only improved airborne protection provided to healthcare workers but also increased their confidence around mask protection.

scholarly journals Fit Testing Retrofitted Full-Face Snorkel Masks as a Form of Novel Personal Protective Equipment During the COVID-19 Pandemic

2021 ◽  
pp. 1-16
Author(s):  
Stephanie Toigo ◽  
Michel Jacques ◽  
Tarek Razek ◽  
Ewa Rajda ◽  
Sidney Omelon ◽  
...  
Keyword(s):  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Health Centre ◽  
Disease Outbreaks ◽  
Protective Equipment ◽  
Test Results ◽  
Passing Rate ◽  
Fit Testing ◽  
Full Face ◽  
Medical Grade

ABSTRACT Objective: Bottlenecks in the personal protective equipment (PPE) supply chain have contributed to shortages of PPE during the COVID-19 pandemic, resulting in fractures in the functionality of healthcare systems. This study was conducted with the aim of determining the effectiveness of retrofitted commercial snorkel masks as an alternative respirator for healthcare workers during infectious disease outbreaks. Methods: A retrospective analysis was performed, analyzing qualitative and quantitative fit test results of the retrofitted Aria Ocean Reef® full-face snorkeling mask on healthcare workers at the McGill University Health Centre between April-June 2020. Historical fit test results, using medical-grade respirators, for healthcare workers were also analyzed. Results: During the study period, 71 participants volunteered for fit testing, 60.6% of which were nurses. The overall fit test passing rate using the snorkel mask was 83.1%. Of the participants who did not previously pass fit testing with medical-grade respirators, 80% achieved a passing fit test with the snorkel respirator. Conclusions: The results suggest that this novel respirator may be an effective and feasible alternative solution to address PPE shortages, while still providing healthcare workers with ample protection. Additional robust testing will be required to ensure that respirator fit is maintained, after numerous rounds of disinfection.

Respiratory Protection by Respirators: The Predictive Value of User Seal Check for the Fit Determination in Healthcare Settings

2011 ◽  
Vol 32 (4) ◽  
pp. 402-403 ◽  
Author(s):  
Simon Ching Lam ◽  
Joseph Kok Long Lee ◽  
Linda Yin King Lee ◽  
Ka Fai Wong ◽  
Cathy Nga Yan Lee
Keyword(s):  
Electronic Device ◽  
World Health ◽  
Respiratory Pathogens ◽  
Respiratory Protection ◽  
Healthcare Settings ◽  
The World ◽  
Fit Testing ◽  
Control And Prevention ◽  
Health Organization ◽  
N95 Respirators

The N95 respirator is one type that is recommended by the World Health Organization and the Centers for Disease Control and Prevention (CDC) to prevent inhalation of droplets that may act to transmit respiratory pathogens. However, the reliability of this respirator to prevent transmission is dependent on how well it is fitted to the wearer. For ill-fitting respirators, the average penetration by ambient aerosol was found to be 33%, compared with 4% for well-fitting respirators. Such penetration or leakage may be caused by the gap between the respirator and the wearer's face. Therefore, formal fit testing should be carried out prior to the use of N95 respirators. Quantitative fit testing measures “the adequacy of respirator fit by numerically measuring the amount of leakage into the respirator” using an electronic device.

scholarly journals Comparing the fit of N95, KN95, surgical, and cloth face masks and assessing the accuracy of fit checking

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245688
Author(s):  
Eugenia O’Kelly ◽  
Anmol Arora ◽  
Sophia Pirog ◽  
James Ward ◽  
P. John Clarkson
Keyword(s):  
Poor Correlation ◽  
Protective Equipment ◽  
Respiratory Protection ◽  
Factor Scores ◽  
Self Assessment ◽  
Fit Testing ◽  
Assessment Guidelines ◽  
Facial Differences ◽  
N95 Respirators

Introduction The COVID-19 pandemic has made well-fitting face masks a critical piece of protective equipment for healthcare workers and civilians. While the importance of wearing face masks has been acknowledged, there remains a lack of understanding about the role of good fit in rendering protective equipment useful. In addition, supply chain constraints have caused some organizations to abandon traditional quantitative or/and qualitative fit testing, and instead, have implemented subjective fit checking. Our study seeks to quantitatively evaluate the level of fit offered by various types of masks, and most importantly, assess the accuracy of implementing fit checks by comparing fit check results to quantitative fit testing results. Methods Seven participants first evaluated N95 and KN95 respirators by performing a fit check. Participants then underwent quantitative fit testing wearing five N95 respirators, a KN95 respirator, a surgical mask, and fabric masks. Results N95 respirators offered higher degrees of protection than the other categories of masks tested; however, it should be noted that most N95 respirators failed to fit the participants adequately. Fit check responses had poor correlation with quantitative fit factor scores. KN95, surgical, and fabric masks achieved low fit factor scores, with little protective difference recorded between respiratory protection options. In addition, small facial differences were observed to have a significant impact on quantitative fit. Conclusion Fit is critical to the level of protection offered by respirators. For an N95 respirator to provide the promised protection, it must fit the participant. Performing a fit check via NHS self-assessment guidelines was an unreliable way of determining fit.

scholarly journals The "Double Eights Mask Brace" Improves the Fit and Protection and Protection of a Basic Surgical Mask Amidst Covid-19 Pandemic

2020 ◽  
Author(s):  
Daniel P Runde ◽  
Karisa Harland ◽  
Paul Van Heukelom ◽  
Brett Faine ◽  
Patrick OShaughnessy ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Rubber Band ◽  
Primary Outcome Measure ◽  
Study Objective ◽  
Fit Testing ◽  
Margin Of Safety ◽  
The Subject ◽  
N95 Respirators ◽  
The Impact ◽  
Median Height

Study Objective: The COVID-19 pandemic has resulted in widespread shortages in personal protective equipment, including N95 respirators. While basic surgical facemasks are more commonly available, their efficacy is limited due primarily to their poor face seal. This pilot study examined the impact of a rubber band mask brace on a basic surgical mask, as determined by quantitative fit testing. Methods: Subjects wearing a basic surgical facemask and the rubber band mask brace underwent quantitative fit testing using machinery designed to certify N95 mask fit. Subjects were tested with the brace anchored behind their eyes, with a paperclip behind the head, and on the side knobs of their face shields. The primary outcome measure was whether the subject passed the quantitative fit test at or above the OSHA verified standard for N95 masks. Results: Subjects (n=11) were 54.5% female, with a median height of 70 inches (IQR 68-74), weight of 170 lbs (IQR 145-215) and BMI of 24.6 (IQR 22.2-27.2), and encompassing 5 distinct N95 mask fit types. We found that 45%, 100% and 100% of subjects passed the quantitative fit test when the brace was anchored behind the ears, with a paperclip and on a face shield respectively. Conclusion: Of the 11 subjects included in the analysis, across a range of body habitus and N95 mask fit types, all passed the quantitative fit test when the mask brace was anchored on either face shield or with a paperclip. This data suggests the brace would offer an improved margin of safety when worn with a basic surgical mask.

scholarly journals The prevalence of asymptomatic carriers of COVID-19 as determined by routine preoperative testing

2020 ◽  
pp. 175717742096709
Author(s):  
Joshua A Bloom ◽  
Zachary Erlichman ◽  
Tina Tian ◽  
Shira Doron ◽  
Lilian Chen ◽  
...  
Keyword(s):  
Surgical Patients ◽  
Test Results ◽  
Preoperative Testing ◽  
Academic Medical Centre ◽  
Asymptomatic Carriers ◽  
Asymptomatic Patients ◽  
Time Period ◽  
Academic Medical ◽  
N95 Respirators ◽  
The Impact

Background: The coronavirus disease SARS-CoV-2 (COVID-19) has swiftly spread throughout the globe, greatly influencing all aspects of life. As in previous pandemics, concerns for limited resources and a sustainable medical workforce have been on the forefront of infrastructure modifications. Consequently, surgical specialties have needed to consider each surgical case for necessity and safety during the COVID-19 outbreak. At our institution, availability of SARS-CoV-2 assay has allowed preoperative testing of asymptomatic surgical patients. Aim/Objective: To better define the prevalence of asymptomatic carriers in a surgical population and to better understand the impact of testing on our personal protective equipment (PPE) supply. Methods: We began routine, preoperative testing for all asymptomatic patients coming to our academic medical centre on 30 March 2020. Scheduled surgeries were deemed urgent by the surgeon with a review for appropriateness by a novel surgical committee. A retrospective patient chart review was performed. Emergency surgeries were excluded. Asymptomatic patients with positive test results had their surgeries rescheduled at the discretion of the surgeon and patient. Patients who tested negative underwent surgery with staff using standard PPE. Results: Eighty-four asymptomatic surgical patients were tested preoperatively with three (3.6%) testing positive for SARS-CoV-2. Preoperative testing saved 498 N95 respirators over this time period. Discussion: This is the first report of routine COVID-19 preoperative testing in an asymptomatic surgical population. Within this population, there is a 3.6% rate of asymptomatic SARS-CoV-2 carriers. Through this practice, personnel exposure can be minimised and access to PPE can be preserved.

scholarly journals Assessment of N95 respirator decontamination and re-use for SARS-CoV-2

2020 ◽  
Author(s):  
Robert J. Fischer ◽  
Dylan H. Morris ◽  
Neeltje van Doremalen ◽  
Shanda Sarchette ◽  
M. Jeremiah Matson ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Nosocomial Transmission ◽  
Protective Equipment ◽  
Respiratory Protection ◽  
Single Use ◽  
N95 Respirators

The unprecedented pandemic of SARS-CoV-2 has created worldwide shortages of personal protective equipment, in particular respiratory protection such as N95 respirators. SARS-CoV-2 transmission is frequently occurring in hospital settings, with numerous reported cases of nosocomial transmission highlighting the vulnerability of healthcare workers. In general, N95 respirators are designed for single use prior to disposal. Here, we have analyzed four readily available and often used decontamination methods: UV, 70% ethanol, 70C heat and vaporized hydrogen peroxide for inactivation of SARS-CoV-2 on N95 respirators. Equally important we assessed the function of the N95 respirators after multiple wear and decontamination sessions.

scholarly journals eHBB: a randomised controlled trial of virtual reality or video for neonatal resuscitation refresher training in healthcare workers in resource-scarce settings

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e048506
Author(s):  
Rachel Umoren ◽  
Sherri Bucher ◽  
Daniel S Hippe ◽  
Beatrice Nkolika Ezenwa ◽  
Iretiola Bamikeolu Fajolu ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Randomised Controlled Trial ◽  
Healthcare Workers ◽  
Controlled Trial ◽  
Neonatal Resuscitation ◽  
Pass Rates ◽  
Healthcare Facilities ◽  
Randomised Controlled ◽  
The Impact

ObjectiveTo assess the impact of mobile virtual reality (VR) simulations using electronic Helping Babies Breathe (eHBB) or video for the maintenance of neonatal resuscitation skills in healthcare workers in resource-scarce settings.DesignRandomised controlled trial with 6-month follow-up (2018–2020).SettingSecondary and tertiary healthcare facilities.Participants274 nurses and midwives assigned to labour and delivery, operating room and newborn care units were recruited from 20 healthcare facilities in Nigeria and Kenya and randomised to one of three groups: VR (eHBB+digital guide), video (video+digital guide) or control (digital guide only) groups before an in-person HBB course.Intervention(s)eHBB VR simulation or neonatal resuscitation video.Main outcome(s)Healthcare worker neonatal resuscitation skills using standardised checklists in a simulated setting at 1 month, 3 months and 6 months.ResultsNeonatal resuscitation skills pass rates were similar among the groups at 6-month follow-up for bag-and-mask ventilation (BMV) skills check (VR 28%, video 25%, control 22%, p=0.71), objective structured clinical examination (OSCE) A (VR 76%, video 76%, control 72%, p=0.78) and OSCE B (VR 62%, video 60%, control 49%, p=0.18). Relative to the immediate postcourse assessments, there was greater retention of BMV skills at 6 months in the VR group (−15% VR, p=0.10; −21% video, p<0.01, –27% control, p=0.001). OSCE B pass rates in the VR group were numerically higher at 3 months (+4%, p=0.64) and 6 months (+3%, p=0.74) and lower in the video (−21% at 3 months, p<0.001; −14% at 6 months, p=0.066) and control groups (−7% at 3 months, p=0.43; −14% at 6 months, p=0.10). On follow-up survey, 95% (n=65) of respondents in the VR group and 98% (n=82) in the video group would use their assigned intervention again.ConclusioneHBB VR training was highly acceptable to healthcare workers in low-income to middle-income countries and may provide additional support for neonatal resuscitation skills retention compared with other digital interventions.

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