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 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.

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.

Rituximab in Previously Treated Primary Immune Thrombocytopenia Patients: Evaluation of Short- and Long-Term Efficacy and Safety

2013 ◽  
Vol 132 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Cristina Santoro ◽  
Francesca Biondo ◽  
Erminia Baldacci ◽  
Maria Stefania De Propris ◽  
Anna Guarini ◽  
...  
Keyword(s):  
Immune Thrombocytopenia ◽  
Efficacy And Safety ◽  
Term Efficacy ◽  
Primary Immune Thrombocytopenia ◽  
Previously Treated ◽  
Short And Long Term

scholarly journals Corticosteroid injection for coccydynia

2020 ◽  
Vol 1 (11) ◽  
pp. 709-714
Author(s):  
Vilhjalmur Finsen ◽  
Ante M. Kalstad ◽  
Rainer G. Knobloch
Keyword(s):  
Logistic Regression ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Corticosteroid Injection ◽  
Term Efficacy ◽  
Early Success ◽  
Cortisone Injection ◽  
Short And Long Term ◽  
Regression Tests

Aims We aimed to establish the short- and long-term efficacy of corticosteroid injection for coccydynia, and to determine if betamethasone or triamcinolone has the best effect. Methods During 2009 to 2016, we treated 277 patients with chronic coccydynia with either one 6 mg betamethasone or one 20 mg triamcinolone cortisone injection. A susequent injection was given to 62 (26%) of the patients. All were reviewed three to four months after injection, and 241 replied to a questionnaire a mean of 36 months (12 to 88) after the last injection. No pain at the early review was considered early success. When the patient had not been subsequently operated on, and indicated on the questionnaire that they were either well or much better, it was considered a long-term success. Results At the three- to four-month review, 22 (9%) reported that they had no pain. The long-term success of one injection was 15% and rose to 29% after a second injection. Logistic regression tests showed that both early success (odds ratio (OR) 5.5, 95% confidence interval (CI) 2.1 to 14.4; p = 0.001) and late success (OR 3.7, 95% CI 1.7 to 8.3; p = 0.001) was greater with triamcinolone than with betamethasone. Late success was greater for patients with symptoms for less than 12 months (OR 3.0, 95% CI 1.4 to 6.7; p = 0.006). We saw no complications of the injections. Conclusion We conclude that the effect of corticosteroid injection for coccygodynia is moderate, possibly because we used modest doses of the drugs. Even so, they seem worthwhile as they are easily and quickly performed, and complications are rare. If the choice is between injections of betamethasone or triamcinolone, the latter should be selected. Cite this article: Bone Joint Open 2020;1-11:709–714.

scholarly journals Fissurectomy combined with botulinum toxin A: a review of short- and long-term efficacy of this treatment strategy for chronic anal fissure; a consecutive proposal of a treatment algorithm for chronic anal fissure

2020 ◽  
Vol 42 (5) ◽  
pp. 400-408
Author(s):  
M. Trzpis ◽  
J. M. Klaase ◽  
R. H. Koop ◽  
P. M. A. Broens
Keyword(s):  
Botulinum Toxin ◽  
Anal Fissure ◽  
Recurrence Rate ◽  
Treatment Strategy ◽  
Chronic Anal Fissure ◽  
Botulinum Toxin A ◽  
Toxin A ◽  
Term Efficacy ◽  
Short And Long Term

Abstract Background Several studies have investigated the short- and long-term efficacy of fissurectomy combined with botulinum toxin A injection for patients with chronic anal fissure. Objective To evaluate the short- and long-term efficacy of the combined treatment strategy of fissurectomy with botulinum toxin A for chronic anal fissure and to discuss recurrence rates in the light of current theory on the aetiology of anal fissure. Materials and methods This is a narrative review. We conducted an article search using PubMed and calculated the means of the reported efficacy ranges. Results Fissurectomy combined with botulinum toxin A injections freed at least 78% of the patients from symptoms and yielded a fissure healing rate of up to 86%. Within 12 months after treatment a 3% recurrence rate was reported. On average, the long-term recurrence rate was 22%. One study reported a 50% recurrence rate 22 months after treatment. Conclusion The efficacy of fissurectomy combined with botulinum toxin A injection for chronic anal fissure is high. The short-term recurrence rate is low, while long-term recurrence is relatively high. Extended follow-up indicates that recurrence of chronic anal fissure is possibly caused by anal basal pressure building up steadily once again. If so, the cause of renewed increase of pressure should be addressed. Based on the literature and on our clinical experience, we assume that the underlying cause of increasing anal basal pressure is that patients use their pelvic floor muscles inadequately and this in turn leads to chronic anal fissure.

scholarly journals Short- and long-term efficacy of aspirin and clopidogrel for thromboprophylaxis for mechanical heart valves: An in vivo study in swine

2008 ◽  
Vol 136 (4) ◽  
pp. 908-914 ◽  
Author(s):  
Stephen H. McKellar ◽  
Jess L. Thompson ◽  
Raul F. Garcia-Rinaldi ◽  
Ryan J. MacDonald ◽  
Thoralf M. Sundt ◽  
...  
Keyword(s):  
Heart Valves ◽  
Mechanical Heart Valves ◽  
In Vivo Study ◽  
Term Efficacy ◽  
Short And Long Term
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