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.

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 918 COVID-19: A Detailed Analysis on Fit-Testing for Respiratory Protective Equipment in the UK

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Gani ◽  
S Green ◽  
M Bailey ◽  
O Brown ◽  
C Hing
Keyword(s):  
Healthcare Workers ◽  
Pass Rate ◽  
Freedom Of Information ◽  
Pass Rates ◽  
Limited Data ◽  
Staff Members ◽  
Pertinent Data ◽  
Fit Testing ◽  
The Uk ◽  
Gender Specific

Abstract Introduction There is limited data in the literature regarding the adequacy of generic FFP3 masks and their facial fit to ensure adequate protection. Mask fit-testing is therefore essential to protect healthcare workers. Method Using the Freedom of Information Act, 137 acute NHS trusts in the UK were approached on the 26/3/2020 by an independent researcher to provide data on the outcome of fit testing at each site. Results 85 Trusts responded to the FOI with 51 trusts providing pertinent data relevant to the FOI request. There was a total of 72 mask types used across 51 trusts. The commonest of which was the FFP3M1863 (used by 47/51 trusts, 92.16%). A positive correlation was found between staff members and number of mask types used (r = 0.75, P = &lt;0.05). Overall fit-testing pass rates were provided by 32 trusts. The mean percentage pass rate was 80.74%. Gender specific failure rates were provided by seven trusts. 4386 males underwent fit-testing in comparison to 16305 females. Across all seven trusts 20.08% of men tested failed the fit-test while only 19.89% of women failed the fit-test. Conclusions Our results may be utilised in choosing respirators for fit testing programme in healthcare-workers during the COVID-19 pandemic.

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 Protecting the front line: a cross-sectional survey analysis of the occupational factors contributing to healthcare workers’ infection and psychological distress during the COVID-19 pandemic in the USA

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e042752 ◽  
Author(s):  
Tsion Firew ◽  
Ellen D Sano ◽  
Jonathan W Lee ◽  
Stefan Flores ◽  
Kendrick Lang ◽  
...  
Keyword(s):  
Mental Health ◽  
Psychological Distress ◽  
Healthcare Workers ◽  
Anxiety Symptoms ◽  
Front Line ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Burn Out ◽  
The Usa

ObjectiveThe COVID-19 pandemic has been associated with significant occupational stressors and challenges for front-line healthcare workers (HCWs), including COVID-19 exposure risk. Our study sought to assess factors contributing to HCW infection and psychological distress during the COVID-19 pandemic in the USA.DesignWe conducted a cross sectional survey of HCWs (physicians, nurses, emergency medical technicians (EMTs), non-clinical staff) during May 2020. Participants completed a 42-item survey assessing disease transmission risk (clinical role, work environment, availability of personal protective equipment) and mental health (anxiety, depression and burn-out).SettingThe questionnaire was disseminated over various social media platforms. 3083 respondents from 48 states, the District of Columbia and US territories accessed the survey.ParticipantsUsing a convenience sample of HCWs who worked during the pandemic, 3083 respondents accessed the survey and 2040 participants completed at least 80% of the survey.Primary outcomePrevalence of self-reported COVID-19 infection, in addition to burn-out, depression and anxiety symptoms.ResultsParticipants were largely from the Northeast and Southern USA, with attending physicians (31.12%), nurses (26.80%), EMTs (13.04%) with emergency medicine department (38.30%) being the most common department and specialty represented. Twenty-nine per cent of respondents met the criteria for being a probable case due to reported COVID-19 symptoms or a positive test. HCWs in the emergency department (31.64%) were more likely to contract COVID-19 compared with HCWs in the ICU (23.17%) and inpatient settings (25.53%). HCWs that contracted COVID-19 also reported higher levels of depressive symptoms (mean diff.=0.31; 95% CI 0.16 to 0.47), anxiety symptoms (mean diff.=0.34; 95% CI 0.17 to 0.52) and burn-out (mean diff.=0.54; 95% CI 0.36 to 0.71).ConclusionHCWs have experienced significant physical and psychological risk while working during the COVID-19 pandemic. These findings highlight the urgent need for increased support for provider physical and mental health well-being.

Evaluation of a Large-Scale Quantitative Respirator-Fit Testing Program for Healthcare Workers: Survey Results

2010 ◽  
Vol 31 (9) ◽  
pp. 918-925 ◽  
Author(s):  
Irene J. Wilkinson ◽  
Dino Pisaniello ◽  
Junaid Ahmad ◽  
Suzanne Edwards
Keyword(s):  
Failure Rate ◽  
Healthcare Workers ◽  
Large Scale ◽  
Smoking Status ◽  
Care Home ◽  
South Australia ◽  
Visual Assessment ◽  
Pass Rate ◽  
Testing Program ◽  
Fit Testing

Objective.To present the evaluation of a large-scale quantitative respirator-fit testing program.Design.Concurrent questionnaire survey of fit testers and test subjects.Setting.Ambulatory care, home nursing care, and acute care hospitals across South Australia.Methods.Quantitative facial-fit testing was performed with TSI PortaCount instruments for healthcare workers (HCWs) who wore 5 different models of a disposable P2 (N95-equivalent) respirator. The questionnaire included questions about the HCWs age, sex, race, occupational category, main area of work, smoking status, facial characteristics, prior training and experience in use of respiratory masks, and number of attempts to obtain a respirator fit.Results.A total of 6,160 HCWs were successfully fitted during the period from January through July 2007. Of the 4,472 HCWs who responded to the questionnaire and were successfully fitted, 3,707 (82.9%) were successfully fitted with the first tested respirator, 551 (12.3%) required testing with a second model, and 214 (4.8%) required 3 or more tests. We noted an increased pass rate on the first attempt over time. Asians (excluding those from South and Central Asia) had the highest failure rate (16.3% [45 of 276 Asian HCWs were unsuccessfully fitted]), and whites had the lowest (9.8% [426 of 4,338 white HCWs]). Race was highly correlated with facial shape. Among occupational groups, doctors had the highest failure rate (13.4% [81 of 604 doctors]), but they also had the highest proportion of Asians. Prior education and/or training in respirator use were not associated with a higher pass rate.Conclusions.Certain facial characteristics were associated with higher or lower pass rates with regard to fit testing, and fit testers were able to select a suitable respirator on the basis of a visual assessment in the majority of cases. For the fit tester, training and experience were important factors; however, for the HCW being fitted, prior experience in respirator use was not an important factor.

The Effect of Respirator Training on the Ability of Healthcare Workers to Pass a Qualitative Fit Test

1996 ◽  
Vol 17 (10) ◽  
pp. 636-640 ◽  
Author(s):  
Donna Hannum ◽  
Kerrie Cycan ◽  
Linda Jones ◽  
Melinda Stewart ◽  
Steve Morris ◽  
...  
Keyword(s):  
Direct Cost ◽  
Prior Experience ◽  
Pass Rate ◽  
Professional Status ◽  
Pass Rates ◽  
Chi Square ◽  
Fit Testing ◽  
Group A ◽  
Group B ◽  
The Cost

AbstractObjectives:To determine the effect of different methods of training on the ability of hospital workers to wear respirators and pass a qualitative fit test, and to compare the direct cost of the training.Design:179 hospital employees were recruited for study and were stratified into three groups based on the type of training they received in the use of respirators. Employees in Group A received one-on-one training by the hospital's industrial hygienist and were fit tested as part of this training. Employees in Group B received classroom instruction and demonstration by infection control nurses in the proper use of respirators, but were not fit tested as part of training. Employees in Group C received no formal training. Each participant in our study underwent a subsequent qualitative fit test using irritant smoke to check for the employee's ability to adjust correctly the fit and seal of the respirator. The direct cost of each method of training was determined by accounting for the cost of trainers and the cost of employee-hours lost during training.Setting:775-bed Veterans' Affairs hospital.Results:94% of Group A participants (49 of 52) passed the qualitative fit test, compared to 91% of Group B participants (58 of 64) and 79% of Group C participants (50 of 63; P=.036, 2 × 3 chi-square). Group A had a significantly higher pass rate than Group C (P=.043), but Group B did not differ significantly from Group A or Group C. Location or professional status did not affect pass rate, but prior experience wearing respirators did. When the study groups were compared after stratifying for prior experience, we found no difference in pass rates, except when Groups A and B (those with any training) were combined and compared with Group C (107 of 116 versus 50 of 63, P=.05, Mantel-Haenszel chi-square).We estimate that the method of training involving individual instruction followed by fit testing took 20 minutes per employee to complete, compared to 10 minutes per six employee class for the method of classroom demonstration. The difference in direct cost between the two methods, applied to the training of 1,200 employees at our hospital, would be approximately $19,000 per year.Conclusion:Our study indicates that training in the proper use of respirators is important, but the method of training may not be, as the two methods we evaluated were nearly equivalent in their pass rates on fit testing (94% versus 91%). Fit testing as part of training may have enhanced the performance of our participants marginally, but was more time consuming and accounted for most of the excess cost.

Love, Inc.

2019 ◽  
Author(s):  
Laurie Essig
Keyword(s):  
Climate Change ◽  
Global Climate Change ◽  
Structural Changes ◽  
Global Climate ◽  
Dating Apps ◽  
Sense Of Security ◽  
True Love ◽  
The Future ◽  
False Sense ◽  
Global Movements

In Love, Inc., Laurie Essig argues that love is not all we need. As the future became less secure—with global climate change and the transfer of wealth to the few—Americans became more romantic. Romance is not just what lovers do but also what lovers learn through ideology. As an ideology, romance allowed us to privatize our futures, to imagine ourselves as safe and secure tomorrow if only we could find our "one true love" today. But the fairy dust of romance blinded us to what we really need: global movements and structural changes. By traveling through dating apps and spectacular engagements, white weddings and Disney honeymoons, Essig shows us how romance was sold to us and why we bought it. Love, Inc. seduced so many of us into a false sense of security, but it also, paradoxically, gives us hope in hopeless times. This book explores the struggle between our inner cynics and our inner romantic.

Front-line Healthcare Workers in COVID-19: The Way from Elbow-Bump Greeting to Closing Body Bags

2020 ◽  
Author(s):  
Stefan Bittmann
Keyword(s):  
Health Service ◽  
Healthcare Workers ◽  
Well Being ◽  
The United States ◽  
Angiotensin Ii Receptor ◽  
Front Line ◽  
Resource Center ◽  
Research Activities ◽  
The World ◽  
The Usa

COVID-19 is a serious coronavirus disease that is spreading all over the world. As of the date of this publication, 2.834.134 people have been infected with COVID-19 and 197.924 deaths have been recorded in 185 countries (John Hopkins Corona Resource Center, 25th April 2020) [1]. This overwhelming mortality rate requires intensive research activities around the world. To date, the number of deaths per day in the United States is still killing, indicating an uncontrollable state of infection spread. SARS-CoV-2 binds to the angiotensin II receptor in various tissues of the human body, particularly in the oral cavity and tongue. SARS-CoV-2 requires the cheerful TMPRSS2 to activate this inertia. SARS-CoV-2 uses the ACE2 receptor as a gateway to the lungs. The SARS-CoV-2 virus binds with the spike protein to the ACE2 receptor. COVID-19 is more common among African Americans in the USA (Science 10th April 2020). The comfort and the emotional loading capacity of the employees in the health service are key components for the maintenance of the essential health services during the outbreak of the COVID-19 virus (Coronavirus) [2,3]. Hence, it will be important to anticipate the charges linked with this work and to release support for employees in the health service. The supervision and assessment of the psychic health and the well-being of the employees in the health service will be important, just as the efforts to guarantee a successful reunion with colleagues if they are infected.

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