Assessing the efficacy of tabs on filtering facepiece respirator straps to increase proper doffing techniques while reducing contact transmission of pathogens

Abstract

NIOSH-certified N95 filtering facepiece respirators (FFRs) are used in healthcare settings as a control measure to mitigate exposures to airborne infectious particles. When the outer surface of an FFR becomes contaminated, it presents a contact transmission risk to the wearer. The Centers for Disease Control and Prevention (CDC) guidance recommends that healthcare workers (HCWs) doff FFRs by grasping the straps at the back of the head to avoid contact with the potentially contaminated surface. Adherence to proper doffing technique is reportedly low due to numerous factors including difficulty in locating and grasping the straps. This study compares the impact of tabs placed on FFR straps to controls (without tabs) on proper doffing, ease of use and comfort, and reduction of transfer of contamination to the wearer. Utilizing a fluorescent agent as a tracer to track contamination from FFRs to hand and head areas of 20 human subjects demonstrated that there was no difference in tabbed FFR straps and controls with respect to promoting proper doffing (p = 0.48), but did make doffing easier (p = 0.04) as indicated by 7 of 8 subjects that used the tabs. Seven of the 20 subjects felt that FFRs with tabs were easier to remove, while only 2 of 20 indicated that FFRs without tabs were easier to remove. Discomfort was not a factor for either FFR strap type. When removing an FFR with contaminated hands, the use of the tabs significantly reduced the amount of tracer transfer compared to straps without tabs (p = 0.012). FFRs with tabs on the straps are associated with ease of doffing and significantly less transfer of the fluorescent tracer.

Transfer of bacteriophage MS2 and fluorescein from N95 filtering facepiece respirators to hands: Measuring fomite potential

“…[11] Images of the subjects’ hands were captured under UV-A light using a Nikon DSLR camera (Nikon Corp., Japan) from a fixed distance of 20 cm. Images were imported into Image J software and analyzed using the Lasso tool to delineate the zone of visual and measure the surface area of contamination.…”

Aerosol Transmission of Infectious Disease and the Efficacy of Personal Protective Equipment (PPE)

“…Furthermore, PPE effectively prevents contact and droplet transmission; however, in the context of aerosol and airborne transmission, PPE is not as efficient. 20 , 65 , 66 , 71 The strength of this systematic review is the primary focus on human-generated aerosol particle size and distribution, evidence of aerosol transmission of infectious disease, and PPE's efficacy. Although the present literature review has performed its due diligence in synthesizing information on the aerosol transmission of infectious disease and PPE efficacy, a few limitations should be noted.…”

Role of Human Factors Engineering in Infection Prevention: Gaps and Opportunities

“…Nevertheless, healthcare workers thought respirators with tabs were easier to remove than those without tabs and they were significantly less likely to contaminate themselves with a tracer when removing the respirators with tabs than those without tabs. These results suggest that the tabs may be a good addition to respirator straps but healthcare workers must be taught to use them properly [126].…”

“…For example, study by AlGharmri et al [125] found that full-face, negative pressure respirators impaired users' motor, visual, and cognitive abilities and were associated with an increased error rate. Strauch et al [126] put tabs on respirator straps to help healthcare workers remove these devices safely. The investigators noted that "use of the tabs was not intuitive."…”