Discomfort and Exertion Associated with Prolonged Wear of Respiratory Protection in a Health Care Setting

Abstract

The nature of discomfort and level of exertion associated with wearing respiratory protection in the health care workplace are not well understood. Although a few studies have assessed these topics in a laboratory setting, little is known about the magnitude of discomfort and the level of exertion experienced by workers while they deliver health care to patients for prolonged periods. The purpose of this study was to determine the magnitude of discomfort and level of exertion experienced by health care workers while wearing respiratory protection for periods up to 8 hr when performing their typical occupational duties. This project was a multiple cross-over field trial of 27 health care workers, aged 24-65, performing their typical, hospital-based occupational duties. Each participant served as his/her own control and wore one of seven respirators or a medical mask for 8 hr (or as long as tolerable) with interposed doffing periods every 2 hr. Self-perceived discomfort and exertion were quantified before each doffing: self-perceived level of discomfort using a visual analog scale, and self-perceived level of exertion using a Borg scale. Overall, and as would be expected, discomfort increased over time with continual respirator use over an 8-hr period. Interestingly, exertion increased only marginally over the same time period. The relatively low level of exertion associated with eight respiratory protective devices, including models commonly used in the U.S. health care workplace, is not likely to substantially influence workers' tolerability or occupational productivity. However, the magnitude of discomfort does appear to increase significantly over time with prolonged wear. These results suggest that respirator-related discomfort, but not exertion, negatively influences respirator tolerance over prolonged periods. Discomfort may also interfere with the occupational duties of workers.

Selecting models for a respiratory protection program: What can we learn from the scientific literature?

“…Shenal et al 37 reported self-perceived discomfort using a visual analog scale and perceived exertion using the Borg scale from 27 HCWs (aged 24–65 years, 55% women) wearing different types of respirators and facial protection equipment during an 8-hour shift. Three N95 FFRs were included: 3M 1860 (cup shaped), 3M 8511 (cup shaped with exhalation valve, 3M, St. Paul, MN), and Kimberly-Clark PFR95170 (duckbill, Kimberly-Clark, Roswell, GA).…”

Are You Covered? Safe Practices for the use of Personal Protective Equipment

“…The use of PPE can affect clinical performance by limiting manual dexterity, impairing hearing and communication, and causing discomfort for the user. [12][13][14][15] Hands-on practice allows the user to be better prepared to provide safe patient care while wearing PPE. A strategy that can be used to prepare health care providers to provide safe care in the emergency setting is the use of in situ simulation training sessions.…”

B95: A new respirator for health care personnel

“…27 Discomfort was routinely raised as a key factor limiting the practicality of the CDC and OSHA recommendations during the 2009 novel H1N1 influenza pandemic. 21,30,31 Psychologic manifestations of respirator wear, such as claustrophobia, may also be considered forms of discomfort, 32 and improper usage of these devices is relatively common, 26,33 such that it may lead to discomfort. In general, surgical masks are viewed as more comfortable than respirators.…”

“…Based on recommendations issued by the IOM 21 and findings from its own respirator research in 2007 and 2008, 26,30,39 the Department of Veterans Affairs (VA) was prompted to improve the PPE practices used by its employees. VA is the largest integrated health care system in the United States and employs or oversees 180,000 HCP who use approximately 1.6 million respirators per year.…”