Evaluation of respiratory protection programs and practices in California hospitals during the 2009-2010 H1N1 influenza pandemic

Abstract

Background Emergence of the novel 2009 influenza A H1N1 virus in California led to an evaluation of hospital respiratory protection programs (RPPs) and practices by the California Department of Public Health during the 2009–2010 influenza season. Methods Onsite evaluation of 16 hospitals consisted of interviews with managers and health care workers about RPPs and practices, review of written RPPs, and limited observations of personnel using respirators. Data were analyzed using descriptive statistics. Results All hospitals had implemented policies requiring the minimum use of N95 filtering facepiece respirators when working with patients with H1N1 virus infection; 95.5% of health care workers (n = 199) reported they would wear at least this level of protection when in close contact with a patient with confirmed or suspected H1N1 virus infection. However, evaluation of written RPPs indicated deficiencies in required areas, most commonly in recordkeeping, designation of a program administrator, program evaluation, employee training, and fit testing procedures. Conclusions Health care workers were aware of respiratory protection required when providing care for patients with confirmed or suspected H1N1 virus infection. Hospitals should improve written RPPs, fully implement written procedures, and conduct periodic program evaluation to ensure effectiveness of respirator use for health care worker protection. Increased accessibility of resources tailored for hospital respirator program administrators may be helpful.

Aerosol Transmission of Infectious Disease

“…There has been widespread resistance to the use of respiratory protection among health care workers and infection control professionals, necessitating clinical trials to evaluate the relative effectiveness of respirators and surgical masks, 82,83 despite evidence that respirators have better filtration and fit. 84,85 Most health care facilities currently have respiratory protection programs, including respirator fit testing, [86][87][88] which suggests that replacement of surgical masks with N95 filtering facepiece respirators will not be onerous.…”

Hospital respiratory protection practices in 6 U.S. states: A public health evaluation study

“…However, other studies have found actual compliance rates to be lower than self-reported rates. 12 In addition, as with all surveys, some of the questions and response options may not have been fully understood by all respondents, which could have resulted in response error.…”

“…Deficiencies noted in a limited number of observations of HCWs included failure to perform a user seal check, incorrect doffing technique, and failure to perform hand hygiene after doffing the respirator. 12 …”

Resistance to synthetic blood penetration of National Institute for Occupational Safety and Health-approved N95 filtering facepiece respirators and surgical N95 respirators

“…The use of surgical N95 FFRs in surgical and nonsurgical environments increases during outbreaks involving a known or suspected respiratory pathogen. For example, a scarcity of respirators during the spread of severe acute respiratory syndrome 9 and influenza 10 has been reported.…”