Exploring respiratory protection practices for prominent hazards in healthcare settings

Abstract

The use of respiratory protection, an important component of personal protective equipment (PPE) in healthcare, is dependent on the hazard and environmental conditions in the workplace. This requires the employer and healthcare worker (HCW) to be knowledgeable about potential exposures and their respective protective measures. However, the use of respirators is inconsistent in healthcare settings, potentially putting HCWs at risk for illness or injury. To better understand respirator use, barriers, and influences, the National Institute for Occupational Safety and Health (NIOSH) Health and Safety Practices Survey of Healthcare Workers provided an opportunity to examine self-reported use of respirators and surgical masks for targeted hazards. The hazards of interest included aerosolized medications, antineoplastic drugs, chemical sterilants, high-level disinfectants, influenza-like illness (ILI), and surgical smoke. Of the 10,383 HCWs who reported respiratory protection behaviors, 1,904 (18%) reported wearing a respirator for at least one hazard. Hazard type, job duties, site characteristics, and organizational factors played a greater role in the likelihood of respirator use than individual factors. The proportion of respirator users was highest for aerosolized medications and lowest for chemical sterilants. Most respondents reported using a surgical mask for at least one of the hazards, with highest use for surgical smoke generated by electrosurgical techniques and ILI. The high proportion of respirator non-users who used surgical masks is concerning because HCWs may be using a surgical mask in situations that require a respirator, specifically for surgical smoke. Improved guidance on hazard recognition, risk evaluation, and appropriate respirator selection could potentially help HCWs better understand how to protect themselves at work.

Use of powered air-purifying respirator(PAPR) as part of protective equipment against SARS-CoV-2-a narrative review and critical appraisal of evidence

“…Many hospitals chose to use PAPRs as part of HCW PPE ensembles. This shift to PAPR use in hospitals may have affected the prevalence of PAPR types available to healthcare workers in the USA 34 .…”

“…Aerosol generating procedures must be performed in an airborne infection isolation room (33). Another factor featuring in the more ready availability of PAPR devices in the USA, was institutional preparedness for management of Ebola Hemorrhagic Fever (Ebola virus) in 2014 (34). The CDC recommends the use of a PAPR or a disposable NIOSH-approved N95 FFR with a face shield for EVD patient care to protect eyes, mouth, and nose from contact and aerosol exposure.…”

Impact of respiratory protective devices on respiration: Implications for panic vulnerability during the COVID-19 pandemic.

“…Furthermore, the most recent recommendations of the World Health Organization and the US Centers for Disease Control and Prevention (CDC) include the wearing of face masks by the general public among the strategies for mitigating the risk and impact of COVID-19 ( CDC, 2020 ). The most used RPDs among HCWs and the general population are surgical facemasks (SMs) and filtering facepiece respirators (FFRs), which include N95 (American standard, CDC), FFP2 (i.e., the closest European equivalent to N95), and FFP3 masks ( Baig et al, 2010 ; Wizner et al, 2018 ).…”

“…In line with our experience, some studies revealed that certain people in the general population appeared to repeatedly move their masks, touch them, or not to wear them when required due to multiple physiological and psychological sources of RPD-related discomfort, thereby decreasing infection prevention. For the same reasons, even HCWs, a category of people who are supposed to be well trained on this issue, were often found to be poorly compliant with RPDs ( Baig et al, 2010 ; Johnson, 2016 ; Wizner et al, 2018 ). Respiratory discomfort is a main complaint of RPD wearers, and it was found that approximately 30% of HCWs complained of breathing difficulties most of the time or always when wearing an N95 respirator.…”

From the Editor: Progress on JOEH procedural changes

“…Journal Scope The scope of articles published in the JOEH remains unchanged: All papers focus on communicating ideas, methods, processes, and research in the areas of occupational and environmental hygiene; exposure assessment; engineering controls; occupational and environmental epidemiology, medicine, and toxicology; ergonomics; and other related disciplines. As a new editorial staff, we have been encouraging new types of studies that I hope will provide insights to developing workplace interventions [2][3][4] or technologies that may improve our ability to make decisions on risk. [5,6] Each manuscript submitted to the JOEH is reviewed for relevance to the JOEH readers and is scientifically reviewed to ensure that the underlying study design, data analysis, and interpretation are sound.…”