Questions about pandemic use of respirators

Current models difficult to use, studies show

In an influenza pandemic, health care workers might find their respirators difficult to tolerate for long hours. Without additional training, they also are likely to forget how to don the respirator properly or even which respirator model they should wear.

Those are the findings of two recent studies that raise questions about the state of respiratory protection for health care workers.1,2 They underscore the need for respirators that are designed specifically for health care, researchers say.

"We expected to find one or two of the models we were using to be reasonably well-tolerated so we could have health care workers wearing them for most of their work shift," says Lewis J. Radonovich, MD, director of the Center for Occupational Safety and Infection Control in the Veterans Health Administration and director of Biosecurity Programs at the Malcolm Randall Veterans Affairs Medical Center in Gainesville, FL. "It doesn't matter what type of respirator you're wearing," he says. "Health care workers don't seem to tolerate them for long periods."

Health care worker confidence in their respiratory protection not only affects their safety on the job, but it could impact their willingness to work during a pandemic, Radonovich notes. "We would want to pick a respirator that is as comfortable as possible and effective," he says.

Meanwhile, Canadian researchers questioned large-scale efforts to fit-test health care workers. Employees who are fit-tested but then don't wear a respirator for six months or longer often forget how to wear them with the best fit.

A. Mark Joffe, MD, FRCPC, medical director of infection prevention services at Royal Alexandra Hospital in Edmonton, says, "Fit-testing large groups of people who then don't use the respirator might not be a good strategy." They looked at whether their employees could take a respirator out of the box, put it on, and achieve an adequate fit, Joffe says. "About half of them did," he says. "For employees who don't use the respirator very often, they don't do much better by fit-testing and training them than by just taking it out of the box."


1. Radonovich LJ, Cheng J, Shenal BV, et al. Respirator tolerance in health care workers. JAMA 2009; 301:36-38.

2. Lee MC, Takaya S, Long R, et al. Respirator fit-testing: Does it ensure the protection of healthcare workers against respirable particles carrying pathogens? Infect Control Hosp Epidemiol 2008; 29:1,149-1,156.