VHA leading the way to respirator comfort
Prototype trials start this summer
After years of development, the Veterans Health Administration (VHA) has created a respiratory protection device prototype that is expected to improve health care workers’ comfort and tolerance when wearing these devices.
The VHA has more than 300,000 employees, and the vast majority of them take care of veterans in medical centers around the country, says Lewis Radonovich, MD, director of the national center for occupational health and infection control at the VHA in Washington, DC, and Gainesville, FL.
"Employees are required to wear respiratory protection devices at various times in their work and we want to make sure they have access to the most comfortable devices," he adds.
The VHA is starting a clinical study of the prototype this summer, with the investigation expected to be completed by June 2015.
Project BREATHE (Better Respiratory Equipment using Advanced Technologies for Healthcare Employees) started six years ago.
"BREATHE is an effort to bring a new respirator to the U.S. health care market, specifically for health care workers," Radonovich says. "We have been bringing health care workers into the study so they could inform the future design."
The VHA is working with NIOSH’s National Personal Protective Technology Laboratory in Pittsburgh on the project, and they’ve engaged two private partners: 3M Corporation and Scott Safety.
"Our hope is that there will be at least one prototype on the U.S. market in a couple of years — devices that are more comfortable for employees," Radonovich says.
Investigators will measure how well the prototype is tolerated by health care workers in a simulated provider-patient situation. A new measurement tool was created to more accurately assess health care workers’ tolerance for wearing filtering face-piece respirators, says Sherri LaVela, PhD, MPH, senior research health scientist at the VHA and Hines (IL) VA Hospital.
"We developed a survey from scratch," she says. "We talked with health care staff and addressed the constructs that would need to be addressed in a survey or measuring instrument to get at the concept of comfort and tolerability."
Researchers met with three focus groups, audiotaped the sessions, and transcribed them to do a qualitative analysis and come up with common themes. The result was a tool they call the R-comfi, which stands for Respirator Comfort-wearing Experience and Function Instrument, LaVela explains.
"We wanted something easy to remember and hoped they’d start calling it the comfi,’ as in, Hey, use a comfi tool,’" she adds.
As part of the project, health care workers at two VA hospitals were fit-tested for the commonly-used N95 respirator to assess their comfort and tolerability.1 The study found that 53% of health care providers could tolerate a fit-tested respirator for 20 minutes or less. A greater proportion of male providers could tolerate wearing the respirator for more than 20 minutes than could female providers.
"Despite being the most commonly used respiratory device in the U.S. market, the tolerability and comfort level was strikingly poor among health care workers in our survey," Radonovich says.
The most commonly cited areas of discomfort were:
• tightness of straps (36%);
• lack of fresh air (34%);
• overall tightness (31%);
• facial warmth/heat (29%).
"A lot of the female workers also complained about how the equipment interfered with their make-up or putting on chap stick," LaVela says. "They were having dry lips."
When the respirator prototype is used in a lab-simulated setting during the trials, researchers will measure comfort and tolerability as health care workers perform patient care tasks on volunteer patients or staff members, LaVela says.
"We need to compare the comfort levels among employees in a scientifically rigorous way," Radonovich says. "This tool Sherri’s group created is important because we can be confident that it will measure what we want it to measure and distill it down to a basic level."
Previous tools would record different results based on personal perceptions of what the rating numbers meant. So two people could be equally uncomfortable but one would rate the discomfort level an eight and another would rate it a two, he notes.
R-comfi eliminates much of the personal subjectivity by observing health care workers’ actions while wearing a respiratory protection device.
"[For example], we counted how many times people were tugging at it and pulling on it," LaVela says.
- LaVela S, Locatelli S, Kostovich C, et al. Discomfort factors and tolerance times for health care providers wearing fit-tested filtering face-piece respirators. Abstract ## IDWeek conference, San Francisco, CA: Oct. 3-6, 2013.