Respirator or mask? Occ health has answer

Webkit boosts competency on resp protection

Most occupational health nurses learn about respiratory protection on the job. They may manage the program, but still have little time to train their hospital’s employees about the difference between a mask and a respirator.

But thanks to the work of professional organizations, new, free resources are available to help guide them.

The American Association of Occupational Health Nurses (AAOHN) released a webkit with 10 modules and 1.5 units of continuing education credit for nurses. Its content was shaped by a survey of occupational health nurses conducted with the Association of Occupational Health Professionals in Healthcare (AOHP), the American Board of Occupational Health Nurses (ABOHN) and the American Nurses Association (ANA).

"There was a gap in the education," says Annette Byrd, RN, MPH, educational consultant to AAOHN, who noted that many occupational health nurses said they felt uncomfortable with their ability to create policies related to respiratory protection.

The new resources could become a foundation for education of nurses in selecting and using respiratory protection and managing PPE programs, says Debra Novak, RN, DSN, senior service fellow with the National Personal Protective Technology Laboratory (NPPTL) of the National Institute for Occupational Safety and Health (NIOSH).

"We want this to be available for schools of nursing to include in their curriculum for the next generation of health care providers," she says.

Confusion about N95 use

Frontline nurses are often confused about what type of protective equipment they need and how to wear it, according to a study involving 98 hospitals in six states. In REACH II (Respirator Use Evaluation in Acute Care Hospitals), about 1,500 health care workers and managers were surveyed about respirator use. They were "least knowledgeable" about scenarios involving seasonal influenza and aerosol-generating procedures and a suspected or confirmed infectious disease that required airborne precautions.1

In other words, health care workers were most uncertain about when to use N95s. Observations also showed that many health care workers don’t know how to properly don or doff respirators.

Occupational health nurses need to help fill the gap in training and education, an Institute of Medicine panel said in 2011. The panel called on occ health nurses to "take responsibility for achieving and maintaining knowledge and skills in respiratory protection that are appropriate to their scope of practice. They should provide instruction and demonstrate leadership in motivating others to use respirators appropriately."2

The panel specifically named AAOHN, and the association responded. "They challenged us to do a survey and to find out what the real situation was," says Byrd, "and then to develop materials, disseminate those materials widely and work with organizations and institutions to get information and training into educational curriculum."

A survey of about 2,300 occupational health nurses found that most (83%) felt they were competent, proficient or expert in respiratory protection. But that overall comfort level dropped off when occupational health nurses were asked about explaining the difference between a surgical mask and an N95 respirator. Some 28.5% of the respondents said they had little or no comfort with that task.3

Eight aspects of competency

The webkit is based on the OSHA Respiratory Protection standard and incorporates information from NIOSH and California. It is free, but requires users to register. (www.aaohn.org)

There are three levels of competency (competent, proficient and expert) and the following eight categories:

• clinical practice
• workplace surveillance
• regulation and litigation
• management/ business/leadership
• health promotion and disease prevention
• health and safety education/training
• research
• professionalism

HCWs protect themselves, patients

The required elements for a respiratory protection program include: Procedures for selecting respirators; medical evaluation of employees; fit-testing for tight-fitting respirators; procedures for use of respirators in routine and emergency situations; procedures to ensure adequate air quality, quantity, and flow; training employees about potential respiratory hazards in routine and emergency situations; training employees in the proper use of respirators; and program evaluation.

"The educational module we developed will help you become more proficient," says Byrd, who notes that there is valuable information even for occupational health nurses who are knowledgeable about respiratory protection. For example, the webkit provides resources to draft respiratory protection policies.

Eventually, Byrd says she would like to see the materials incorporated into nursing curricula "so every nurse realizes how to use a respirator to protect themselves and to protect their patients."

References

1. Stradtman L, Krah J, and Novak D. Reaching towards a healthier, safer workplace: NIOSH looks at healthcare worker familiarity with recommended respiratory protection practices. NIOSH Science Blog, June 26, 2014. Available at http://blogs.cdc.gov/niosh-science-blog/2014/06/26/reach/.
2. Institute of Medicine. Clever LH, Rogers B, Schultz AM and Liverman CT, eds. Occupational Health Nurses and Respiratory Protection: Improving Education and Training – Letter Report. August 2, 2011. The National Academies Press, Washington, DC.
3. Burgel BJ, Novak D, Burns CM, et al. Perceived competence and comfort in respiratory protection: Results of a nationwide survey of occupational health nurses. Workplace Health & Safety 2013; 61:103-115.