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Fit isn't the only factor for HCWs
Tolerability is a major concern
The search for a better respirator continues. For health care workers, the difficulties with respiratory protection extend beyond the question of fit. They also struggle with tolerability and comfort throughout a shift.
In a study of healthcare workers who were asked to wear a respirator for the full duration of an 8-hour work shift, there was a probability as high as 59% that they would be unable to wear the respirator to the end of the shift. Their complaints included diminished speech communication, heat, pressure, and dizziness.1
The Veterans Health Administration in collaboration with the National Institute for Occupational Safety and Health (NIOSH), are now collaborating with manufacturers to design a respirator specifically for health care – one that health care workers would be willing to wear throughout a shift, if necessary.
Project B.R.E.A.T.H.E. (Better Respiratory Equipment using Advanced Technologies for Healthcare Employees) aims to produce a prototype respirator within a year or two, says Lewis J. Radonovich, MD, and director of Biosecurity Programs for the Office of Program Development at the North Florida/South Georgia Veterans Health System in Gainesville, FL.
Meanwhile, Radonovich is also coordinating a major study that will compare the use of respirators and surgical masks to prevent the spread of influenza and influenza-like illness. They study will recruit thousands of health care workers at multiple sites who will wear respirators or masks during patient care with patients diagnosed with flu or ILI for a 12-week period. The study will run for three or four years, Radonovich says.
"A variety of professional groups are interested in how well surgical masks perform against respiratory masks with infections such as the flu," he says. "The scientific and public health community would like to see results that are more definitive than what's out there."
The H1N1 pandemic that began last year prompted a new wave of debate about respiratory protection for influenza. The Centers for Disease Control and Prevention advised hospitals and health care providers to use NIOSH-certified respirators with the novel virus. The professional organizations of infection control practitioners insisted that surgical masks were adequate for influenza.
"N95 respirators are not superior to surgical masks in the prevention of transmission of influenza in most patient care settings," the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Association for Professionals in Infection Control and Epidemiology (APIC) said in a letter to President Obama, requesting a moratorium on U.S. Occupational Safety and Health enforcement of the CDC respiratory protection guideline.
At presstime for HEH, CDC was widely expected to alter its recommendation and allow the use of surgical masks to prevent transmission of H1N1 in hospitals – largely because of the widespread availability of a vaccine.
1. Radonovich LJ, Cheng J, Shenal BV, et al. Respirator tolerance in health care workers. JAMA 2009; 30:36-38. Available at jama.ama-assn.org/cgi/content/full/301/1/36.