Research quest: Ensure proper use of PPE
NIOSH action plan focuses on compliance
Occupational health research is zeroing in on one of the most difficult aspects of respiratory protection: Health care worker compliance.
Health care workers have a poor record when it comes to personal protective equipment. A multi-state study found many gaps. For example, in North Carolina, about one in three health care workers don’t don or doff respirators properly or perform hand hygiene after removing them. In Minnesota, one in seven didn’t even know they were supposed to be fit-tested.1
So for the next few years, the National Institute for Occupational Safety and Health (NIOSH) is focusing its action plan for health care worker personal protective equipment on compliance. That includes continued work toward a more comfortable, user-friendly respirator as well as research into awareness, training strategies, and safety culture.
"It’s not enough just to build a better respirator," says Ron Shaffer, PhD, senior scientist in the Office of the Director of NIOSH’s National Personal Protective Technology Laboratory in Pittsburgh. "You need to build a better respirator that people actually wear."
Previous studies have actually demonstrated the relationship between proper use and protection, he says. "You really need to be wearing your respirator during all periods of exposure," he says. "Even a small non-wear time dramatically reduces the protection that you will get."
In some cases, NIOSH research may confirm the need for certain aspects of respirator protection, giving evidence to support recommended practices. For example, Shaffer notes that research showed user seal checks, which health care workers should perform each time they don a respirator, create a greater consistency in fit. "It makes it more likely that you’ve put it on correctly if you do the user seal check," he says.
The NIOSH action plan was influenced by a 2011 Institute of Medicine report, which cited gaps in research related to personal protective equipment for health care and emphasized the importance of safety culture as well as technological advances.2
"In essence, there should be universal acknowledgement that PPE use is an integral component of providing quality health care," the IOM said. "As with other priorities, this aspect of healthcare delivery needs to be carefully planned at the organizational/institutional level. Furthermore, managers and frontline workers alike need to understand and accept their roles and responsibilities, and PPE use needs to be as easy and convenient as possible."
Meanwhile, NIOSH is moving forward on its "total inward leakage" rule, which will require manufacturers to meet certain fit criteria. The agency also is supporting work toward a B95, a respirator designed specifically for health care.
NIOSH solicited input on its action plan through September 13 and a final version is expected by the end of the year. The action plan is available at www.regulations.gov/#!documentDetail;D=CDC-2013-0016-0001.
- NIOSH National Personal Protective Technology Laboratory. Presentations and posters from the personal protective equipment selection, use and expectations. March 20-21, 2012. Available at www.cdc.gov/niosh/npptl/resources/certpgmspt/meetings/03202012/PresentationsPosters03202012.html.
- Institute of Medicine. Preventing transmission of pandemic influenza and other viral respiratory diseases: Personal protective equipment for healthcare personnel: Update 2010. Washington, DC: The National Academies Press, 2011. Available at www.iom.edu/Reports/2011/Preventing-Transmission-of-Pandemic-Influenza-and-Other-Viral-Respiratory-Diseases.aspx.