Evaluation of Minnesota and Illinois Hospital Respiratory Protection Programs and Health Care Worker Respirator Use

Abstract

The objective of this study was to assess respiratory protection programs for aerosol-transmissible diseases in acute care hospitals for conformance with regulatory requirements and public health guidelines. Twenty-eight representative hospitals were selected by size, location, and ownership in Minnesota and Illinois. Interviews were conducted with 363 health care workers and 171 managers from high-risk departments. Written programs from each hospital were reviewed for required elements. Seventy-seven health care workers were observed donning and doffing a FFR. The most serious deficiency in many written programs was failure to identify a program administrator. Most written programs lacked adequate details about medical evaluation, fit-testing, and training and did not include a comprehensive risk assessment for aerosol transmissible diseases; tuberculosis was often the only pathogen addressed. Employees with the highest probability of tuberculosis exposure were most likely to pick a respirator for close contact, but higher levels of respiratory protection were rarely selected for aerosol-generating procedures. Surgical masks were most commonly selected for close contact with droplet disease- or influenza-infected patients; better protection (e.g., respirator) was rarely selected for higher-risk exposures. Most of the observed health care workers had access to a NIOSH-certified N95 FFR, properly positioned the facepiece, and formed the nose clip. The most frequent deficiencies were failure to correctly place straps, perform a user seal check, and remove the respirator using straps.

Keywords:

• aerosol transmissible disease
• health care
• respiratory protection

ACKNOWLEDGMENTS

We thank Deborah Novak, NIOSH contract officer, for her review and input to this manuscript. We also acknowledge support we received from infection control and health and safety professionals in both states. In particular, we thank Barbara Bor, president of Minnesota Association for Professionals in Infection Control and Epidemiolgoy (APIC), who published an article highlighting this project in the chapter's April 2011 newsletter. We also thank John Franke (Northshore HealthCare), Patrice Beal (Vice President, Illinois Hospital Association of Occupational Health Nurses) and Robert Cohen (John Stroger Hospital of Cook County) for providing contacts and assistance in Illinois. We thank graduate students Jason Lotter and Lasbat Ergobogbo for their assistance with interviews in Illinois hospitals.

FUNDING

Funding support was provided by the National Institute for Occupational Safety and Health (NIOSH) National Personal Protection Technology Laboratory through contract No. 254-2010-36476 awarded to the University of Minnesota. None of the authors has any financial or other conflicts of interest.