Friday, October 23, 2015

NIOSH Study Finds Inconsistent Respirator Practices In Hospitals


Credit NIOSH


# 10,654


This time last year we were focusing heavily on the proper donning and doffing of PPEs – including respirators – in the wake of the first nosocomial transmission of Ebola to US healthcare workers in Texas.  Six years ago, we were looking at similar concerns over the H1N1 pandemic virus (see Report: Nurses File Complaint Over Lack Of PPE).


The first tenet of the CDC’s updated Interim Guidance for HCWS for working with Ebola patients – released last October - stressed the importance of receiving repeated training prior to encountering an Ebola patient:


Prior to working with Ebola patients, all healthcare workers involved in the care of Ebola patients must have received repeated training and have demonstrated competency in performing all Ebola-related infection control practices and procedures, and specifically in donning/doffing proper PPE.


And while the focus then was on Ebola, the same can be said for MERS, Novel Flu strains, and a short list of other exotic infectious diseases, all of which are increasingly showing up on our shores.  Over the past couple of years H5N1, H7N9, Ebola, MERS, and Lassa fever have all showed up at North American hospitals.


When a hospital has a known `exotic’ infection to deal with, the checklists come out, trained monitors supervise the PPE donning and doffing procedures, and infection control training becomes paramount. 


But during day-to-day operations, particularly away from `high risk’  settings, procedures, attitudes, training, and awareness often become lax.  


Despite appearances, that `respiratory case’  just sent up from the ER could be carrying something a lot more dangerous than CA pneumonia.  The overriding lesson from South Korea’s MERS outbreak over the summer is that these viruses can show up unannounced, and we’d better be preparing ourselves now to deal with them. 


Many HCWs - particularly those who do not work in ICU or isolation units - may only get one brief training session a year  on PPEs (often during their annual fit-testing for N95s).  In some facilities, in-service instruction may consist of little more than an array of infection control posters on the wall.


Over the summer, in APIC: Most HCWs Are Removing PPEs Improperly, we saw a study that found fewer than 20% of (4 of 30) HCWs followed the CDC’s PPE doffing recommendations to the letter.


A few  months ago, in HHS Launches National Ebola Training & Education Center, we looked at a program designed to help prepare medical facilities to deal with emerging infectious disease threats. While in June, in TFAH Issue Brief: Preparing The United States For MERS-CoV & Other Emerging Infections, we looked at the steps that governments, healthcare facilities, and public health departments around the world need to take in order to prepare for the arrival of MERS and other Emerging infections. 


The expectation is that we will see more of these imported exotic pathogens in the coming years, not less.


Which brings us to an item highlighted in October’s NIOSH RESEARCH ROUNDS on a study of 98 hospitals across six states, that found there’s a lot of work yet to be done:


Research Study Finds Inconsistent Respirator Practices in Sampled Hospitals

A research study involving a sample of 98 hospitals in six states found inconsistencies in some practices for using respirators to safeguard healthcare workers when in close contact with patients who may have seasonal flu or other infectious respiratory diseases. The findings from the study, which was supported by the National Institute for Occupational Safety and Health (NIOSH) and included two NIOSH co-authors, were published in a peer-reviewed journal.

The sampled hospitals followed most respiratory protection program requirements, including providing healthcare workers with medical evaluations, respirator fit testing, and training prior to their use of a respirator. However, the study also found that healthcare workers did not consistently check respirator seals and hospitals did not conduct follow-up training on how to properly put on and take off a respirator.

The study was conducted between January 2011 and June 2012 in sampled hospitals in California, Illinois, Michigan, Minnesota, New York, and North Carolina. Because this was an exploratory study, the findings can’t be generalized beyond the six hospitals involved, but the results do suggest questions for further analysis and issues for attention, the research article said.

To read the full article, go to American Journal of Infection ControlExternal Web Site Icon.



Hospital respiratory protection practices in 6 U.S. states: A public health evaluation study

Kristina Peterson, PhDa, Debra Novak, PhD, RNb, , , Lindsay Stradtman, MPHb, David Wilson, PhDa, Lance Couzens, BSa 




Most acute care hospitals adhere to requirements for initial medical evaluations, fit testing, training, and recommended respiratory protection when in close contact with patients who have suspected or confirmed seasonal influenza.

Low hospital adherence was found for respiratory protection with infectious diseases requiring airborne precautions, aerosol-generating procedures with seasonal influenza, and checking of the respirator's user seal. Hospitals' adherence was also low with follow-up program evaluations, medical re-evaluations, and respirator maintenance.

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