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Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators
JAMA ( IF 51.273 ) Pub Date : 2020-03-25 , DOI: 10.1001/jama.2020.4806
Lisa A. Pompeii; Colleen S. Kraft; Erik A. Brownsword; Morgan A. Lane; Elisa Benavides; Janelle Rios; Lewis J. Radonovich

The demand for disposable respiratory protective devices needed to protect health care personnel may exceed supply during large outbreaks of respiratory infectious diseases.1,2 Concerns are growing over global shortages of respiratory protective devices during the novel coronavirus disease 2019 (COVID-19) pandemic.3 A reusable alternative to N95 respirators for which health care personnel can be rapidly assessed for fit (fit testing) and trained for use is needed. Elastomeric half-mask respirators (EHMRs), which provide the same level of respiratory protection as N95 respirators, are one alternative4 (eFigure in Supplement 1). These reusable respirators are used in construction and manufacturing, but not widely used in health care4 because of uncertainty about disinfection methods and upfront costs.5 The goal of this demonstration study was to test the feasibility of rapidly training and fit testing health care workers to EHMRs. In 2019, 2 US health care organizations (Emory University and University of Texas Health [UTHealth] Science Center at Houston) conducted an outbreak simulation in which health care personnel, who were randomized to EHMR (80%) or N95 (20%) groups, were rapidly fit tested and trained. The institutional review boards at UTHealth, Baylor College of Medicine, and Emory University approved this study. Written informed consent was obtained at recruitment. Fit testing was performed to assess respirator fit to face, checking for leaks, using an Occupational Safety and Health Administration qualitative fit testing process.6 The number of fit testing attempts and testing time were recorded. Both groups were trained using a 9-minute video. The EHMR group was assessed 3 times consecutively for 26 performance indicators in the following 6 key areas: (1) inspection, (2) donning, (3) positive-pressure user seal check, (4) negative-pressure user seal check, (5) doffing, and (6) disinfection. Trainers scored participants based on the degree of assistance needed to complete each step (1 indicated physical assistance; 2, verbal assistance; 3, no assistance). A total score for each area consisted of a sum of 4 or 6 individual performance indicators (3 points each) ranging from 12 or 18, with a possible overall score of 78 points. Mean differences for time to completion of fit testing between groups was calculated using t tests, differences in the number of attempts to achieve proper fit were calculated using χ2 tests, and ANOVA with post hoc and 2-sided pairwise comparisons were used to compare EHMR performance scores by attempts with α = .05. No sample size calculation was performed. Additional details are available in the protocol (Supplement 2). Analyses were conducted using SPSS, version 25. Of 193 health care personnel randomized, 153 (79%) participated in the study (124 in the EHMR group and 29 in the N95 group) (Table 1). The majority of participants were women (77%), with a mean age of 38 years. Overall, 87% of participants had at least 1 year of experience wearing a respiratory protective device; 9.7% of participants in the EHMR group vs 27.6% in the N95 group had no prior experience. Few participants (1.3%) had prior experience using an EHMR.
更新日期:2020-03-26

 

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