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Selecting models for a respiratory protection program: What can we learn from the scientific literature?

Published:December 10, 2014DOI:https://doi.org/10.1016/j.ajic.2014.10.021

      Background

      An unbiased source of comparable respirator performance data would be helpful in setting up a hospital respiratory protection program.

      Methods

      The scientific literature was examined to assess the extent to which performance data (respirator fit, comfort and usability) from N95 filtering facepiece respirator (FFR) models are available to assist with FFR model selection and procurement decisions.

      Results

      Ten studies were identified that met the search criteria for fit, whereas 5 studies met the criteria for comfort and usability.

      Conclusion

      Analysis of these studies indicated that it is difficult to directly use the scientific literature to inform the FFR selection process because of differences in study populations, methodologies, and other factors. Although there does not appear to be a single best fitting FFR, studies demonstrate that fit testing programs can be designed to successfully fit nearly all workers with existing products. Comfort and usability are difficult to quantify. Among the studies found, no significant differences were noted.

      Key Words

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      References

      1. Occupational Safety and Health Administration (OSHA). Respiratory protection. 29 CFR Sect. United States Government Printing Office: Washington, DC; 1910.134. 2012.

        • Larson E.L.
        • Liverman C.T.
        Preventing transmission of pandemic influenza and other viral respiratory diseases: personal protective equipment for healthcare workers: update 2010.
        National Academies Press, Washington, DC2011
        • Figueroa M.
        Respiratory protection programs and healthcare professionals: compliance, knowledge and perceptions.
        Rutgers University, New Brunswick2013
        • Beckman S.
        • Materna B.
        • Goldmacher S.
        • Zipprich J.
        • D'Alessandro M.
        • Novak D.
        • et al.
        Evaluation of respiratory protection programs and practices in California hospitals during the 2009-2010 H1N1 influenza pandemic.
        Am J Infect Control. 2013; 41: 1024-1031
        • Lee K.
        • Slavcev A.
        • Nicas M.
        Respiratory protection against mycobacterium tuberculosis: quantitative fit test outcomes for five type N95 filtering-facepiece respirators.
        J Occup Environ Hyg. 2004; 1: 22-28
        • Occupational Safety and Health Administration (OSHA)
        Safety and health program management guidelines; issuance of voluntary guidelines.
        Fed Regist. 1989; 54: 3904-3916
        • Janssen L.
        • Ettinger H.
        • Graham S.
        • Shaffer R.
        • Zhuang Z.
        The use of respirators to reduce inhalation of airborne biological agents.
        J Occup Environ Hyg. 2013; 10: D97-D103
        • Baig A.S.
        • Knapp C.
        • Eagan A.E.
        • Radonovich Jr., L.J.
        Health care workers' views about respirator use and features that should be included in the next generation of respirators.
        Am J Infect Control. 2010; 38: 18-25
        • Radonovich Jr., L.J.
        • Cheng J.
        • Shenal B.V.
        • Hodgson M.
        • Bender B.S.
        Respirator tolerance in health care workers.
        JAMA. 2009; 301: 36-38
        • Lofgren D.J.
        A must for NIOSH: certify fit performance of the half mask particulate respirator.
        J Occup Environ Hyg. 2012; 9: D191-D195
        • Marsh J.L.
        Evaluation of saccharin qualitative fitting test for respirators.
        Am Ind Hyg Assoc J. 1984; 45: 371-376
        • Mullins H.E.
        • Danisch S.G.
        • Johnston A.R.
        Development of a new qualitative test for fit testing respirators.
        Am Ind Hyg Assoc J. 1995; 56: 1068-1073
        • da Roza R.B.
        Evaluation of Portacount for determining respirator fit factors, Part III: human subject tests and comparison with an aerosol photometer.
        J Int Soc Respir Prot Prot. 1991; 9: 22-37
        • Coffey C.C.
        • Lawrence R.B.
        • Campbell D.L.
        • Zhuang Z.
        • Calvert C.A.
        • Jensen P.A.
        Fitting characteristics of eighteen N95 filtering-facepiece respirators.
        J Occup Environ Hyg. 2004; 1: 262-271
        • Janssen L.L.
        • Luinenburg D.M.
        • Mullins H.E.
        • Nelson T.J.
        Comparison of three commercially available fit-test methods.
        AIHA J (Fairfax Va). 2002; 63: 762-767
        • Lawrence R.B.
        • Duling M.G.
        • Calvert C.A.
        • Coffey C.C.
        Comparison of performance of three different types of respiratory protection devices.
        J Occup Environ Hyg. 2006; 3: 465-474
        • Bidwell J.
        • Janssen L.
        Workplace performance of an N95 respirator in a concrete block manufacturing plant.
        J Int Soc Resp Prot. 2004; 21: 94-103
        • Cho K.J.
        • Jones S.
        • Jones G.
        • McKay R.
        • Grinshpun S.A.
        • Dwivedi A.
        • et al.
        Effect of particle size on respiratory protection provided by two types of N95 respirators used in agricultural settings.
        J Occup Environ Hyg. 2010; 7: 622-627
        • Cho K.J.
        • Reponen T.
        • McKay R.
        • Dwivedi A.
        • Adhikari A.
        • Singh U.
        • et al.
        Comparison of workplace protection factors for different biological contaminants.
        J Occup Environ Hyg. 2011; 8: 417-425
        • Janssen L.L.
        • Nelson T.J.
        • Cuta K.T.
        Workplace protection factors for an N95 filtering facepiece respirator.
        J Occup Environ Hyg. 2007; 4: 698-707
        • Myers W.R.
        • Zhuang Z.
        • Nelson T.
        • Sides S.
        • Wilmes D.
        Field performance measurements of half-facepiece respirators - study protocol.
        Am Ind Hyg Assoc J. 1995; 56: 765-775
        • Gershon R.R.
        • Pearson J.M.
        • Westra L.J.
        Evaluation tool for the assessment of personal protective respiratory equipment.
        Infect Cont Hosp Ep. 2009; 30: 716-718
        • Guo Y.P.
        • Yi L.
        • Tokura H.
        • Wong T.K.
        • Chung J.W.
        • Gohel M.D.
        • et al.
        Evaluation on masks with exhaust valves and with exhaust holes from physiological and subjective responses.
        J Physiol Anthropol. 2008; 27: 93-102
        • Hayashi C.
        • Tokura H.
        The effects of two kinds of mask (with or without exhaust valve) on clothing microclimates inside the mask in participants wearing protective clothing for spraying pesticides.
        Int Arch Occup Environ Health. 2004; 77: 73-78
        • Li Y.
        • Tokura H.
        • Guo Y.P.
        • Wong A.S.
        • Wong T.
        • Chung J.
        • et al.
        Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations.
        Int Arch Occup Environ Health. 2005; 78: 501-509
        • Roberge R.J.
        • Kim J.H.
        • Benson S.
        N95 filtering facepiece respirator deadspace temperature and humidity.
        J Occup Environ Hyg. 2012; 9: 166-171
        • Roberge R.J.
        • Kim J.H.
        • Coca A.
        Protective facemask impact on human thermoregulation: an overview.
        Ann Occup Hyg. 2012; 56: 102-112
      2. Berry Ann R. NIOSH Investigation of 3M Model 8000 Filtering Facepiece Respirators Requested by the California Occupational Safety and Health Administration, Division of Occupational Safety and Health. Oakland, CA 2010-0044-3109; 2010. Available at: http://www.cdc.gov/niosh/hhe/reports/pdfs/2010-0044-3109.pdf. Accessed December 3, 2014.

        • Derrick J.L.
        • Chan Y.F.
        • Gomersall C.D.
        • Lui S.F.
        Predictive value of the user seal check in determining half-face respirator fit.
        J Hosp Infect. 2005; 59: 152-155
        • Lam S.C.
        • Lee J.K.
        • Yau S.Y.
        • Charm C.Y.
        Sensitivity and specificity of the user-seal-check in determining the fit of N95 respirators.
        J Hosp Infect. 2011; 77: 252-256
        • Lam S.C.
        • Lee J.K.
        • Lee L.Y.
        • Wong K.F.
        • Lee C.N.
        Respiratory protection by respirators: the predictive value of user seal check for the fit determination in healthcare settings.
        Infect Cont Hosp Epidemiol. 2011; 32: 402-403
        • Lee M.C.
        • Takaya S.
        • Long R.
        • Joffe A.M.
        Respirator-fit testing: does it ensure the protection of healthcare workers against respirable particles carrying pathogens?.
        Infect Cont Hosp Epidemiol. 2008; 29: 1149-1156
        • Winter S.
        • Thomas J.H.
        • Stephens D.P.
        • Davis J.S.
        Particulate face masks for protection against airborne pathogens - one size does not fit all: an observational study.
        Crit Care Resusc. 2010; 12: 24-27
        • McMahon E.
        • Wada K.
        • Dufresne A.
        Implementing fit testing for N95 filtering facepiece respirators: practical information from a large cohort of hospital workers.
        Am J Infect Control. 2008; 36: 298-300
        • Bryce E.
        • Forrester L.
        • Scharf S.
        • Eshghpour M.
        What do healthcare workers think? A survey of facial protection equipment user preferences.
        J Hosp Infect. 2008; 68: 241-247
        • Viscusi D.J.
        • Bergman M.S.
        • Novak D.A.
        • Faulkner K.A.
        • Palmiero A.
        • Powell J.
        • et al.
        Impact of three biological decontamination methods on filtering facepiece respirator fit, odor, comfort, and donning ease.
        J Occup Environ Hyg. 2011; 8: 426-436
        • Shenal B.V.
        • Radonovich Jr., L.J.
        • Cheng J.
        • Hodgson M.
        • Bender B.S.
        Discomfort and exertion associated with prolonged wear of respiratory protection in a health care setting.
        J Occup Environ Hyg. 2012; 9: 59-64
        • Gosch M.E.
        • Shaffer R.E.
        • Eagan A.E.
        • Roberge R.J.
        • Davey V.J.
        • Radonovich Jr., L.J.
        B95: a new respirator for health care personnel.
        Am J Infect Control. 2013; 41: 1224-1230
        • Danyluk Q.
        • Hon C.Y.
        Strengthening N95 filtering facepiece respirator protection programs by evaluating the contribution of each of the program elements.
        Workers' Compensation Board of British Columbia, Richmond, British Columbia, Canada2011 (WCB File RS2007-OG09)
        • Wilkinson I.J.
        • Pisaniello D.
        • Ahmad J.
        • Edwards S.
        Evaluation of a large-scale quantitative respirator-fit testing program for healthcare workers: survey results.
        Infect Cont Hosp Epidemiol. 2010; 31: 918-925