Better Protection for Health Care Workers
Working together, manufacturers and providers can ensure there is an abundant supply of N95 respirators workers will use.
- By Richard B. Jaffe
- May 01, 2010
The health care industry is a hotbed for continual
waves of technological innovation and
advancement, so why are front-line medical
workers relying on respirator technology that
hasn't changed much in more than 20 years? And why
are manufacturers of personal protective technology
so slow in responding to continuous complaints about
respirator comfort and breathability?
Recent discussions about respirator technology
have turned to debates over the comparative efficacy
of N95 models versus standard surgical masks for
protecting health care workers from the H1N1 pandemic
threat. The continuing dispute, which was
partially fueled by a well-publicized supply shortage
in the United States, intensified when several limited
studies suggested face masks and N95 respirators provide
similar protection against influenza.
As leading nurses' unions and the CDC joined
forces on one side of the debate, the California Department
of Public Health issued a recall of the state's
stockpile of respirators due to a low success rate in
fit testing. Amid product recalls, supply shortages,
and ongoing respirator vs. surgical mask debates, the
CDC, NIOSH, and OSHA have stood firm in their
positions that N95 respirators play a critical role in
safeguarding health care workers from airborne particles,
including transmission of H1N1 influenza.
However, numerous studies reveal health care
workers generally don't comply with respiratory
protection guidelines because of discomfort; excessive
humidity, or heat; headaches; diminished visual,
vocal, or auditory acuity; skin irritation; and other
interferences with occupational duties. A recurring
theme emanating from empirical and anecdotal research
points to the fact that health care workers feel
traditional respirators do not provide the comfort and
breathability they need to perform at their peak.
The bottom line: Traditional respirator technology
does not meet the comfort and breathability needs of
today's front-line medical workers. In order to provide
this workforce of more than 14 million with the protection
they need for an entire eight-hour shift , medical
device manufacturers and health care providers
must play an equally important role. Manufacturers
must embrace product innovation and evolve current
respirator designs to focus more on wearability,
breathability, comfort, and the ability to communicate
while wearing. Health care providers, in turn, must
stockpile these technologically advanced respirators
as part of an ongoing commitment to proper pandemic
preparedness. Working together in this manner,
manufacturers and providers can ensure that the
next time there is a critical need for personal protective
equipment -- be it a third wave of H1N1 activity
or another unforeseen disaster or pandemic -- health
care workers will enjoy access to an abundant supply
of N95 respirators that provide the comfort, breathability,
and protection they need to do their jobs right.
Challenges with Today's Respirators
The most important aspect of an N95 respirator also
represents the biggest challenge: It must fit snugly to
the face to minimize the degree of inward leakage and,
therefore, risk of exposure. Airtight face seals, however,
can cause problems with breathability, comfort,
communication, heat buildup, and condensation. The
most popular respirators on the market today typically
sport either a cup-shaped or pouch style ("duckbill")
design, which can make them very difficult to
breathe through for long periods of time.
To address these issues, CDC, NIOSH, and the
Veterans Administration teamed in 2007 to create
Project BREATHE (Better Respirator Equipment
Using Advanced Technologies for Healthcare Employees).
The charter of this group is to determine
the ideal characteristics of a health care-specific respirator.
In December 2009, the group published the
results of a survey that solicited responses from 159
health care workers at two tertiary care medical centers.
The survey requested their views about respirator use and asked them to identify the features
that should be included in next-generation
respirators. Nearly nine out of 10 of the
respondents reported they couldn't tolerate
wearing a traditional respirator for an
entire eight-hour shift . Survey results also
indicated health care workers wanted respirator
designs to be more comfortable,
interfere less with breathing, diminish heat
buildup, disposable, and permit the user
to have facial hair. Based on the results,
the study concluded respirators should
be modified to meet the specific needs of
health care workers in order to increase acceptance
and improve compliance rates.
Next-Gen Respirator Development
Fortunately, newer respirator technology
is emerging to address the "wearability"
concerns of N95 respirators by combining
the "look and feel" of a surgical mask with
the added protection of an N95 respirator.
These disposable, "hybrid" respirators
adhere to strict NIOSH N95 certification
requirements and embrace advanced faceseal
technologies to achieve high fit-testing
success rates, which is significant because
this necessary process can become time
consuming, expensive, and laborious if the
product doesn't fit a large percentage of the
organization's employees.
Additionally, the new generation of
respirators features innovative face seals
that allow air through the top, bottom,
and sides of the respirator but filter it before
entry, all while providing exceptional
filtration capabilities through the front of
the respirator. This advanced design significantly reduces breathability challenges
associated with traditional, tight-fitting
respirators while lessening heat buildup
and humidity problems generally encountered
with traditional respirators. Early usage
reports reveal health care workers can
breathe and speak more clearly through
hybrid respirators, making it much easier
to communicate with patients and perform
occupational duties. Another advancement
gaining ground is the addition
of antimicrobial protection on the respirator's
outer surface, which adds another layer
of product protection against airborne
particles and microorganisms.
In order to encourage increased compliance
among health care workers, N95
respirator technology must continually
evolve to deliver the protection they need
without sacrificing critical factors that are
essential to job performance. With the latest
advancements, the hybrid respirator
blends the best of both worlds: It's designed
to leverage the high user acceptance rates
associated with surgical masks while ensuring
health care workers have the full filtration
protection associated with NIOSH
N95 protection.
This article originally appeared in the May 2010 issue of Occupational Health & Safety.