Better Protection for Health Care Workers

Working together, manufacturers and providers can ensure there is an abundant supply of N95 respirators workers will use.

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.

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