Analysis of Respiratory Program Practices and Simulated Workplace Protection Factor Studies

Background: Respiratory protection is an important way to protection people while they work. A good respiratory protection program utilizes a strong written program and also applies appropriate fit-testing measures to ensure a respirator fits and adequately protects employees while they work. Little is known regarding how well this fit test reflects how the respirator performs while someone performs their workplace tasks and if there are specific activities that would cause the respirator to fail. Methods: This research looks at the effectiveness of acute care hospital respiratory protection programs and compares them to practices as interpreted from interview responses. Next this research validates real-time methodology for measuring respirator fit on N95 filtering facepiece respirators. This real-time methodology is then used in an ensemble study of first responders and a study of realistic healthcare activities. Results: Results from the analysis of hospital written respiratory protection programs showed very few hospital designated a program administrator or performed a proper risk assessment. Written programs lacked sufficient detail in all aspects. There was no correlation between written programs and hospital practices. Real-time methodology was successfully validated against a gold standard fit-testing methodology. The real-time ensemble research with first responders showed how big of an effect the ensemble can have on respirator fit and also the importance of repeated measures to detect trends in respirator fit over time. The realistic healthcare activity research again showed the importance of repeated measures of fit and a low within-subject variability in respirator fit and a high between-subject variability. Conclusions: This research was the first of its kind to analyze how well-written hospital respiratory protection programs are. This research begins to answer questions regarding how well a respirator fits while employees perform their actual jobs and how tests can be conducted to measure real-time respirator fit.