N95 respirator seal integrity following extended-use by healthcare workers in the intensive care unit: A cohort study

IF 2.6 3区医学 Q2 CRITICAL CARE MEDICINE

Australian Critical Care Pub Date : 2025-01-01 DOI:10.1016/j.aucc.2024.07.080

Samuel J. Reade MBChB, MRes, Ahmad Bassam MBBS, BMedSci, Wisam Al-Bassam FCICM, MBChB, Umesh Kadam MD, MRCP UK, FCICM

{"title":"N95 respirator seal integrity following extended-use by healthcare workers in the intensive care unit: A cohort study","authors":"Samuel J. Reade MBChB, MRes, Ahmad Bassam MBBS, BMedSci, Wisam Al-Bassam FCICM, MBChB, Umesh Kadam MD, MRCP UK, FCICM","doi":"10.1016/j.aucc.2024.07.080","DOIUrl":null,"url":null,"abstract":"<div><h3>Aim/objectives</h3><div>Fit testing of N95/FFP2 respirators is universally recommended before exposure to airborne infectious diseases such as COVID-19. Respirator supply shortage in the COVID-19 pandemic encouraged extended-use for up to 4 h, despite uncertainty about seal integrity over time. The aim of our study was to assess N95 seal integrity after at least 2 h of continuous clinical use in the intensive care unit (ICU). We hypothesised that seal integrity would deteriorate over time, with variability between respirator shapes.</div></div><div><h3>Methods</h3><div>A prospective cohort study of healthcare workers in a metropolitan ICU setting in Australia between April 2021 and August 2022. Following consent and screening, participants underwent qualitative fit testing in the ICU, and fit tests were repeated following a continuous period of at least 2-h usage. The primary outcome was N95 fit-test failure rate measured by qualitative fit testing of >2 h compared to baseline. Secondary outcomes evaluated effects of respirator shape, demographic characteristics, and duration of respirator use on respirator fit after 2 h use.</div></div><div><h3>Results</h3><div>Fifty-one participants were recruited and consented. Six participants were excluded; four failed baseline fit test, one could not taste saccharin, and one did not complete 2 h of usage. Fourteen of 45 participants (∼31%) failed the extended-use fit test (median duration: 2 h 10 min [interquartile range: 2:07–2:20]). Fit-test rates differed between respirator shapes; three-piece flat-fold respirators had lower failure rates (6/32; 19%) than duckbill-shaped respirators (6/11; 55%) p = 0.046. No other demographic characteristic or respirator shape was significantly associated with increased failure rate.</div></div><div><h3>Conclusions</h3><div>Following 2 h of use, approximately 30% of participants failed repeat fit testing, suggesting incomplete respiratory protection. Three-piece flat-fold respirators outperformed duckbill respirators. Extended use of respirators, even without respirator reuse, may put healthcare workers at risk of inadequate respiratory protection, in particular when using duckbill-shaped respirators.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101099"},"PeriodicalIF":2.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Australian Critical Care","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1036731424002091","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Aim/objectives

Fit testing of N95/FFP2 respirators is universally recommended before exposure to airborne infectious diseases such as COVID-19. Respirator supply shortage in the COVID-19 pandemic encouraged extended-use for up to 4 h, despite uncertainty about seal integrity over time. The aim of our study was to assess N95 seal integrity after at least 2 h of continuous clinical use in the intensive care unit (ICU). We hypothesised that seal integrity would deteriorate over time, with variability between respirator shapes.

Methods

A prospective cohort study of healthcare workers in a metropolitan ICU setting in Australia between April 2021 and August 2022. Following consent and screening, participants underwent qualitative fit testing in the ICU, and fit tests were repeated following a continuous period of at least 2-h usage. The primary outcome was N95 fit-test failure rate measured by qualitative fit testing of >2 h compared to baseline. Secondary outcomes evaluated effects of respirator shape, demographic characteristics, and duration of respirator use on respirator fit after 2 h use.

Results

Fifty-one participants were recruited and consented. Six participants were excluded; four failed baseline fit test, one could not taste saccharin, and one did not complete 2 h of usage. Fourteen of 45 participants (∼31%) failed the extended-use fit test (median duration: 2 h 10 min [interquartile range: 2:07–2:20]). Fit-test rates differed between respirator shapes; three-piece flat-fold respirators had lower failure rates (6/32; 19%) than duckbill-shaped respirators (6/11; 55%) p = 0.046. No other demographic characteristic or respirator shape was significantly associated with increased failure rate.

Conclusions

Following 2 h of use, approximately 30% of participants failed repeat fit testing, suggesting incomplete respiratory protection. Three-piece flat-fold respirators outperformed duckbill respirators. Extended use of respirators, even without respirator reuse, may put healthcare workers at risk of inadequate respiratory protection, in particular when using duckbill-shaped respirators.

查看原文本刊更多论文

重症监护室医护人员长时间使用 N95 呼吸器后的密封完整性：一项队列研究。

目的/目标：在接触 COVID-19 等空气传播传染病之前，普遍建议对 N95/FFP2 呼吸器进行密合度测试。在 COVID-19 大流行中，呼吸器供应短缺促使人们延长使用时间长达 4 小时，尽管随着时间的推移密封完整性仍存在不确定性。我们研究的目的是评估在重症监护室（ICU）连续临床使用至少 2 小时后 N95 密封件的完整性。我们的假设是，密封完整性会随着时间的推移而恶化，不同形状的呼吸器之间存在差异：前瞻性队列研究：2021 年 4 月至 2022 年 8 月期间，对澳大利亚大都市 ICU 环境中的医护人员进行研究。在征得同意和筛选后，参与者在重症监护室进行了密合度定性测试，并在连续使用至少 2 小时后重复进行密合度测试。主要结果是与基线相比，N95密合度测试失败率（通过>2小时的定性密合度测试进行测量）。次要结果是评估呼吸器形状、人口统计学特征和呼吸器使用时间对使用 2 小时后呼吸器密合度的影响：共招募了 51 名参与者并征得其同意。结果：共招募了 51 名参与者并征得其同意，其中 6 人被排除在外；4 人未通过基线密合度测试，1 人无法品尝糖精，1 人未完成 2 小时的使用。45 名参与者中有 14 人（31%）未能通过延长使用时间的密合度测试（中位数时间：2 小时 10 分钟[四分位间范围：2:07-2:20]）。不同形状呼吸器的密合度测试失败率不同；三片式平折呼吸器的失败率（6/32；19%）低于鸭嘴型呼吸器（6/11；55%），P = 0.046。其他人口特征或呼吸器形状均与故障率的增加无明显关联：使用 2 小时后，约 30% 的参与者未能通过重复密合度测试，这表明呼吸保护功能不完善。三片式平折叠呼吸器的性能优于鸭嘴式呼吸器。长时间使用呼吸器，即使没有重复使用呼吸器，也可能使医护人员面临呼吸保护不足的风险，尤其是在使用鸭嘴型呼吸器时。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Australian Critical Care NURSING-NURSING

CiteScore

4.90

自引率

9.10%

发文量

148

审稿时长

>12 weeks

期刊介绍： Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.