Health care workers' perceptions and reported use of respiratory protective equipment: A qualitative analysis.

Background: Little is known about health care workers' (HCW) perceptions of, or experiences using, respiratory protective equipment (RPE). We sought to characterize their perceptions and identify reasons underlying inappropriate use.

Methods: We conducted 12 focus groups with nurses and nursing assistants at 4 medical centers.

Epidemiology of nontuberculous mycobacterial infections in the U.S. Veterans Health Administration.

Objective: We identified patients with non-tuberculous mycobacterial (NTM) disease in the US Veterans Health Administration (VHA), examined the distribution of diseases by NTM species, and explored the association between NTM disease and the frequency of clinic visits and mortality.

Methods: We combined mycobacterial isolate (from natural language processing) with ICD-9-CM diagnoses from VHA data between 2008 and 2012 and then applied modified ATS/IDSA guidelines for NTM diagnosis. We performed validation against a reference standard of chart review.

Implementing a negative-pressure isolation ward for a surge in airborne infectious patients.

Background: During a large-scale airborne infectious disease outbreak, the number of patients needing hospital-based health care services may exceed available negative-pressure isolation room capacity.

Methods: To test one method of increasing hospital surge capacity, a temporary negative-pressure isolation ward was established at a fully functioning hospital. Negative pressure was achieved in a 30-bed hospital ward by adjusting the ventilation system.

Development and initial validation of the Respirator Comfort, Wearing Experience, and Function Instrument [R-COMFI].

Filtering face-piece respirators (FFRs) are worn to protect health care personnel from airborne particles; however, clinical studies have demonstrated that FFR adherence is relatively low in some settings, in part, due to discomfort and intolerance. The objective of this study was to develop and initially evaluate the psychometric properties of an instrument designed to measure the comfort and tolerability of FFRs. Instrument items were developed through literature reviews, focus groups, and several iterations of ranking and refining by experts.

Potential airborne pathogen transmission in a hospital with and without surge control ventilation system modifications.

To better understand the transport of airborne particulate matter (PM) in hospital environments when surge control strategies are implemented, tests were conducted in a recently decommissioned hospital during a one-week period. An aerosol was released within a patient room and concentrations measured in the room and hallway with and without surge control ventilation system modifications. The average hallway protection efficiencies were high (>98%) both for the baseline ventilation configuration and when the ventilation system was modified for whole floor negative pressure, indicating very little PM reached the hallway.

The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel.

Background: Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts.

Methods: The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.

Activity of Fosfomycin against Extended-Spectrum-β-Lactamase-Producing Uropathogens in Patients in the Community and Hospitalized Patients.

Few oral antibiotics exist for the empirical treatment of extended-spectrum β-lactamase (ESBL) urinary tract infections (UTI). In this study, we sought to determine the activity of fosfomycin against ESBL-producing uropathogens from patients at 3 Veterans Affairs (VA) facilities between 2010 and 2013. Among the ESBL uropathogens, 19.

Two Simple Rules for Improving the Accuracy of Empiric Treatment of Multidrug-Resistant Urinary Tract Infections.

The emergence of multidrug-resistant (MDR) uropathogens is making the treatment of urinary tract infections (UTIs) more challenging. We sought to evaluate the accuracy of empiric therapy for MDR UTIs and the utility of prior culture data in improving the accuracy of the therapy chosen. The electronic health records from three U.

Clinical and economic impact of various strategies for varicella immunity screening and vaccination of health care personnel.

Background: Exposure to patients with varicella or herpes zoster causes considerable disruption to a health care facility's operations and has a significant health and economic impact. However, practices related to screening for immunity and immunization of health care personnel (HCP) for varicella vary widely.

Methods: A decision tree model was built to evaluate the cost-effectiveness of 8 different strategies of screening and vaccinating HCP for varicella.

Comparative Cost of Stockpiling Various Types of Respiratory Protective Devices to Protect the Health Care Workforce During an Influenza Pandemic.

Specific guidance on the size and composition of respiratory protective device (RPD) stockpiles for use during a pandemic is lacking. We explore the economic aspects of stockpiling various types and combinations of RPDs by adapting a pandemic model that estimates the impact of a severe pandemic on a defined population, the number of potential interactions between patients and health care personnel, and the potential number of health care personnel needed to fulfill those needs. Our model calculates the number of the different types of RPDs that should be stockpiled and the consequent cost of purchase and storage, prorating this cost over the shelf life of the inventory.

Disinfection of reusable elastomeric respirators by health care workers: a feasibility study and development of standard operating procedures.

Background: This was a feasibility study in a Department of Veterans Affairs Medical Center to develop a standard operating procedure (SOP) to be used by health care workers to disinfect reusable elastomeric respirators under pandemic conditions. Registered and licensed practical nurses, nurse practitioners, aides, clinical technicians, and physicians took part in the study.

Methods: Health care worker volunteers were provided with manufacturers' cleaning and disinfection instructions and all necessary supplies.

Collateral benefit of screening patients for methicillin-resistant Staphylococcus aureus at hospital admission: isolation of patients with multidrug-resistant gram-negative bacteria.

Background: Surveillance at hospital admission for multidrug-resistant (MDR) gram-negative bacteria (GNB) is not often performed, potentially leaving patients carrying these organisms unrecognized and not placed in transmission precautions until they develop infection. Veterans Affairs (VA) facilities screen all admissions for methicillin-resistant Staphylococcus aureus (MRSA) and place positive patients in contact precautions. We assessed how often patients with MDR GNB in clinical cultures obtained within 30 days following admission would have been in contact precautions because of a positive MRSA admission screen.

Effectiveness of common healthcare disinfectants against H1N1 influenza virus on reusable elastomeric respirators.

This study evaluated the efficacy of 3 common hospital disinfectants to inactivate influenza virus on elastomeric respirators. Quaternary ammonium/isopropyl alcohol and bleach detergent wipes eliminated live virus, whereas 70% isopropyl alcohol alone was ineffective.

B95: a new respirator for health care personnel.

Background: Respiratory protection relies heavily on user compliance to be effective, but compliance among health care personnel is less than ideal.

Methods: In 2008, the Department of Veterans Affairs formed the Project Better Respiratory Equipment using Advanced Technologies for Healthcare Employees (BREATHE) Working Group, composed of a variety of federal stakeholders, to discuss strategies for improving respirator compliance, including the need for more comfortable respirators.

Results: The Working Group developed 28 desirable performance characteristics that can be grouped into 4 key themes: (1) respirators should perform their intended function safely and effectively; (2) respirators should support, not interfere, with occupational activities; (3) respirators should be comfortable and tolerable for the duration of wear; and (4) respiratory protective programs should comply with federal/state standards and guidelines and local policies.

MRSA nasal carriage patterns and the subsequent risk of conversion between patterns, infection, and death.

Background: Patterns of methicillin-resistant S. aureus (MRSA) nasal carriage over time and across the continuum of care settings are poorly characterized. Knowledge of prevalence rates and outcomes associated with MRSA nasal carriage patterns could help direct infection prevention strategies.

The effects of the Health Insurance Portability and Accountability Act privacy rule on influenza research using geographical information systems.

The Health Insurance Portability and Accountability Act (HIPAA) privacy rule was enacted to protect patients' personal health information from undue disclosure. Despite its intention to protect patients, recent reports suggest that HIPAA restrictions may be negatively impacting health research. Quantitative, visual geographical and statistical analysis of zip code geographical information systems (GIS) mapping, comparing 3-digit HIPAA-compliant and 5-digit HIPAA-non-compliant simulated data, was chosen to identify and describe the type of distortion that may result.

Health care workers' views about respirator use and features that should be included in the next generation of respirators.

Background: Numerous studies have demonstrated that health care workers are, in general, poorly compliant with respiratory protection guidelines, especially when a N95 respirator is recommended. The purpose of this study was to assess health care workers' views about respirator use and the features they prefer to be included in the next generation of respirators.

Methods: A 63-item survey was distributed to health care workers in 27 units of 2 tertiary care medical centers.

Diminished speech intelligibility associated with certain types of respirators worn by healthcare workers.

This study sought to determine the level of communication interference associated with commonly used disposable and reusable respirators and surgical masks worn by healthcare workers. Speech intelligibility was assessed using the modified rhyme test in an intensive care unit environment. Respirators decreased speech intelligibility by a range of 1% to 17%, although not all were statistically significant.

Preventing the soldiers of health care from becoming victims on the pandemic battlefield: respirators or surgical masks as the armor of choice.

The respiratory protective equipment necessary to protect health care workers from the novel swine-origin influenza A (H1N1) virus is not known. The knowledge gap created by this unanswered question has caused substantial debate and controversy on a global scale, leading public health organizations to feel pressured into issuing decisive recommendations despite a lack of supportive data. Changes in clinical practice caused by public health guidance during such high-profile events can be expected to establish a new standard of care.