Effectiveness Of Respiratory Protection Research Articles

Take-home kits to detect respiratory viruses among healthcare personnel: Lessons learned from a cluster randomized clinical trial

BackgroundHealth care personnel (HCP) working in outpatient settings routinely interact with patients with acute respiratory illnesses. Absenteeism following symptom development and lack of staff trained to obtain samples limit efforts to identify pathogens among infected HCP. MethodsThe Respiratory Protection Effectiveness Clinical Trial assessed respiratory infection incidence among HCP between 2011 and 2015. Research assistants obtained anterior nasal and oropharyngeal swabs from HCP in the workplace following development of respiratory illness symptoms and randomly while asymptomatic. Participants received take-home kits to self-collect swabs when absent from work. Samples mailed to a central laboratory were tested for respiratory viruses by reverse transcription polymerase chain reaction. ResultsAmong 2,862 participants, 3,467 swabs were obtained from symptomatic participants. Among symptomatic HCP, respiratory virus was detected in 904 of 3,467 (26.1%) samples. Self-collected samples by symptomatic HCP at home had higher rates of viral detection (40.3%) compared to 24% obtained by trained research assistants in the workplace (P < .001). ConclusionsIn this randomized clinical trial, take-home kits were an easily implemented, effective method to self-collect samples by HCP. Other studies have previously shown relative equivalence of self-collected samples to those obtained by trained healthcare workers. Take-home kit self-collection could diminish workforce exposures and decrease the demand for personnel protective equipment worn to protect workers who collect respiratory samples.

Geoffrey Rose's Strategy of Prevention Applied to COVID-19.

Geoffrey Rose's Strategy of Prevention Applied to COVID-19.

Risk Factors for Healthcare Personnel Infection With Endemic Coronaviruses (HKU1, OC43, NL63, 229E): Results from the Respiratory Protection Effectiveness Clinical Trial (ResPECT).

BackgroundSARS-CoV-2 presents a large risk to healthcare personnel. Quantifying the risk of coronavirus infection associated with workplace activities is an urgent need.MethodsWe assessed the association of worker characteristics, occupational roles and behaviors, and participation in procedures with the risk of endemic coronavirus infection among healthcare personnel who participated in the Respiratory Protection Effectiveness Trial (ResPECT), a cluster randomized trial to assess personal protective equipment to prevent respiratory infections and illness conducted from 2011 to 2016.ResultsAmong 4,689 HCP-seasons, we detected coronavirus infection in 387 (8%). HCP who participated in an aerosol generation procedure (AGP) at least once during the viral respiratory season were 105% (95% CI 21%, 240%) more likely to be diagnosed with a laboratory-confirmed coronavirus infection. Younger individuals, those who saw pediatric patients and those with household members under the age of five were at increased risk of coronavirus infection.ConclusionsOur analysis suggests the risk of HCP becoming infected with an endemic coronavirus increases approximately two-fold with exposures to AGP. Our findings may be relevant to the Coronavirus Disease 2019 (COVID-19) pandemic; however, SARS-COV-2, the virus that causes COVID-19, may differ from endemic coronaviruses in important ways.

410. Influence of Pre-season Antibody Titers to Influenza on Influenza Risk in a Cohort of Healthcare Personnel

BackgroundInfluenza (flu) and other respiratory viruses circulate regularly throughout healthcare systems, often placing healthcare personnel (HCP) at high risk for illness. Hemagglutination inhibition (HAI) titers are associated with protection from flu illness, though few studies have characterized HAI in HCP. The Respiratory Protection Effectiveness Clinical Trial (ResPECT), provided HAI titers and data to assess infection risk based on four flu seasons. Participants from multiple outpatient settings wore respiratory protection within six feet of symptomatic patients.MethodsSerological samples obtained at the beginning and end of each season and anterior nasopharyngeal swabs were taken randomly and when participants reported respiratory symptoms were assessed. Our primary outcome was PCR-confirmed influenza.ResultsDuring 5,180 participant-seasons of observation, 128 PCR-confirmed influenza A infections (20 H1N1, 108 H3N2) and 34 PCR-confirmed influenza B infections. 4,041 (78%) reported receiving an annual influenza vaccine. Each log base 2 increase in titer subtype-specific titer reduced the hazard of influenza infection with A/H3N2 by 18%(Relative Risk (RR) 0.82 95% CI 0.72,0.94), by 28% for influenza B (RR 0.72 95% CI 0.56,0.92 and by 25% for influenza A H1N1 (RR 0.75 95% CI 0.57–1.0). After adjusting for HAI titers, age was not significantly associated with risk for any of the subtypes.ConclusionIn this prospective cohort of monitored HCPs, these findings support the current literature demonstrating that HAI titers are associated with protection from influenza infection. The relationship between HAI titers, influenza, and vaccination is complex, however. Vaccination was not shown to be associated with infection outcome in our model, though their effect may be difficult to separate from their effect on HAI titers.DisclosuresTrish M. Perl, MD, MSc, 7–11: Advisory Board; medimmune: Research Grant.

1204. Increased Risk of Respiratory Infections Among Healthcare Personnel (HCP) Caring for Children

BackgroundHealthcare personnel (HCP) are exposed to many individuals with respiratory illness while providing care. Because children more frequently present for care with respiratory infections compared with older individuals, we hypothesized that HCP working in pediatric settings might experience greater risks of respiratory infection than HCP working in adult settings. The Respiratory Protection Effectiveness Clinical Trial (ResPECT) prospectively compared respiratory protection among HCP at seven health systems across the United States between 2011 and 2015.MethodsSwabs were collected from asymptomatic participants twice each respiratory season. Swabs were collected from symptomatic HCP within 24 hours of self-reported respiratory symptoms and again if participants were still symptomatic after 7 days. PCR confirmation for 13 viruses was done by a single laboratory. We compared hazards of multiple outcomes associated with respiratory infections among HCP working in pediatric clinics and HCP working in clinics that care for adults.ResultsThe main outcomes were risk factors for symptomatic and asymptomatic viral respiratory infections. A total of 5,180 participant-seasons were evaluated from 2011–2015, 1,130 of which worked solely with children. There were 403 and 1,162 incidents of asymptomatic and symptomatic PCR-confirmed respiratory infection, respectively. Risk factors associated with respiratory infection in the entire cohort included age, race, vaccination status, smoking status, wearing contacts, total household members, study site, and age of patient population. HCP working exclusively with pediatric patients had 1.5 (95% CI 1.2–1.8) times the rate of respiratory virus infection compared with HCP working only with adults. HCP who worked with both populations had 1.4 times (95% CI: 1.2–1.7) the rate of infection with respiratory viruses.ConclusionThe risk of respiratory infections was increased among HCP that saw children. This risk was not mitigated by working only part-time with children and extended to those who identified as working with both adult and pediatric populations. Our findings highlight the need to target interventions in pediatric settings to decrease HCP acquisition of respiratory infections.DisclosuresTrish M. Perl, MD; MSc, 7–11: Advisory Board; medimmune: Research Grant.

1716. Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT)

Results of the Respiratory Protection Effectiveness Clinical Trial (ResPECT)BackgroundRespiratory protection (RP) for healthcare personnel (HCP) is controversial and clinical studies are inconclusive about the effectiveness of N95 respirators (N95) and medical masks (MM) for protecting HCP from workplace viral respiratory infections and illnesses (VRII).MethodsWe conducted a cluster-randomized, investigator-blinded, multisite effectiveness study comparing N95 to MM in geographically diverse, high exposure outpatient settings between 2011 and 2016. Each year during VRII season, participants wore assigned devices when within 6 feet of patients with known or suspected respiratory illness. Respiratory swabs were collected from symptomatic and asymptomatic participants. Diaries detailed VRII exposures, influenza vaccination, adherence to RP and hand hygiene, and manifestations of illness. The primary and secondary outcomes were the incidence of laboratory-confirmed influenza (LCI) using polymerase chain reaction (PCR) and hemagglutinin inhibition assays (HAI), and acute respiratory illness (ARI), influenza-like illness (ILI), laboratory-confirmed respiratory illness (LCRI), and laboratory-detected respiratory infection (LDRI) (figure). Intervention protective effects were estimated using unadjusted odds and incidence rate ratios.Figure:ResPECT Outcomes. (A) Influenza Incidence and Primary Outcomes Panel. (B) Secondary OutcomesResults5,180 HCP seasons enrolled and randomized (2,243 to N95 and 2,446 to MM), with 4,689 (91%) completing the study. In the intention-to-treat cohort (ITT), among participants in the N95 and MM groups, respectively, 207 (8.2%) and 193 (7.2%) were diagnosed with LCI (odds ratio [OR] 1.14, 95% confidence interval [CI] 0.93–1.40); 1,556 (61.9%) and 1711 (64.1%) were diagnosed with ARI (relative risk (RR) 0.99, CI 0.92–1.06); 128 (5.1%) and 166 (6.2%) were diagnosed with ILI (RR 0.87, CI 0.68–1.10), 371 (14.8%) and 417 (15.6%) were diagnosed with LCRI (RR 0.97, CI 0.84–1.12); and 679 (27.0%) and 745 (27.9%) were diagnosed with LDRI (RR 0.99, CI 0.89–1.09). The adjusted ITT and per-protocol analyses yielded similar results.ConclusionIn this outpatient-based, cluster-randomized, controlled trial, neither N95 nor MM resulted in superior protection from LCI or VRII.Disclosures C. Gaydos, BioFire: Consultant, Consulting fee. Cepheid: Speaker’s Bureau, Speaker honorarium. Becton Dickinson: Speaker’s Bureau, Speaker honorarium.

In-mask temperature and humidity can validate respirator wear-time and indicate lung health status

The effectiveness of respiratory protection is dependent on many factors, including the duration and times during the day when it is worn. To date, these factors could only be assessed by direct observation of the respirator user. We describe the novel use of a data-logging temperature and humidity sensor (iButton Hygrochron) located inside a facemask to quantify respirator wear-time through supervised experiments (Phase 1) and an unsupervised wearing trial (Phase 2). Additionally, in Phase 1 the in-mask temperature was compared with measurements of exhaled breath temperature. We found humidity responds more rapidly than temperature to donning a mask, so it was considered a more sensitive measure of wear-time, particularly for short durations. Supervised tests showed that this method can provide accurate and precise estimates of wear-time, although the approach may be unsuitable for use in situations where there is high ambient humidity. In-mask temperature is closely associated with exhaled breath temperature, which is linked to lung inflammation. This technique could provide a useful way of evaluating the effectiveness of respirators in protecting health in real-life situations.

Protecting Healthcare Personnel in Outpatient Settings: The Influence of Mandatory Versus Nonmandatory Influenza Vaccination Policies on Workplace Absenteeism During Multiple Respiratory Virus Seasons.

OBJECTIVE To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP). DESIGN Retrospective observational cohort study. SETTING This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies. PARTICIPANTS The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites. METHODS To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012-2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models. RESULTS The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07-0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012-2013 and 2013-2014, 0.82; 95% CI, 0.72-0.93; OR for 2014-2015, 0.81; 95% CI, 0.69-0.95). CONCLUSIONS These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies. Infect Control Hosp Epidemiol 2018;39:452-461.

Effect of Respiratory Protection on Respiratory Flow Rates of Vehicle Spray Painters in Ibadan Metropolis, Oyo State, Nigeria

Effect of Respiratory Protection on Respiratory Flow Rates of Vehicle Spray Painters in Ibadan Metropolis, Oyo State, Nigeria

The Influence of Mandatory Vs. Non-Mandatory Influenza Vaccination Policies on Workplace Absenteeism During Respiratory Virus Season

BackgroundWe analyzed data from health care personnel (HCP) participating in the multicenter, cluster randomized Respiratory Protection Effectiveness Clinical Trial (ResPECT) obtained over three viral respiratory (influenza) illness seasons (2012–2015) at three university health systems where influenza vaccination was mandated, and four Veterans Affairs (VA) health systems where it was encouraged but not mandated, to determine the incidence and duration of symptomatic influenza like illness (SILI) associated absenteeism.MethodsParticipants reported SILI daily, vaccination status, and days absent from work due to SILI weekly throughout a 12 week period during the peak viral respiratory illness season each year. Adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.ResultsOverall 97.1%, 96.3%, and 92.1% of participants reported being vaccinated during each of the three study years where the vaccine was mandated, while 67.9%, 63.3%, and 60.4% reported vaccination at sites where it was encouraged but not mandated. The percent of HCP claiming any sick days at mandatory sites was estimated to be 5.9% lower than at non-mandatory sites (95% CI, -12.5, -1.4; P = 0.02). Among HCP who reported at least one sick day, the mean number of symptomatic sick days at mandatory sites was 0.74 lower than at non-mandatory sites (95% CI, -1.37, -0.37, P < 0.01). After adjusting for possible confounding factors (e.g., season, vaccination statues, mandatory or non-mandatory vaccination site, age, children at home) the relative rate of sick days taken by vaccinated compared with unvaccinated subjects was reduced in the entire cohort of HCP and in the vaccinated compared with unvaccinated subset of HCP from non-mandatory sites (see Figure).ConclusionWe conclude that influenza vaccination rates are increased and SILI-related absenteeism is decreased at sites where influenza vaccination is mandated and that this should be one of the factors taken into consideration when healthcare facilities make decisions about influenza vaccination policies.FigureAdjusted Odds Ratio for Vaccination Status and Taking Any Sick Time, Adjusted Relative Rate of Sick Days Taken.Disclosures All authors: No reported disclosures.

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

BackgroundAlthough 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.MethodsThe Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team.DiscussionResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems.Trial registrationThe trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010).

Respiratory Protection from Isocyanate Exposure in the Autobody Repair and Refinishing Industry

This study, part of the Survey of Painters and Repairers of Auto bodies by Yale (SPRAY), evaluated the effectiveness of respiratory protection against exposure to aliphatic polyisocyanates. A total of 36 shops were assessed for respiratory protection program completeness; 142 workers were measured for respirator fit factor (FF) using PortaCount Plus respirator fit tester. Twenty-two painters from 21 shops were sampled using NIOSH method 5525 to determine the workplace protection factor (WPF) of negative pressure, air-purifying half-facepiece respirators equipped with organic vapor cartridges and paint prefilters during spray-painting and priming activities. Only 11 shops (30%) had written respiratory protection programs. Eighty percent of all fit tested workers passed the test on the first try with FF ≥ 100, and 92% passed the second test after respirator use training. Overall geometric mean (GM) FF was 1012 for all fit tested workers. Significant differences on pass rate (92% vs. 72%) and on FF (1990 vs. 736) were found between previously fit tested workers vs. nontested workers. Twenty-nine WPF samples were collected. The outside facepiece GM concentration of total isocyanate group (NCO) was 378.4 μ g NCO/m3 with 96% concentrations exceeding the U.K. short-term exposure limit, 70 μ g NCO/m3, but no in-facepiece concentrations exceeded the limit. The GM WPF of total NCO was 319 (GSD 4) and the 5th percentile was 54. WPF of total NCO was positively correlated with the duration of painting task. FF positively correlated with WPF when FF was ≤450 but negatively correlated with WPF when FF was >450. We conclude that negative pressure, air-purifying half-facepiece respirators equipped with organic vapor cartridges and paint prefilters provide effective protection against isocyanate exposure in spray and priming operations if workers are properly trained and fitted.

The effect of respiratory protection with biological monitoring on the health management of lead workers in a storage battery industry.

Respiratory protection with maintenance free respirator and regular biological monitoring with the measurement of zinc protoporphyrin for one year period not only made significant decreases of biological indices indicative of lead exposure (blood lead, delta-aminolevulinic acid in urine) in a storage battery workers, but also reduced the prevalence of lead related symptoms.

Review of respirator performance testing in the workplace: issues and concerns.

Performance capability of respirators has traditionally been evaluated by testing components of the respirator (e.g., filter efficiency), facepiece fit, total inward leakage, or some other measure of performance evaluated under laboratory conditions. In recent years, increased emphasis has been placed on development of test methods suitable for evaluating respirator performance in the workplace. The goal of such testing is to evaluate the level of protection provided by respirators in the work environment. The AIHA Respiratory Protection Committee believes that workplace testing of respirators has the potential to be an excellent tool for increasing knowledge about the effectiveness of respiratory protection. However, a number of technical issues remain to be addressed before optimal test protocols and data analysis methods can be defined. The progress made to date in workplace testing will be reviewed, and broader discussion about key elements that must be considered when developing guidelines for testing respirators in the workplace will be initiated.

The effect of respiratory protection with biological monitoring on the health promotion of lead workers

The effect of respiratory protection with biological monitoring on the health promotion of lead workers

Great depth pneumatic caisson and its load work involved with the efficiency of respiratory protection

Pneumatic caisson work in Japan has been in operation since 1924. Afterward, this technique of compressed air work has been utilized in the constructions like as foundation works, the basements, and shafts of the bottom tunnel or shields for subway and so forth. While, it means for people to be exposed to hyperbaric environment that they use compressed air work, this technique has risks to be suffered from not only decompression sickness (DCS) but toxicity of poisonous gas or oxygen deficiency. However, this technique is necessary for urban civil engineering and recent compressed air works over than 1.0 kg/cm2 has been increased in 1.5 times more than in 1970's and the higher compressed air work more than 4.0 kg/cm2 will be actually planned in near future. So unmanned caisson work is considered as a better technique for such high pressure work, even though people must enter into hyperbaric working fields for maintenance or repair of unmanned operated machinery and materials. This research is to establish the safety work under hyperbaric environment within 7 kg/cm2. It is necessary for us to establish the system not only to keep safety but to maintain working efficiency. According to obtain the purpose, the effect of respiratory protection has been investigated and work load under hyperbaric caisson work has also been studied.

Respiratory exposure to organic phosphorus insecticides. Observations on effectiveness of respiratory protection in preventing poisoning from occupational exposure to parathion and 2-carbomethoxy-1-methylvinyldimethyl phosphate.

Respiratory exposure to organic phosphorus insecticides. Observations on effectiveness of respiratory protection in preventing poisoning from occupational exposure to parathion and 2-carbomethoxy-1-methylvinyldimethyl phosphate.