Respiratory Protection Program Research Articles

An After-Action Review of the Implementation of a Statewide Respiratory Protection Program- Perspectives from Fit Test Assessors and Program Leads

An After-Action Review of the Implementation of a Statewide Respiratory Protection Program- Perspectives from Fit Test Assessors and Program Leads

Prospective comprehensive evaluation of an elastic-band beard cover for filtering facepiece respirators in healthcare workers.

To undertake a healthcare-based multimodal evaluation of the combination of filtering facepiece respirator (FFR) with the elastic-band beard cover technique, including quantitative fit test (QNFT) results, skills assessment, and usability assessment. We conducted a prospective study through the Respiratory Protection Program at the Royal Melbourne Hospital from May 2022 to January 2023. Healthcare workers who required respiratory protection and could not shave for religious, cultural, or medical reasons. Online education and personal face-to-face training on the use of FFR with the elastic-band beard cover technique. Among 87 participants (median beard length 38 mm; interquartile range [IQR], 20-80), 86 (99%) passed 3 QNFTs consecutively with the elastic-band beard cover under a Trident P2 respirator and 68 (78%) passed 3 QNFTs consecutively with a 3M 1870+ Aura respirator. The first QNFT pass rate and the overall fit factors were significantly higher when using the technique than without the elastic-band beard cover. Most participants displayed a high skill level in their donning, doffing, and user seal-check techniques. Of 87 participants, 83 (95%) completed the usability assessment. The overall ease of use, comfort, and overall assessment were rated highly. The elastic-band beard cover technique can provide safe and effective respiratory protection for bearded healthcare workers. The technique was easily taught, comfortable, well tolerated and accepted by healthcare workers, potentially allowing them full participation in the workforce during pandemics with airborne transmission. We recommend further research and evaluation of this technique in a broader health workforce.

Innovate and Stockpile: Respiratory Protection for Essential Workers in a Catastrophic Pandemic.

Innovate and Stockpile: Respiratory Protection for Essential Workers in a Catastrophic Pandemic.

Victoria's surgical response to the COVID-19 pandemic: the first two years.

Victoria suffered three major waves during the first two years of the COVID-19 pandemic. Melbourne became the longest locked down city in the world at 267 days. This narrative review documents the chronological waves of COVID-19 in Victoria and key themes influencing the State-wide surgical response. In 2020, Victoria needed to secure supplies of personal protective equipment (PPE) and later, recognizing the importance of aerosol transmission, introduced a respiratory protection program to protect health care workers (HCWs) with fit-tested N-95 masks. It established routine preoperative PCR testing for periods when community prevalence was high and developed strategies to restrict elective surgery when hospital capacity was limited. In 2021, three short-term outbreaks were contained and eliminated whilst vaccination of HCWs and the vulnerable was taking place. A third major wave (Delta) occurred July to November 2021, succeeded by another involving the Omicron variant from December 2021. Planned surgery waiting list numbers, and waiting times for surgery, doubled between March 2020 and March 2022. In early 2022, almost 300 patients underwent surgery when infected with Omicron, with a low mortality (2.6%), though mortality was significantly higher in the unvaccinated (7.3% versus 1.4%). In conclusion, the Victorian response to COVID-19 involved tight state-wide social restrictions, contact tracing, furlough, escalating PPE guidance and respiratory protection. HCW infections were greatly reduced in 2021 compared with 2020. Pre-operative PCR testing gave confidence for emergency and urgent elective surgery to proceed during pandemic waves. Other elective cases were performed as health system capacity allowed, without compromising outcomes.

Protocol of a prospective comprehensive evaluation of an elastic band beard cover for filtering facepiece respirators in healthcare.

Individuals who are unable to be clean shaven for religious, medical or cultural reasons are unable to wear a filtering facepiece respirator (FFR), as the respirator cannot provide adequate protection against aerosol-transmissible diseases. There is currently a paucity of validated techniques to ensure the safe inclusion of bearded healthcare workers in the pandemic workforce. We propose to undertake a healthcare-based multi-modal evaluation study on the elastic band beard cover for FFR technique, examining the quantitative fit test (QNFT) results, usability and skill level of participants with repeated assessments over time. This is a prospective study conducted through the Respiratory Protection Program at the Royal Melbourne Hospital. Healthcare workers are invited to participate if they require respiratory protection and cannot shave for religious, cultural or medical reasons. An online education package on the use of respiratory protective equipment and the elastic band beard cover for FFR technique is provided. This is followed by a face-to-face session, where the participant will receive: one-on-one training; undergo a skill assessment on their donning, doffing and user seal check techniques; complete QNFTs and a usability survey. Participants will be invited to repeat the assessment within 3 months of the first session and at 12 months. This study involves multimodal and repeated assessments of an elastic band beard cover for FFRs. The findings of this study will provide information on: whether this simple technique can provide safe, consistent and effective respiratory protection; whether it will interfere with occupational activities; and whether it is comfortable and tolerable for the duration of wear. This is of significant importance to the health workforce around the world, who cannot shave but require access to respiratory protective equipment during the COVID-19 pandemic.

Implementation of a respiratory protection program within healthcare facilities during the COVID-19 pandemic- lessons learned

The use of fit tested respirators in the workplace is required to protect health workers against airborne pathogens. The COVID-19 pandemic required rapid upscaling of fit testing which was achieved using the framework of a respiratory protection program. Implementing and sustaining such a program in the midst of a pandemic was challenging and required clear direction from a lead agency combined with stakeholder engagement.

N95 respirators: quantitative fit test pass rates and usability and comfort assessment by health care workers.

ObjectivesTo compare the performance of four N95 respirator types with respect to quantitative fit test pass rate and health care worker‐rated usability and comfort.Design, setting, participantsHealth care workers who participated in the respiratory protection program at the Royal Melbourne Hospital, 1 October 2020 – 31 May 2021. Participants underwent quantitative N95 respirator fit testing (at least three of four types: semi‐rigid cup, flat‐fold cup, duckbill, and three‐panel flat‐fold types), and were invited to complete an online usability and comfort assessment for respirators for which their fit test results were passes.Main outcome measuresFit test pass rate, and user‐rated overall comfort and assessment ratings (five‐point Likert scales), by N95 respirator type.ResultsA total of 2161 health care workers underwent quantitative fit testing (women, 1586 [73.4%]; nurses, 1271 [58.8%]). The overall fit test pass rates were 65.0% for the semi‐rigid cup respirators (1029/1583 tests), 32.4% for the flat‐fold respirator (660/2035 tests), 59.2% for the duckbill respirators (2005/3387 tests), and 96.4% for the three‐panel flat‐fold respirator (1876/1946 tests). 378 health care workers completed the comfort and usability survey. Overall comfort and assessment ratings each differed by respirator group (P < 0.001); the median overall comfort (4; IQR, 3–4) and overall assessment values (4; IQR, 3–5) were highest for the three‐panel flat‐fold respirator and lowest for the semi‐rigid cup respirators (comfort: 2 [IQR, 1–3]; assessment: 2 [IQR, 2–3]).ConclusionsThe three‐panel flat‐fold N95 respirator outperformed the three alternative types with regard to fit test pass rate and user‐rated comfort and usability. To maximise respiratory protection for health care workers, these factors should be considered when making respirator procurement decisions.

Enhancing respiratory protection in skilled nursing facilities during the COVID-19 pandemic: A public health fit-test training program

Background: The Occupational Safety and Health Administration (OSHA) Respiratory Protection standard (29 CFR 1910.134) states that it is an employer’s responsibility to establish and maintain a respiratory protection program when a respirator is necessary to protect the health of employees, including annual assessment of adequate respirator fit. Prior to the COVID-19 pandemic, N95 respirators were rarely used in Philadelphia skilled-nursing facilities (SNFs), and many facilities did not have programs in place or materials to fit test their staff. Methods: The Philadelphia Department of Public Health’s (PDPH) Healthcare Associated Infections/Antimicrobial Resistance (HAI/AR) Program designed and pilot-tested 1.5-hour “train-the-trainer” sessions on OSHA-compliant fit-testing requirements and qualitative procedures. This training was offered to all 47 SNFs beginning May 2021. Training covered the role N95 respirators play in healthcare, proper donning and doffing, OSHA training requirements, medical clearances, record keeping, fit-testing procedure, and demonstrated competency to perform fit testing. Resources that were provided after training included templates of a respiratory protection policy for SNFs, a fit-test record, the OSHA medical clearance form, and a competency checklist. This bundle was designed to help SNFs establish self-sustaining respiratory protection programs. Post-training evaluations were administered on a 6-point Likert scale as well as qualitative, open-ended questions to evaluate the overall quality and effectiveness of the training session. Results: In total, 50 employees (clinical and nonclinical) from 13 Philadelphia SNFs received N95 fit-test training from June through December 2021. The average rating for the training overall was very high (5.9 of 6 points). On average, participants strongly agreed that content presented was directly applicable to their work (5.9 of 6 points), and most strongly agreed that information they learned would alter practices and procedures (5.79 of 6 points). When asked qualitatively what the participant would do differently in practice as a result of the training, the most frequent responses were fit test staff (58%) and educate staff on proper N95 use (60%). Conclusions: The PDPH HAI/AR program created a successful pilot fit-test training program for SNFs, demonstrated by program enrollment and high ratings by participants. This relatively low-cost intervention has provided tools to enhance respiratory protection during the COVID-19 pandemic and has increases the capacity of SNFs to provide essential services for their staff and residents. The PDPH will continue to offer these training sessions to SNFs, with plans to expand to other care settings, such as inpatient behavioral health facilities, outpatient clinics, and emergency medical services.Funding: Funded by the CDC ELC Project FirstlineDisclosures: None

A Field Study on Volatile Organic Compounds Generated During Cooking in a Large Pot Using PTR ToF MS

Various volatile organic compounds (VOCs), including aldehydes, are present in fried food being cooked in high-temperature oil. In this study, real-time VOC concentration was measured in the upper part of a large pot in the cooking room using Proton Transfer Reaction Time-of-Flight Mass Spectrometry (PTR ToF MS) for 3 days (roasted on the first day, fried on the second day, and simmered on the third day). The average concentration of diacetyl was the highest on the first day of stir-frying and steaming. The highest concentrations of formaldehyde was on day 3 when pork was cooked in sugar and sauce. Formaldehyde, 1,3-butadiene, acrolein, diacetyl, and naphthalene were detected during the frying process on the second day, and were detected in descending order of boiling point. In addition, various VOCs such as methanol were detected. The maximum/minimum concentration ratio was the highest for acrolein (3,030), so it was confirmed that many aldehydes were generated during frying. Although there is a limit to direct comparison with Occupational Exposure Limit as a result of area sample by PTR ToF MS, the mean concentrations of formaldehyde and diacetyl during the frying operation for 15 minutes were 232 ppb and 16 ppb, respectively, which was 80% of the American Conference of Governmental Industrial Hygienists Threshold Limit Value-Short Term Exposure Limit. After the frying was over, the VOC concentration began to decrease, and it took more than 3 hours to lower the VOC concentration to the level before the oil was heated. As various harmful gaseous substances are generated when cooking deep-frying, improvement methods such as using oil with high boiling points and developing respiratory protection programs should be devised.

Impacts on staff after implementation of a respiratory protection program in a Victorian public hospital.

In October 2020, the Royal Melbourne Hospital implemented a Respiratory Protection Program (RPP), which was initiated by the Victorian Government. This study was to evaluate the effectiveness of the program. A cohort of 158 employees, who were identified as high risk to respiratory biohazard exposure, were invited to participate in the RPP. We provided a bundle of interventions, which included an online training package, and mandatory quantitative fit testing. The main outcomes included the participants' knowledge and attitude toward respiratory protection equipment (RPE), which were assessed via an online survey. Their donning and doffing skills, and user seal check techniques on four different types of N95 respirators were also assessed by an observer using a pre-determined marking sheet. We compared these outcomes before and after participation in the program. There was a total of 125 participants, all of whom completed the knowledge and attitude assessment, and 69 completed the skill assessment before and after the program. There was a statistically significant improvement in their knowledge scores, donning and doffing skills, and user seal check techniques after participation in the RPP. Participants also reported significant increased level of confidence in their RPE knowledge, training and skills; and workplace safety. This initial report of the implementation of a novel RPP in a Victorian major tertiary hospital provides guidance on the benefits to respiratory protection, staff knowledge, skills, confidence and morale that can be acquired from a scalable online training package combined with mandatory quantitative fit testing.

Fit Testing Disposable P2/N95 Respirators during COVID-19 in Victoria, Australia: Fit Check Evaluation, Failure Rates, and a Survey of Healthcare Workers

Quantitative fit testing was utilised to evaluate the Department of Health and Human Services in Victoria (DHHS) recommended fit check and determine pass/fail rates for self-selected P2/N95 respirators. Survey experience and training related to P2/N95 respirators were also obtained. This was an observational study at a specialist tertiary referral centre, Melbourne, Australia, between 29 May 2020 and 5 June 2020. The primary outcome was quantitative fit test pass/fail results, with fit check reported against fit test as a 2 × 2 contingency table. The secondary outcomes were the number of adjustments needed to pass, as well as the pass rates for available sizes and types of self-selected respirators, survey data for attitudes, experience and training for P2/N95 respirators. The fit check predicts respirator seal poorly (PPV 34.1%, 95% CI 25.0–40.5). In total, 69% (40/58) of respirators failed quantitative fit testing after initial respirator application and is a clinically relevant finding (first-up failure rate for P2/N95 respirators). Only one person failed the fit test for all three respirator fit tests. There was significant variability between each of the seven types of self-selected P2/N95 respirators, although sample sizes were small. Few participants were trained in the use of P2/N95 respirators or the fit check prior to COVID-19, with a high number of participants confident in achieving a P2/95 respirator seal following a fit test. The fit check alone was not a validated method in confirming an adequate seal for P2/N95 respirators. Quantitative fit testing can facilitate education, improve the seal of P2/N95 respirators, and needs to be integrated into a comprehensive Respiratory Protection Program (RPP).

Case study: Dust in the housing of laying birds

As dust particles in laying poultry houses can have negative effects on health and on the environment,this study aimed to measure and compare dust concentrations in egg production sheds. The experiment was carried out in three sheds: Californian shed (G1), conventional closed shed with artificial ventilation (G2) and conventional closed shed without artificial ventilation (G3), and the birds housed were in the 22nd week of housing, in Cuité, Paraíba, Brazil.The dust particles were collected by a gravimetric pump, attached to the workers' clothes, at the height of the respiratory zone, being removed at the end of the working day. Using the evaluation methodologies (total or breathable dust) according to NIOSH (1998), weighing was performed with sample concentration calculation, then the particle size was measured by microscopy according to the methodology described by Feret(Santos, 2001), with diameter of function obtained using an optical microscope, and particles classified by size (inhalable &lt;100 μm, thoracic &lt;25 μm and breathable &lt;10 μm).Considering the limit of concentration x exposure time of 3.0 mg/m3, according to ACGIH (2013), the sheds had the following values: G1-0.98 mg/m3, G2-1.45 mg/m3 and G3-1.13 mg/m3. In the classification of particles by size, the highest frequencieswere 83% thoracic, 13% inhalable, and 4% breathable.With the results presented, the implementation of the Respiratory Protection Program - PPR is suggested.

NSF Response Case Study: Hazardous Materials Release at Intercontinental Terminal Company, Deer Park, Texas

ABSTRACT On March 17th, 2019 the Intercontinental Terminal Company (ITC) Deer Park, Texas river terminal and storage facility, comprised of 242 above ground storage tanks with a site capacity of 13.1 million barrels of hazardous products, experienced a tank fire. This incident would also become known as the “2nd 80s Fire” based on the identification of tanks impacted. The fire was contained to a single grouping of 15 tanks, with stored products including Naphtha, Toluene, Xylene, Benzene, Pyrolysis Gasoline, and Gasoline Blend stocks. Extended firefighting efforts resulted in volumes of water and firefighting foam that exceeded the capacity of the containment systems, resulting in the subsequent containment failure on March 22nd, which enabled the hazardous chemicals and mixture of various products to eventually reach the Houston Ship Channel. The surrounding industrial and residential communities experienced shelter-in-place orders due to the air quality concerns, and the vital waterway was shut down to commercial traffic. On-water benzene levels exceeded 20 parts per million (ppm) during the initial phases of the response near the facility while many areas within five miles exceeded the Occupational Safety Health Agency (OSHA) Permissible Exposure Limit (PEL) for benzene exposures. Benzene remained the primary chemical hazard to response crews seeking to contain, remove, and reopen the waterways for more than two weeks past the initial chemical release events. An interagency agreement was developed between the Environmental Protection Agency (EPA) and the U.S. Coast Guard (USCG) to assist in response activities, which included containing, collecting, recovering and disposing of the released materials from the shoreline and the surface water. The National Strike Force (NSF) deployed 52 personnel from each of the three Strike Teams, Public Information Assist Team (PIAT) and CG-Incident Management and Assistance Team (CG-IMAT). Due to the elevated presence of benzene, the NSF was the only USCG trained, experienced and qualified organic response resource prepared to respond to environmental threats with elevated concentrations of products that represented an inhalation hazard requiring respiratory protection devices. This paper demonstrates the significance of NSF's respiratory protection program, and how their capabilities can be used for both technical operations support, and also for site safety management, especially during complex spills or releases.

Safely Returning America to Work Part II: Industry-Specific Guidance.

Safely Returning America to Work Part II: Industry-Specific Guidance.

Perspectives of region II OSHA authorized safety and health trainers about initial COVID-19 response programs

In this cross-sectional survey-based study conducted in early fall 2020, we attempted to measure and ascertain the extent of whether employers in New York and New Jersey were prepared to manage and follow occupational safety and health (S&H) regulations and industry risk processes in developing an exposure control response program to COVID-19, the disease caused by exposure to the coronavirus SARS-CoV-2. We focused on Region II of the U.S. Department of Labor (USDOL)-Occupational Safety and Health Administration (OSHA). In addition, we examined possible explanations for lack of compliance and uniformity across the region in various USDOL-OSHA regulatory aspects like training, respiratory protection program administration and proper task-specific application of occupational S&H hazard controls through risk management systems. We suggest opportunities for employer and governmental interventions to reduce potential worker exposures and better control future worksite biological hazards and infectious disease transmission. Overall, data suggested prevalent inconsistencies, noncompliance and a less than uniform approach to implementing COVID-19 response programs.

Coccidioidomycosis outbreak among inmate wildland firefighters: California, 2017.

In California, state prison inmates are employed to fight wildfires, which involves performing soil-disrupting work. Wildfires have become more common, including areas where Coccidioides, the soil-dwelling fungus that causes coccidioidomycosis, proliferates. However, work practices that place wildland firefighters at risk for coccidioidomycosis have not been investigated. On August 17, 2017, the California Department of Public Health was notified of a cluster of coccidioidomycosis cases among Wildfire A inmate wildland firefighters. We collected data through medical record abstraction from suspected case-patients and mailed a survey assessing potential job task risk factors to Wildfire A inmate firefighters. We described respondent characteristics and conducted a retrospective case-control investigation to assess coccidioidomycosis risk factors. Among 198 inmate firefighters who worked on Wildfire A, 112 (57%) completed the survey. Of 10 case-patients (four clinical and six laboratory-confirmed), two were hospitalized. In the case-control analysis of 71 inmate firefighters, frequently cutting fire lines with a McLeod tool (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 1.1-37.2) and being in a dust cloud or storm (OR: 4.3; 95% CI: 1.1-17.4) were associated with illness. Two of 112 inmate firefighters reported receiving coccidioidomycosis training; none reported wearing respiratory protection on this wildfire. Wildland firefighters who use hand tools and work in dusty conditions where Coccidioides proliferates are at risk for coccidioidomycosis. Agencies that employ them should provide training about coccidioidomycosis and risk reduction, limit dust exposure, and implement respiratory protection programs that specify where respirator use is feasible and appropriate.

Dust in the Housing of Laying Hens: A case study

ABSTRACT As dust particles in laying poultry houses can have negative effects on health and on the environment, this study aimed to measure and compare dust concentrations in egg production sheds. The experiment was carried out in three sheds: Californian shed (G1), conventional closed shed with artificial ventilation (G2) and conventional closed shed without artificial ventilation (G3), and the birds housed were in the 22nd week of housing, in Cuite, Paraiba, Brazil. The dust particles were collected by a gravimetric pump, attached to the workers’ clothes, at the height of the respiratory zone, being removed at the end of the working day. Using the evaluation methodologies (total or breathable dust) according to NIOSH (1998), weighing was performed with sample concentration calculation, then the particle size was measured by microscopy according to the methodology described by Feret (Santos, 2001), with diameter of function obtained using an optical microscope, and particles classified by size (inhalable <100 µm, thoracic <25 µm and breathable <10 µm). Considering the limit of concentration x exposure time of 3.0 mg/m3, according to ACGIH (2013), the sheds had the following values: G1-0.98 mg/m3, G2-1.45 mg/m3 and G3-1.13 mg/m3. In the classification of particles by size, the highest frequencies were 83% thoracic, 13% inhalable, and 4% breathable. With the results presented, the implementation of the Respiratory Protection Program - PPR is suggested.

Respiratory Protection Programs (RPP) Implementation at Production Unit of A Tin Smelter at Bangka Belitung Islands Province

The fume generated from the reaction of flux and molten tin produces tin compounds in the atmosphere which potentially lead to stanosis or also known as tin pneumoconiosis after chronic inhalation and prolonged exposure in the workplaces e.g. in smelter industries. The risk can be minimized by implementing Respiratory Protection Program (RPP). This study aimed to evaluate the implementation of RPP at one smelter industries in Bangka Belitung Province. This is a evaluation study that qualitatively evaluate the implementation of RPP. eigth RPP elements from National safety Council (NSC) Australia was used as guideline. The secondary data from Occupational Health and Safety inspection and monitoring report at one of tin smelter from Department of Manpower (Disnaker), Banga Belitung Island province. It was found that several RPP elements have not been fully implemented, which were (1) compliance with respirator standards, (2) no selection of respirators procedure, (3) no protective clothing, (4) no fit testing execution, (5) improper management of cleaning and inspections, and (6) no evaluation of respirator usage. Moreover, specific work process that need Supplied Air Respirator (SAR) has not been anticipated, and improvement in the training materials, periodic training schedule and evaluation of the Respiratory Protection Program were emphasized. There were 3 informants in this study consisting of company managers, safety officers, and labor inspector. The implementation of RPP at PT X. Tin needs to be enhanced. Continuous coaching, monitoring, inspection, and evaluation related to the Respiratory Protection Program must be carried out more intensively both internally and externally from the government.

Exposure assessment of elemental carbon, ultrafine particles, and crystalline silica at highway toll booths

Highway toll booth workers have been reported to be at an increased risk of occupational lung cancer. Moreover, insufficient studies have been performed on exposure assessment of workers at highway toll booths. Elemental carbon (EC), black carbon (BC), and respirable crystalline silica (RCS) concentrations were measured at highway toll booths in Gyeongsangbuk-do (Republic of Korea). The particle number (PN) concentration and size distribution of ultrafine particle were measured using three SMPS devices. The average concentration of the EC inside the booth was 3.3 μg/m&lt;sup&gt;3&lt;/sup&gt;, with the maximum being 5.8 μg/m&lt;sup&gt;3&lt;/sup&gt;. The concentrations of EC were highest for booths that operated exclusively for trucks. The average PN concentration inside the booth was 3.54 × 10&lt;sup&gt;4&lt;/sup&gt; cm&lt;sup&gt;-3&lt;/sup&gt;, approximately 5-fold higher than the reference indoor background. The average BC concentration in the booths were approximately 8 μg/m&lt;sup&gt;3&lt;/sup&gt;, and the instantaneous peak concentration was 271 μg/m&lt;sup&gt;3&lt;/sup&gt;. The RCS was below the detection limit in all samples. This study revealed that toll workers were most frequently exposed to diesel engine particle less than 100 nm, with an extremely high respiratory deposition rate. Therefore, a respiratory protection program is necessary to safeguard these workers against vehicle-related pollutants.

Using a Critical Safety Behavior Scoring Tool for N95 Respirator Use to Evaluate Training Interventions

Background: Hospitals struggle nationally to educate healthcare workers on the safe use of N95 respirators as part of their respiratory protection programs. Practical and effective interventions are needed to improve this clinical behavior, which is critical to healthcare worker safety in airborne precautions, hazardous drug administration, and pandemic response. Objective: In this analysis, we specifically investigated 2 just-in-time training interventions that would be practical to implement in a hospital setting. Methods: A simulation approach was used to evaluate 2 interventions for N95 respirator use at a Midwestern Academy Hospital system (n = 62 respirators: 32 control and 30 treatment). Healthcare workers were asked to don and doff an N95 respirator while being video-recorded in an empty hospital corridor and room. After a randomized intervention was applied, they repeated the respirator donning and doffing while being video-recorded. One intervention used an instructional video alone, and the other used the same instructional video but added a video reflection intervention. The video reflection intervention asked the participant to review and score their first performance of N95 donning and doffing using the Critical Safety Behavior Scoring Tool (CSBST). The research team used the same CSBST to score all performances of donning and doffing for comparison and evaluation. Result: The critical safety behaviors at the pretest and posttest for the 2 intervention groups reveal the impact of the 2 types of just-in-time training on demonstrated N95 respirator skills. The video alone and video reflection scores were not significantly different at pretest between the 2 groups. Scores were significantly higher on the posttest for the reflective practice intervention. Findings related to demographic information included years in healthcare, frequency of use, history of needlestick, and fatigue. Conclusions: Video reflection may improve compliance with critical safety behaviors for just-in-time training on N95 respirator use. Further research should examine the video-recorded findings for measurement elements that can be expanded in a scoring tool such as facial hair, hairstyle, and the quality of hand hygiene. Intervention studies should also examine how often the training must be repeated to maintain competency. This intervention may have implications for the training of other critical safety behaviors in infection control and other high-risk procedures.Funding: NoneDisclosures: None