Use Of Respiratory Protection Research Articles

Safety implications of mask use: a systematic review and evidence map

BackgroundWidespread use of respiratory protection masks has become a critical component of public health response.ObjectivesThis systematic review synthesises the evidence on the acute physiological, cognitive and psychological impacts associated with...

Tralopyril poisoning due to respiratory exposure

Introduction Tralopyril is a metabolite of the pesticide chlorfenapyr. Direct toxicity by tralopyril has not been described. We report two cases of tralopyril poisoning via inhalation. Case presentations Two workers developed heat intolerance, diaphoresis, and weight loss after occupational inhalational exposure to tralopyril. Patient 1: The exposure was due to the absence of respiratory protection. Magnetic resonance imaging showed abnormal signals in the bilateral periventricular white matter, corpus callosum, basal ganglia, brainstem, and spinal cord. The patient’s blood tralopyril concentrations on days 1, 3, 5, 8, and 11 post-admission were 1.09 mg/L, 1.04 mg/L, 1.01 mg/L, 0.71 mg/L, and 0.313 mg/L, respectively. Haemoperfusion (HA330), haemoperfusion (HA380), and haemodiafiltration were performed on days 1–3, 5–8, and 9–10, respectively. Patient 2: The patient’s symptoms followed inappropriate use of respiratory protection. His blood tralopyril concentrations on days 1, 4, 5, and 6 were 0.592 mg/L, 0.482 mg/L, 0.370 mg/L, and 0.228 mg/L, respectively. Discussion The patients presented with features typical of chlorfenapyr poisoning, which suggests that tralopyril is the main toxic metabolite of chlorfenapyr. Conclusion Tralopyril can be absorbed by inhalation, leading to delayed clinical symptoms and organ damage, including toxic encephalopathy and spinal cord damage.

Hexavalent chromium still a concern in Sweden – Evidence from a cross-sectional study within the SafeChrom project

ObjectivesHexavalent chromium (Cr(VI)) is classified as a human carcinogen. Occupational Cr(VI) exposure can occur during different work processes, but the current exposure to Cr(VI) at Swedish workplaces is unknown. MethodsThis cross-sectional study (SafeChrom) recruited non-smoking men and women from 14 companies with potential Cr(VI) exposure (n = 113) and controls from 6 companies without Cr(VI) exposure (n = 72). Inhalable Cr(VI) was measured by personal air sampling (outside of respiratory protection) in exposed workers. Total Cr was measured in urine (pre- and post-shift, density-adjusted) and red blood cells (RBC) (reflecting Cr(VI)) in exposed workers and controls. The Bayesian tool Expostats was used to assess risk and evaluate occupational exposure limit (OEL) compliance. ResultsThe exposed workers performed processing of metal products, steel production, welding, plating, and various chemical processes. The geometric mean concentration of inhalable Cr(VI) in exposed workers was 0.15 μg/m3 (95% confidence interval: 0.11–0.21). Eight of the 113 exposed workers (7%) exceeded the Swedish OEL of 5 μg/m3, and the Bayesian analysis estimated the share of OEL exceedances up to 19.6% for stainless steel welders. Median post-shift urinary (0.60 μg/L, 5th-95th percentile 0.10–3.20) and RBC concentrations (0.73 μg/L, 0.51–2.33) of Cr were significantly higher in the exposed group compared with the controls (urinary 0.10 μg/L, 0.06–0.56 and RBC 0.53 μg/L, 0.42–0.72). Inhalable Cr(VI) correlated with urinary Cr (rS = 0.64) and RBC-Cr (rS = 0.53). Workers within steel production showed the highest concentrations of inhalable, urinary and RBC Cr. Workers with inferred non-acceptable local exhaustion ventilation showed significantly higher inhalable Cr(VI), urinary and RBC Cr concentrations compared with those with inferred acceptable ventilation. Furthermore, workers with inferred correct use of respiratory protection were exposed to significantly higher concentrations of Cr(VI) in air and had higher levels of Cr in urine and RBC than those assessed with incorrect or no use. Based on the Swedish job-exposure-matrix, approximately 17 900 workers were estimated to be occupationally exposed to Cr(VI) today. ConclusionsOur study demonstrates that some workers in Sweden are exposed to high levels of the non-threshold carcinogen Cr(VI). Employers and workers seem aware of Cr(VI) exposure, but more efficient exposure control strategies are required. National strategies aligned with the European strategies are needed in order to eliminate this cause of occupational cancer.

Examining the Impact of Elastomeric Half Mask Respirator Knowledge and User Barriers on Safety Climate Perceptions in Health Care Settings.

Availability of personal protective equipment (PPE) and its effective use may influence safety climate perceptions among health care personnel (HCP). It is unclear how health care organizations can leverage the effective use of respiratory protection to engage in continuous improvement of their safety climate, which can inform opportunities for employee education and engagement. After using an elastomeric half mask respirator (EHMR) as their primary form of respiratory protection for several months, 1,080 HCP provided feedback in an electronic survey about respiratory protection training, confidence in EHMR use, barriers during use, and perceived safety climate. Ordinal logistic regressions were used as nonlinear models to test relationships between these variables. We observed that an increase in user confidence (p < .013), training content (p < .001), training formats (p < .001), and a decrease in EHMR barriers (p < .001) were associated with a statistically significant increase in proactive safety climate. In the second model, an increase in user confidence (p < .006) and training content (p < .001), and a decrease in barriers (p < .001), was associated with a statistically significant increase in compliant safety climate. HCP EHMR confidence was positively associated with safety climate perceptions, underscoring the value of competency building by respiratory protection leaders prior to implementation. Because fewer barriers experienced while using an EHMR were associated with a more positive perception of safety climate, it is important to first communicate with end users about potential barriers and, second, to continue research with end users and manufacturers to improve the design of EHMRs moving forward.

A randomised crossover trial of two flat-fold cup respirators: BYD DE2322 N95 versus Care Essentials MSK-002 P2.

The use of respiratory protection remains important in protecting health care workers from airborne pathogens such as viruses. Respirator supply is constantly changing with new models regularly becoming available. Health services should consider a broad range of factors when procuring respirators, including the results of quantitative fit testing in a representative sample of the workforce. Subjective comfort factors and compatibility with a variety of workplace tasks, such as suitability for staff use near magnetic resonance imaging (MRI) environments where relevant, should also be considered. This article compares the quantitative fit factors and user assessments for two styles of flat-fold cup respirators, Care Essentials (CE) MSK-002 P2 and BYD DE2322 N95. Quantitative fit tests (QNFT) were performed on 300 participants on each model of respirator in this randomised crossover trial. Participants then completed a questionnaire on their assessments of each respirator. The Care Essentials MSK-002 had a significantly higher quantitative fit test pass rate than the BYD DE2322 (57% vs 18%, p<0.001). There was no concordance between fit test pass rates for each model. Additionally, the Care Essentials MSK-002 achieved significantly higher scores on each of the responses in the subjective usability survey. It is recommended that the Care Essentials MSK-002 be made available for health care use due to higher QNFT pass rates, higher subjective usability assessment scores, plus its potential for use in MRI environments when compared to the BYD DE2322.

SARS-CoV-2 Aerosol and Surface Detections in COVID-19 Testing Centers and Implications for Transmission Risk in Public Facing Workers.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and resulting COVID-19 (coronavirus disease 2019) pandemic have required mass diagnostic testing, often taking place in testing sites within hospitals, clinics, or at satellite locations. To establish the potential of SARS-CoV-2 aerosol transmission and to identify junctures during testing that result in increased viral exposure, aerosol and surface samples were examined for the presence of SARS-CoV-2 RNA from locations within Nebraska Medicine COVID-19 testing and vaccine clinics. Aerosols containing SARS-CoV-2 RNA detected within clinics suggest viral shedding from infected individuals. SARS-CoV-2 RNA detection in aerosol samples was shown to correlate with clinic operation and patient infection, as well as with community infection findings. Additionally, SARS-CoV-2 RNA was detected in surface samples collected from clinics. The presence of SARS-CoV-2 RNA in aerosols in these clinics supports the continued use of respiratory protection and sanitization practices for healthcare workers, and other workers with public facing occupations.

Hygienic assessment of the use of masks by airport workers during the COVID-19 pandemic

The use of respiratory protection is one of the measures for the non-specific prophylaxis of coronavirus infection. The wearing of masks is mandatory for the entire population in several countries, including Russia. The object of the study is airport workers who are at an increased risk of infection. They are in contact with many passengers arriving from other countries where mass vaccination has not yet been carried out. The study aims to assess the hygienic prevalence of adverse reactions when using face masks, to identify risk factors for their occurrence. A questionnaire survey and an evaluation of the bacterial contamination of the masks after wearing were carried out. Face sweating under the mask (68.60 %) and feeling short of breath (66.94 %) were the most frequent and pronounced reactions to wearing in comparison with other manifestations (p &lt; 0.001). The more often an adverse reaction occurred, the more apparent it was (r = 0.79–0.95). We found a moderate positive relationship between wearing time and the frequency of facial sweating (r = 0.31). Facial skin reactions were more frequent and pronounced among users of a cotton mask compared with users of neoprene and non-woven masks. An association was found between the frequency and severity of skin manifestations and bacterial contamination of the inner mask’s surface after wearing. A moderate positive relationship was found between the colonies number and wearing time for neoprene and cotton masks (r = 0.33 and 0.46, respectively). The number of colonies increases with the duration of wearing. Factors aggravating adverse reactions’ manifestation: problem skin, young age, moderate and hard work. Recommended: keep the skin clean and well hydrated, change the mask every 2 hours, select the face mask size, fix mask on the face so as not to cause chafing and squeezing of the skin.

Prevalence and Risk Factors for Pulmonary Conditions among Farmers and Ranchers in the Central United States

ABSTRACT This study was conducted to evaluate the prevalence and risk factors for work-related respiratory conditions (asthma, farmer’s lung, sinusitis, rhinitis, and environmental allergies, diagnosed by a physician) among farm and ranch operators in the central US. A survey was conducted by the Central States Center for Agricultural Safety and Health (CS-CASH) in 2018, focusing on work-related injuries, illnesses, exposures, and preventive measures in a seven-state region (Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and South Dakota). Farms and ranches (n = 16,818) with an email address and annual sales exceeding $5,000 were randomly selected for the survey. Agricultural production and weather data were merged with survey responses. The relationship between exposures and respiratory conditions was analyzed using generalized estimating equations. We received responses from 3,268 agricultural operations (19% response rate) containing information on 4,064 individual operators. The life-time prevalence of (any) respiratory conditions among farm/ranch operators was 18%. Risk factors for respiratory conditions included exposures to grain/hay/feed dust (OR 2.41), animal confinement dust (OR 1.57), field/road dust (OR 2.11), manure/silage gasses (OR 1.66), anhydrous ammonia (OR 1.51), fuels/solvents/paints (OR 1.92), older age group >70 vs. <43 (OR 1.40), female gender (OR 1.82), and being primary vs. third operator (OR 1.61). Farmers and ranchers have a high prevalence of respiratory conditions associated with dust and gas exposures at work. More effective protective measures are needed using the hierarchy of controls, including improved use of respiratory protection.

Coccidioidomycosis Knowledge and Behaviors of California Hispanic Farm Workers

ABSTRACT (1) Describe knowledge, attitudes, beliefs, and behaviors related to coccidioidomycosis (Valley fever, VF) reported by farm workers in a highly endemic area to design and evaluate prevention messages and (2) identify health information sources preferred by farm workers to disseminate VF prevention messages. There were 119 primarily Mexican-born residents of two migrant farm labor housing centers in Kern County, who completed an interviewer-administered survey on VF knowledge, attitudes, beliefs, and behaviors in 2017. The 73% of participants aware of VF demonstrated a knowledge score of 53%. Over 90% erroneously believed VF was associated with pesticide exposure; approximately two-thirds believed that wearing a bandana mask was protective. Over half of respondents believed that VF was contagious, could be contracted from contaminated food or water, and caused gastrointestinal symptoms. Of those aware of VF, 75% expressed concern about becoming infected because of where they lived and working outdoors. Working outdoors in dusty conditions was the most commonly reported risk-associated work practice. Among 67 participants reporting use of respiratory protection, 94% indicated they wear a bandana; most male participants did not wear face coverings in dusty conditions. The most frequent protective work practice was wetting soil. Preferred sources of health information included television; family, friend, or co-worker; healthcare provider; and radio. Farm workers reported multiple risk factors for VF. Results identified several areas of poor knowledge, risk behavior, and preferred channels of prevention messages. Important protective behaviors are not under the control of farm workers; engagement with employers is essential.

Respiratory Protective Equipment and Facial Hair in Light of COVID-19: Legal and Ethical Dilemmas

Facial hair inhibits the functionality of certain respiratory protective equipment, yet employers have a duty of care to provide protection for their employees against communicable respiratory diseases such as COVID-19. Could individuals be forced to remove their facial hair? How can staff with facial hair be protected from COVID-19? These issues present legal and ethical dilemmas for employers and employees alike regarding the provision and use of respiratory and personal protective equipment under health and safety considerations. This is a law review examining various UK statutory instruments and case law surrounding the use of facial hair and the use of respiratory protection. Facial hair is a hazard when considering respiratory protective equipment provision and use. Unless there is an absolute need requiring the removal of facial hair for any reason, individuals have the right to grow facial hair as they see fit. It is arguable though what an “absolute need” may be, as numerous proportional and reasonable adjustments can be made to accommodate facial hair that can mitigate the risks associated with respiratory diseases.

유병 농업인의 호흡기계 질병 현황 및 영향요인

This study was undertaken to determine the status and influencing factors of respiratory system diseases among farmers with disease. Data collected was analyzed by using the 2018 Farmer’s Occupational Disease Survey by the Rural Development Administration. The analyses were focused on farmers who were unable to work for more than half a day due to an ongoing respiratory system disease. Data were weighted by household members for population estimation using the SPSS 20.0 program. Analysis methods applied were frequency, percent, cross-analysis, Chi-square test, and logistic regression analysis. The rate of respiratory system disease among farmers with disease was 3.2%. The highest disease was asthma (28.5%), followed by pneumonia (21.7%), chronic obstructive pulmonary disease (18.4%), and tuberculosis (2.5%). Factors influencing the onset of respiratory system disease among farmers were gender, age, period of work, main crop, drinking status, smoking status, exercise status, gas inhalation, and the use of respiratory protection (p＜0.001). In order to prevent farmers from contracting respiratory system infections, disease management through early and regular health check-ups is necessary. In addition, it is necessary to raise the awareness of preventing respiratory system disease by providing guidance on improving working conditions, such as cessation training, raising awareness of using respiratory protection, and suggesting efficient working hours.

Practical learnings from an epidemiology study on TDI-related occupational asthma: Part II-Exposure without respiratory protection to TWA-8 values indicative of peak events is a good indicator of risk.

The anonymized data of an epidemiology study on the incidence of toluene diisocyanate (TDI)-related occupational asthma in three US-based TDI production facilities have been reanalyzed to identify where to best focus exposure reduction efforts in industrial practice in order to reduce the risk of sensitization to TDI. In Part I, it was demonstrated that cumulative exposure is not a good indicator of the risk of developing TDI-related occupational asthma. In this Part II, an alternative model was developed based on net exposure parameters (i.e. samples taken when no respiratory protection was used). A statistically significant relationship was determined between asthma incidence and the frequency of exposure to TDI levels indicative of peak events that are expressed as time-weighted average-8 (TWA-8) values greater than 3 ppb during which no respiratory protection was used. This relationship suggests a threshold to induction of TDI-related asthma. The findings also highlight the importance of a comprehensive program for controlling workplace atmosphere in the plant by technical measures (e.g. selection of equipment, cleaning procedures) and controlling exposure by organizational measures and situational awareness (e.g. training, use of in-the-field direct reading indicators) during high potential exposure scenarios (e.g. line breaking, spills) to encourage or enforce the appropriate use of respiratory protection.

Practical learnings from an epidemiology study on TDI-related occupational asthma: Part I-Cumulative exposure is not a good indicator of risk.

The anonymized data of an epidemiology study on incidence of toluene diisocyanate (TDI)-related occupational asthma in three US-based TDI production facilities have been reanalyzed to identify where to best focus exposure reduction efforts in industrial practice to reduce the risk of sensitization to TDI. Since the induction of sensitization has sometimes been attributed to cumulative exposure, this relationship was examined first. Gross cumulative exposure values (i.e. not taking into account whether respiratory protection was used or not) and net cumulative exposure values (i.e. accounting for the use of respiratory protection) per participant were calculated based on the duration of their study participation and the average time-weighted average value of the exposure group to which they belonged. These two sets of cumulative exposure data were compared with asthma incidence using logistic regression. Incidence was zero among workers who rarely come into contact with open plant systems (e.g. during maintenance or spills). Notwithstanding, no statistically significant relationship between asthma incidence and either gross or net cumulative exposure could be determined. This is shown to be consistent with the results of several other epidemiology studies on TDI-related occupational asthma. In conclusion, cumulative exposure values are not a good indicator of the risk of developing TDI-related occupational asthma.

Physical distancing, face masks, and eye protection for prevention of COVID-19

Physical distancing, face masks, and eye protection for prevention of COVID-19

A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients

BackgroundThe pandemic of COVID-19 is growing, and a shortage of masks and respirators has been reported globally. Policies of health organizations for healthcare workers are inconsistent, with a change in policy in the US for universal face mask use. The aim of this study was to review the evidence around the efficacy of masks and respirators for healthcare workers, sick patients and the general public. MethodsA systematic review of randomized controlled clinical trials on use of respiratory protection by healthcare workers, sick patients and community members was conducted. Articles were searched on Medline and Embase using key search terms. ResultsA total of 19 randomised controlled trials were included in this study – 8 in community settings, 6 in healthcare settings and 5 as source control. Most of these randomised controlled trials used different interventions and outcome measures. In the community, masks appeared to be effective with and without hand hygiene, and both together are more protective. Randomised controlled trials in health care workers showed that respirators, if worn continually during a shift, were effective but not if worn intermittently. Medical masks were not effective, and cloth masks even less effective. When used by sick patients randomised controlled trials suggested protection of well contacts. ConclusionThe study suggests that community mask use by well people could be beneficial, particularly for COVID-19, where transmission may be pre-symptomatic. The studies of masks as source control also suggest a benefit, and may be important during the COVID-19 pandemic in universal community face mask use as well as in health care settings. Trials in healthcare workers support the use of respirators continuously during a shift. This may prevent health worker infections and deaths from COVID-19, as aerosolisation in the hospital setting has been documented.

OVERVIEW OF WORKERS' PULMONARY FAAL CONDITIONS AND WORKER ACTIONS AT THE END OF THE FINAL SCRUB INDUSTRY X SURABAYA

ABSTRACTOne type of air pollution that has the potential to harm human health is particulate dust. Particulate dust causes pulmonary damage when inhaled during work continuously. The purpose of this study was to see the description of the condition of the lung physiology ,workers' actions,worker smoking habits,use of respiratory tract,and physical quality of the environment. This was descriptive research, using design cross-sectional. The sample size used total population as 14 people. physical environmental quality includes PM2.5 concentration,air temperature and humidity. The action variable was measured using an observation sheet, while smoking habits and respiratory tract measured using a questionnaire. Lung function disorder was measured using spirometry. Based on the results,50% of workers had a bad action, 64.3% of workers had a smoking habit, and 28.6% of workers didn’t use continuous respiratory protection during working hours. The measurement of physical environmental quality at PM2.5 still meets the quality standard, while for the temperature and humidity do not meet quality standards. A total of 5 workers in the final rub section have lung function disorders. The conclusion that can be taken is more lung function disorder is experienced by workers who have smoking habits, not using continuous respiratory protection during working hours. The advice that can be given is that the use of the respiratory protector of masks should always be used continuously while workin. For workers with lung function disorders, should immediately conduct further medical examination and reduce smoking habits so that the lung physiological condition doesn’t decrease.Keywords: PM2.5 concentration, lung function disorders, workers' actions,worker smoking habits,use of respiratory protection

Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings.

Infection control policies and guidelines recommend using facemasks and respirators to protect healthcare workers (HCWs) from respiratory infections. Common types of respirators used in healthcare settings are filtering facepiece respirators (FFRs) and powered air-purifying respirators (PAPRs). Aims of this study were to examine the current attitudes and practices of HCWs regarding the selection and use of respiratory protection and determine the acceptability of a novel PAPR. In-depth interviews were undertaken with 20 HCWs from a large tertiary hospital in Sydney, Australia. Participants were fit tested with a lightweight tight-fitting half-facepiece PAPR (CleanSpace2™ Power Unit, PAF-0034, by CleanSpace Technology®) using the TSI™ Portacount quantitative fit test method. Interview results showed that HCWs had a limited role in the selection and use of facemasks and respirators and had been using the devices provided by the hospital. The majority of subjects had no knowledge of hospital policy for the use of facemasks and respirators, had not been trained on the use of respirators, and had not been fit tested previously. Compliance with the use of facemasks and respirators was perceived as being low and facemasks and respirators were typically used only for short periods of time.All 20 participants were successfully fit tested to the CleanSpace2™ PAPR (overall geometric mean fit factor-6768). According to the exit surveys, CleanSpace2™ PAPRs were easy to don (14/20) and doff (15/20) and comfortable to wear (14/20). Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations. HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs.

Manganese fractionation using a sequential extraction method to evaluate welders’ flux core arc welding exposures in a shipyard, structural steel and custom parts manufacturers/Studie zur Bewertung der Exposition am Arbeitsplatz gegenüber Mangan (Mn) im Schweißrauch beim Fülldraht-Lichtbogenschweißen (flux core arc welding, FCAW) mithilfe eines sequentiellen Extraktionsverfahrens in einer Werft, bei Baustahl und Anlagen für Sonderteile

The National Institute for Occupational Safety and Health (NIOSH) has conducted an occupational exposure assessment study of manganese (Mn) in flux core arc welding fume at three facilities. The objective of this study was to evaluate exposures to different Mn fractions using a sequential extraction procedure. Sixty-seven worker-days were monitored for either total or respirable Mn. The samples were analyzed using an experimental method to separate four Mn fractions based on chemical solubility: soluble Mn in a mild ammonium acetate solution; Mn0,2+ in 25% acetic acid; Mn3+,4+ in hydroxylamine hydrochloride in 25% acetic acid; and insoluble Mn fractions in hydrochloric/nitric acid. The full-shift total particle size Mn time-weighted average (TWA) breathing zone concentrations ranged from 0.51 to 43; 2.9 to 850; 1.7 to 620; and 0.56 to 331 µg·m-3, for the different Mn fractions, respectively. The summation of all the total particulate Mn fractions yielded results that ranged from 16 to 1,530 µg m-3. The ranges of respirable size Mn TWA concentrations were 0.27 to 75 for soluble Mn; 1.6 to 690 for Mn0,2+; 1.3 to 740 for Mn3+,4+; 0.52 to 570 for insoluble Mn; and 3.8 to 1,800 µg·m-3 for Mn (sum of fractions). Total particulate TWA GM concentrations of the Mn(sum) were 56 (GSD = 4.0), 380 (GSD = 2.7), and 176 (GSD = 3.3) µg·m-3 for the shipyard, structural steel and custom parts facilities. Although most of the workers’ exposures measured were below the NIOSH Recommended Exposure Limit for Mn (1,000 µg·m-3), 44 welders’ exposures exceeded the ACGIH Threshold Limit Values® for total Mn (100 µg·m-3) and 46 exceeded the new respirable Mn TLV (20 µg·m-3). This study shows that a welding fume exposure control and management program is warranted for Mn, which includes improved exhaust ventilation and may necessitate the use of respiratory protection, especially for welding in enclosed or confined spaces.

Factors motivating the use of respiratory protection against volcanic ashfall: A comparative analysis of communities in Japan, Indonesia and Mexico

Communities living near active volcanoes may be exposed to respiratory hazards from volcanic ash. Understanding their perception of the risks and the actions they take to mitigate against those risks is important for developing effective communication strategies. To investigate this issue, the first comparative study of risk perceptions and use of respiratory protection was conducted on 2003 residents affected by active volcanoes from three countries: Japan (Sakurajima volcano), Indonesia (Merapi and Kelud volcanoes) and Mexico (Popocatépetl volcano). The study was designed to test the explanatory value of a theoretical framework which hypothesized that use of respiratory protection (i.e., facemask) would be motivated by two cognitive constructs from protection motivation theory: threat appraisal (i.e., perceptions of harm/ worry about ash inhalation) and coping appraisal (i.e., beliefs about mask efficacy). Using structural equation modelling (SEM), important differences in the predictive ability of the constructs were found between countries. For example, perceptions of harm/ worry were stronger predictors of mask use in Japan and Indonesia than they were in Mexico where beliefs about mask efficacy were more important. The SEM also identified differences in the demographic variants of mask use in each country and how they were mediated by the cognitive constructs. Findings such as these highlight the importance of contextualising our understanding of protection motivation and, thus, the value of developing targeted approaches to promote precautionary behaviour.

Development of Competencies for Respiratory Protection for Health Care Workers.

According to the Bureau of Labor Statistics, more than 18 million health care workers in the United States are currently employed in the health care field and at risk of infectious respiratory exposure. With the emergence of global infectious diseases such as Ebola and Severe Acute Respiratory Syndrome (SARS), there is a need for increased and more clinically competent use of respiratory protection among healthcare workers. In an effort to improve knowledge about the practice of respiratory protection against respiratory infectious agents, a NIOSH-funded project that included an educational program, observations of HCWs, and focus groups was conducted. This study aimed to develop, implement, and evaluate respiratory protection educational program for HCWs and hospital management. This study identified respiratory protection practice issues among HCWs and strategies for integration of respiratory protection standards and procedures into practice. Findings from these efforts were used to develop respiratory protection competencies. Any worker who has the potential for respiratory exposure to infectious agents should be protected and should be able to demonstrate these specific competencies to achieve a standard level of respiratory protection.