Samuel J. Reade MBChB, MRes, Ahmad Bassam MBBS, BMedSci, Wisam Al-Bassam FCICM, MBChB, Umesh Kadam MD, MRCP UK, FCICM
{"title":"重症监护室医护人员长时间使用 N95 呼吸器后的密封完整性：一项队列研究。","authors":"Samuel J. Reade MBChB, MRes, Ahmad Bassam MBBS, BMedSci, Wisam Al-Bassam FCICM, MBChB, Umesh Kadam MD, MRCP UK, FCICM","doi":"10.1016/j.aucc.2024.07.080","DOIUrl":null,"url":null,"abstract":"<div><h3>Aim/objectives</h3><div>Fit testing of N95/FFP2 respirators is universally recommended before exposure to airborne infectious diseases such as COVID-19. Respirator supply shortage in the COVID-19 pandemic encouraged extended-use for up to 4 h, despite uncertainty about seal integrity over time. The aim of our study was to assess N95 seal integrity after at least 2 h of continuous clinical use in the intensive care unit (ICU). We hypothesised that seal integrity would deteriorate over time, with variability between respirator shapes.</div></div><div><h3>Methods</h3><div>A prospective cohort study of healthcare workers in a metropolitan ICU setting in Australia between April 2021 and August 2022. Following consent and screening, participants underwent qualitative fit testing in the ICU, and fit tests were repeated following a continuous period of at least 2-h usage. The primary outcome was N95 fit-test failure rate measured by qualitative fit testing of >2 h compared to baseline. Secondary outcomes evaluated effects of respirator shape, demographic characteristics, and duration of respirator use on respirator fit after 2 h use.</div></div><div><h3>Results</h3><div>Fifty-one participants were recruited and consented. Six participants were excluded; four failed baseline fit test, one could not taste saccharin, and one did not complete 2 h of usage. Fourteen of 45 participants (∼31%) failed the extended-use fit test (median duration: 2 h 10 min [interquartile range: 2:07–2:20]). Fit-test rates differed between respirator shapes; three-piece flat-fold respirators had lower failure rates (6/32; 19%) than duckbill-shaped respirators (6/11; 55%) p = 0.046. No other demographic characteristic or respirator shape was significantly associated with increased failure rate.</div></div><div><h3>Conclusions</h3><div>Following 2 h of use, approximately 30% of participants failed repeat fit testing, suggesting incomplete respiratory protection. Three-piece flat-fold respirators outperformed duckbill respirators. Extended use of respirators, even without respirator reuse, may put healthcare workers at risk of inadequate respiratory protection, in particular when using duckbill-shaped respirators.</div></div>","PeriodicalId":51239,"journal":{"name":"Australian Critical Care","volume":"38 1","pages":"Article 101099"},"PeriodicalIF":2.6000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"N95 respirator seal integrity following extended-use by healthcare workers in the intensive care unit: A cohort study\",\"authors\":\"Samuel J. Reade MBChB, MRes, Ahmad Bassam MBBS, BMedSci, Wisam Al-Bassam FCICM, MBChB, Umesh Kadam MD, MRCP UK, FCICM\",\"doi\":\"10.1016/j.aucc.2024.07.080\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Aim/objectives</h3><div>Fit testing of N95/FFP2 respirators is universally recommended before exposure to airborne infectious diseases such as COVID-19. Respirator supply shortage in the COVID-19 pandemic encouraged extended-use for up to 4 h, despite uncertainty about seal integrity over time. The aim of our study was to assess N95 seal integrity after at least 2 h of continuous clinical use in the intensive care unit (ICU). We hypothesised that seal integrity would deteriorate over time, with variability between respirator shapes.</div></div><div><h3>Methods</h3><div>A prospective cohort study of healthcare workers in a metropolitan ICU setting in Australia between April 2021 and August 2022. Following consent and screening, participants underwent qualitative fit testing in the ICU, and fit tests were repeated following a continuous period of at least 2-h usage. The primary outcome was N95 fit-test failure rate measured by qualitative fit testing of >2 h compared to baseline. Secondary outcomes evaluated effects of respirator shape, demographic characteristics, and duration of respirator use on respirator fit after 2 h use.</div></div><div><h3>Results</h3><div>Fifty-one participants were recruited and consented. Six participants were excluded; four failed baseline fit test, one could not taste saccharin, and one did not complete 2 h of usage. Fourteen of 45 participants (∼31%) failed the extended-use fit test (median duration: 2 h 10 min [interquartile range: 2:07–2:20]). Fit-test rates differed between respirator shapes; three-piece flat-fold respirators had lower failure rates (6/32; 19%) than duckbill-shaped respirators (6/11; 55%) p = 0.046. No other demographic characteristic or respirator shape was significantly associated with increased failure rate.</div></div><div><h3>Conclusions</h3><div>Following 2 h of use, approximately 30% of participants failed repeat fit testing, suggesting incomplete respiratory protection. Three-piece flat-fold respirators outperformed duckbill respirators. Extended use of respirators, even without respirator reuse, may put healthcare workers at risk of inadequate respiratory protection, in particular when using duckbill-shaped respirators.</div></div>\",\"PeriodicalId\":51239,\"journal\":{\"name\":\"Australian Critical Care\",\"volume\":\"38 1\",\"pages\":\"Article 101099\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Australian Critical Care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1036731424002091\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Australian Critical Care","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1036731424002091","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
N95 respirator seal integrity following extended-use by healthcare workers in the intensive care unit: A cohort study
Aim/objectives
Fit testing of N95/FFP2 respirators is universally recommended before exposure to airborne infectious diseases such as COVID-19. Respirator supply shortage in the COVID-19 pandemic encouraged extended-use for up to 4 h, despite uncertainty about seal integrity over time. The aim of our study was to assess N95 seal integrity after at least 2 h of continuous clinical use in the intensive care unit (ICU). We hypothesised that seal integrity would deteriorate over time, with variability between respirator shapes.
Methods
A prospective cohort study of healthcare workers in a metropolitan ICU setting in Australia between April 2021 and August 2022. Following consent and screening, participants underwent qualitative fit testing in the ICU, and fit tests were repeated following a continuous period of at least 2-h usage. The primary outcome was N95 fit-test failure rate measured by qualitative fit testing of >2 h compared to baseline. Secondary outcomes evaluated effects of respirator shape, demographic characteristics, and duration of respirator use on respirator fit after 2 h use.
Results
Fifty-one participants were recruited and consented. Six participants were excluded; four failed baseline fit test, one could not taste saccharin, and one did not complete 2 h of usage. Fourteen of 45 participants (∼31%) failed the extended-use fit test (median duration: 2 h 10 min [interquartile range: 2:07–2:20]). Fit-test rates differed between respirator shapes; three-piece flat-fold respirators had lower failure rates (6/32; 19%) than duckbill-shaped respirators (6/11; 55%) p = 0.046. No other demographic characteristic or respirator shape was significantly associated with increased failure rate.
Conclusions
Following 2 h of use, approximately 30% of participants failed repeat fit testing, suggesting incomplete respiratory protection. Three-piece flat-fold respirators outperformed duckbill respirators. Extended use of respirators, even without respirator reuse, may put healthcare workers at risk of inadequate respiratory protection, in particular when using duckbill-shaped respirators.
期刊介绍：
Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.
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