Wear Compliance and Donning/Doffing of Respiratory Protection for Bioaerosols or Infectious Agents: A Review of the Effectiveness, Safety, and Guidelines

There are several common issues that factor in to a health care worker (HCW) not being compliant with policies for respirator wear. The most common of these problems is that respirators have tight fitting straps which can cause discomfort. Discomfort is produced by facial pressure, heat, labored movement of facial muscles, and itchiness. Other common complaints are more subjective in nature such as claustrophobia and perceived shortness of breath. In addition the most common problems encountered when respirators are worn is that the straps are not placed in the correct manner, a seal check in not completed after donning, and removal is not done by touching the straps only.

There are three types of respirators used by health care facilities; particulate-filtering face-piece respirators, elastomeric respirators, and powered air-purifying respirators. The most commonly used group in health care settings are the particulate-filtering face-piece respirators, specifically those certified by the National Institute for Occupational Safety and Health (NIOSH) called N95 respirators. The Centers for Disease Control and Prevention (CDC) has estimated that there are approximately 1.7 million health care associated infections yearly which account for 99,000 deaths. Proper use of respiratory protection is a critical part of the process of protecting HCWs from contracting these diseases.

The purpose of this report is to review the effectiveness, safety and guidelines for different levels of wear compliance of HCW along with donning and doffing behavior for respirator use in health care settings.

Contents

• CONTEXT AND POLICY ISSUES
• RESEARCH QUESTIONS
• KEY FINDINGS
• METHODS
  • Literature Search Strategy
  • Selection Criteria and Methods
  • Exclusion Criteria
  • Critical Appraisal of Individual Studies
• SUMMARY OF EVIDENCE
  • Quantity of Research Available
  • Summary of Study Characteristics
  • Summary of Critical Appraisal
  • Summary of Findings
• LIMITATIONS
• CONCLUSIONS AND IMPLICATIONS FOR DECISION OR POLICY MAKING
• APPENDIX 1 Selection of Included Studies
• APPENDIX 2 Summary of Study Characteristics
• APPENDIX 3 Study Characteristics – Guidelines for Respirator Use
• APPENDIX 4 Critical Appraisal of Included Literature
• Appendix 5 Summary of Findings
• REFERENCES

Disclaimer: The Rapid Response Service is an information service for those involved in planning and providing health care in Canada. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. The intent is to provide a list of sources of the best evidence on the topic that CADTH could identify using all reasonable efforts within the time allowed. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. While CADTH has taken care in the preparation of the report to ensure that its contents are accurate, complete and up to date, CADTH does not make any guarantee to that effect. CADTH is not liable for any loss or damages resulting from use of the information in the report.