The purpose of the study was to determine the adherence to and usage of the N95 respirator mask as a TB control measure in healthcare facilities in the Tshwane district during managing a patient suspected or confirmed with pulmonary TB infection. A cross-sectional, descriptive survey design was used to collect the data. A sample of 204 healthcare professionals and healthcare workers working in five healthcare facilities in the Tshwane health district met the inclusion criteria for this study. More than 83.33 %( n=170) of the staff were nurses; physiotherapists in the healthcare facility constituted the lowest percentage (1.96%; n=4). Chi-square test was done to test whether there was a significant difference between knowledge on the fit test of the N95 respirator mask and the healthcare professionals and healthcare workers. There was no significant difference in knowledge across the five staff categories P-value of >0.05. Ensuring successful protection of the healthcare workers from contracting M-TB in the TB healthcare facilities depends on effective implementation of a respiratory protection programme and the correct usage of the N95 respirator mask.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Public Health (Occupational Hygiene). Johannesburg, May 2015 / In the hierarchy of controls, the use of respirators is listed as the least preferable means of exposure or infection control; however it is often the primary means of protection in many industries including the health care industry. The National Health Laboratory Service (NHLS) provides diagnostic pathology laboratory services to the national and provincial health departments in nine South African Provinces. NHLS staff includes N95 respirator users working with infectious diseases such as tuberculosis (TB). It has been shown that an individual‟s facial structure influences their chances of achieving respirator fit. Study aim This study aims to describe the proportion of NHLS respirator users with adequate quantitative respirator fit while wearing their currently supplied respirators. Study objectives 1. To determine the proportion of NHLS respirator users achieving an adequate fit 2. To describe facial characteristics of NHLS respirator users and to group these faces into three face sizes (small, medium and large) based on the NIOSH fit test panel and two facial dimensions (face width and face length) 3. To explore the relationship between face size and demographic variables (sex, age, and race) of tested NHLS respirator users 4. To explore the influence of face size on respirator fit obtained by NHLS respirator users wearing their current respirator Materials and methods This was a cross sectional study with descriptive and analytical components. NHLS employees from selected laboratories in Gauteng, Cape Town and Durban were invited to participate. Study participants were respirator users and the majority were exposed to hazardous biological agents (HBA) including tuberculosis (TB). The NHLS employees included the four common South African race groups (as per Statistics South Africa) namely African, White, Coloured and Asian. A minimum sample size of 240 study participants was calculated for the study based on 30 participants per race group and sex. At the close of data collection 610 employees participated in this study. Quantitative respirator fit testing was conducted using a Portacount fit testing machine. Four facial dimensions were taken using callipers and a tape measure. STATA 12 was used to perform descriptive and interferential statistics. The associations between pass and fail and key predictors were investigated by chi-square tests. Student‟s t-tests and Kruskal-Wallis one way analysis of variance were used to investigate the overall fit factor in groups by face size, sex, race, age group and nose bridge width. The effect of the independent variables was explored using multiple linear regressions stratified by sex. Results and discussion Of the 610 employees who participated, a large percentage (78%) of NHLS respirator users failed fit testing and was not protected by their currently supplied medium size respirator. Ninety one percent of the respirators supplied were medium. The race group which achieved a highest proportion of fit factor passes was White (27%) followed by Africans (26%), a drop of pass rate was seen in Coloureds (21%) while the Asians achieved the lowest proportion at 7%. These poor pass rates indicate that a respiratory protection programme is needed in the NHLS, with focus on supplying the correct size and style of respirators. When the measured face length and face width of participants were plotted against the new bivariate NIOSH fit test panel, it was found that 35%, 58% and 7% of the participants had small, medium and large faces respectively. Our study population did fall within the panel but the distributions were different between cells compared to the American population. In the South African population Asians were more likely to be associated with a small face than Africans (p=0.00), Whites (p=0.00) and Coloureds (p= 0.00). While the Coloureds were not significantly different from the Whites or Africans (p= 0.397 p=0.713). The study showed that in addition to face length and face width, nose bridge width play a role in respirator fit. Multiple linear regression analysis showed that face size and nose bridge width were both significant predictors of overall fit. Although both sex and race predicted respirator fit in unadjusted analysis, these fell away when facial characteristic measurements were placed in the model. This suggests that sex and race maybe proxies for facial characteristics in predicting respirator fit. Conclusion and recommendation The high percentage of employees in this study sample achieving poor fit with their current respirator indicates a need for immediate testing of all NHLS respirator users and for a range of sizes and styles of respirators to be provided to all staff requiring respirators. The use of poorly fitting respirators could create a false impression of protection in the laboratories where employees are possibly exposed to HBA‟s including all types of TB. This also leads to in a large amount of funds being spent on purchasing ineffective respirators at the NHLS. A respiratory protection programme including respirator fit testing needs to be compiled, implemented and reviewed regularly to ensure sustainability. Future studies may include the investigation of the relevance of panels used in designing respirators to be worn by South Africans.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1990.

Cette étude a pour objectif de déterminer dans quelle mesure les APR, dont les performances sont qualifiées pour des particules supérieures à 100 nm, sont efficaces pour des nanoparticules. En effet, dans le cas où l'utilisation d'une filtration collective est insuffisante, le port d'un Appareil de Protection Respiratoire (APR) est le dernier rempart préconisé. Une synthèse bibliographique a montré qu'aucune recherche n'a porté sur l'efficacité de demi-masques avec filtres pour des nanoparticules. Le banc d'ETude des NAnoparticules a été dimensionné et réalisé afin de pallier ces manques. Deux demi-masques ont été testés selon différentes configurations d'essais : débit constant et débit cyclique (débit moyen de 84 L/min) ; taille des particules (de 5 à 100 nm) ; pose du masque (scellée, libre, ou avec des fuites calibrées). Les résultats montrent que, dès lors que les APR utilisés contiennent des media (non électrets) efficaces pour des particules de la zone MPPS (100 nm - 300 nm), les APR sont plus efficaces pour les particules nanométriques. De plus, les résultats obtenus, en présence de fuites réelles et calibrées, ont mis en évidence l'importance des fuites au visage dans la détermination des performances des APR. Un modèle de calcul du facteur de protection a été établi, basé sur la différenciation des débits d'air traversant la fuite et le filtre. Cette modélisation a été validée à l'aide des mesures obtenues en présence des fuites calibrées, et appliquée pour l'analyse de nos résultats en pose libre / This study aims to determine how the respiratory protective devices (RPD), whose performances are qualified for particles above 100 nm, are effective for nanoparticles. Indeed, if the use of a collective filtration is inadequate, wearing a RPD is the last protection recommended. A literature review showed that no research concerned the effectiveness of half-masks for nanoparticles. The test bench ETNA has been sized and built to overcome these lacks. Two half masks were tested according to different configurations: constant flow rate and cyclic flow rate (average flow of 84 L /min) ; particle size (from 5 to 100 nm) ; positions of the mask (sealed, usual, or with calibrated leaks). The results show that, since the RPD contain high efficiency filter media (without charged fibers) for the most penetrating particle size (100 nm - 300 nm), the RPD is more efficient for nanoparticles. Furthermore, the results obtained in the presence of actual and calibrated leaks, highlighted the importance of faceseal leakages in determining the performance of RPD. A model for calculating the protection factor was established based on the balance between the airflow through the filter and the leak. This model was validated using measurements obtained in the presence of calibrated leaks, and applied for the analysis of our results in usual position

O transplante de células-tronco hematopoéticas (TCTH) consiste em um procedimento complexo e relacionado à ocorrência de diversas complicações, dentre elas os processos infecciosos decorrentes do longo período de imunossupressão vivenciado após a instituição do regime de condicionamento. Inúmeras medidas têm sido empregadas visando à prevenção e controle de infecções, porém, observam-se divergências em relação à utilização das mesmas; sendo que o emprego da prática baseada em evidências possibilita ao profissional tomar decisões em relação à sua prática fundamentadas em resultados de pesquisas científicas atuais. Esta revisão integrativa da literatura teve como objetivo identificar e avaliar as evidências disponíveis na literatura e publicadas nos últimos 20 anos em relação ao uso de três medidas de prevenção de infecção em pacientes submetidos ao TCTH durante o período de internação: uso de filtros de ar de alta eficiência, isolamento protetor e máscaras. Para a seleção dos artigos foram utilizadas as bases de dados LILACS, PUBMED, CINAHL, EMBASE e a Biblioteca Cochrane. A amostra foi composta por 15 estudos, sendo que apenas um apresentou nível de evidência forte (nível I), dois apresentaram nível de evidência moderado (nível IV e V) e doze consistiram em estudos com evidências fracas (nível VI e VII). Dez estudos abordaram a utilização dos filtros HEPA, sendo recomendado seu emprego para pacientes submetidos ao transplante alogênico durante o período de neutropenia. A necessidade de seu uso para pacientes submetidos ao transplante autólogo ainda é controversa. Nove trabalhos abordaram o uso do isolamento protetor e, embora alguns autores relatem que o emprego do mesmo parece apresentar benefícios quando não se dispõe de filtros HEPA, a utilização desta medida já não é mais indicada tanto pelos Centers for Disease Control and Prevention (CDC) quanto pela maioria dos estudos analisados. Em relação à utilização de máscaras por pacientes, profissionais de saúde ou visitantes dentro das unidades de internação para TCTH, não foram encontrados estudos com evidências fortes que justifiquem o seu uso. No entanto, recomenda-se que sejam seguidas as diretrizes dos CDC quanto ao uso de respiradores especiais (como as máscaras N95) pelos pacientes imunocomprometidos submetidos ao TCTH ao deixar a unidade de transplante provida de filtro HEPA quando próximo a ela houver áreas de construção/reforma ou atividades geradoras de poeira. Embora os dados evidenciados auxiliem na tomada de decisão para a implementação da assistência de enfermagem a estes pacientes, verificou-se a necessidade de realização de estudos com nível de evidência forte que comprovem ou refutem a efetividade destas medidas. / Hematopoietic stem cell transplantation (HSCT) is a complex procedure related to the occurrence of different complications, including infectious processes deriving from the long period of immunosuppression experienced after the establishment of the conditioning regimen. Countless measures have been used for infection prevention and control, but divergences are observed with regard to their use; evidence-based practice allows professionals to make decisions for practice based on current scientific research results. This integrative literature review aimed to identify and assess evidence available in literature and published in the last 20 years about the use of three infection prevention measures in patients submitted to HSCT during hospitalization: use of high-efficiency air filters, protective isolation and masks. LILACS, PUBMED, CINAHL, EMBASE and the Cochrane Library were used to select the articles. The sample comprised 15 studies, only one of which presented strong evidence (level I), while two presented moderate evidence (levels IV and V) and twelve were studies with weak evidence (levels VI and VII). Ten studies discussed the use of HEPA filters, recommended for patients submitted to allogeneic transplantation during the neutropenia period. It remains controversial whether these filters need to be used for patients submitted to autologous transplant. Nine studies addressed the use of protective isolation and, although some authors report that using this measure can be beneficial when HEPA filters are unavailable, neither the Centers for Disease Control and Prevention (CDC) nor by most of the studies under analysis indicate it any longer. With regard to the use of masks by patients, health professionals or visitors inside HSCT hospitalization units, no studies with strong evidence were found that justify its use. However, it is recommended that CDC recommendations be followed regarding the use of special respirators (like N95 masks) by immunocompromised patients submitted to HSCT when they leave the transplantation unit with a HEPA filter in case of nearby construction/reform areas or activities that generate dust. Although the evidenced data support decision making with a view to nursing care delivery to these patients, research with strong evidence is needed to prove or reject the efficacy of these measures.

O transplante de células-tronco hematopoéticas (TCTH) consiste em um procedimento complexo e relacionado à ocorrência de diversas complicações, dentre elas os processos infecciosos decorrentes do longo período de imunossupressão vivenciado após a instituição do regime de condicionamento. Inúmeras medidas têm sido empregadas visando à prevenção e controle de infecções, porém, observam-se divergências em relação à utilização das mesmas; sendo que o emprego da prática baseada em evidências possibilita ao profissional tomar decisões em relação à sua prática fundamentadas em resultados de pesquisas científicas atuais. Esta revisão integrativa da literatura teve como objetivo identificar e avaliar as evidências disponíveis na literatura e publicadas nos últimos 20 anos em relação ao uso de três medidas de prevenção de infecção em pacientes submetidos ao TCTH durante o período de internação: uso de filtros de ar de alta eficiência, isolamento protetor e máscaras. Para a seleção dos artigos foram utilizadas as bases de dados LILACS, PUBMED, CINAHL, EMBASE e a Biblioteca Cochrane. A amostra foi composta por 15 estudos, sendo que apenas um apresentou nível de evidência forte (nível I), dois apresentaram nível de evidência moderado (nível IV e V) e doze consistiram em estudos com evidências fracas (nível VI e VII). Dez estudos abordaram a utilização dos filtros HEPA, sendo recomendado seu emprego para pacientes submetidos ao transplante alogênico durante o período de neutropenia. A necessidade de seu uso para pacientes submetidos ao transplante autólogo ainda é controversa. Nove trabalhos abordaram o uso do isolamento protetor e, embora alguns autores relatem que o emprego do mesmo parece apresentar benefícios quando não se dispõe de filtros HEPA, a utilização desta medida já não é mais indicada tanto pelos Centers for Disease Control and Prevention (CDC) quanto pela maioria dos estudos analisados. Em relação à utilização de máscaras por pacientes, profissionais de saúde ou visitantes dentro das unidades de internação para TCTH, não foram encontrados estudos com evidências fortes que justifiquem o seu uso. No entanto, recomenda-se que sejam seguidas as diretrizes dos CDC quanto ao uso de respiradores especiais (como as máscaras N95) pelos pacientes imunocomprometidos submetidos ao TCTH ao deixar a unidade de transplante provida de filtro HEPA quando próximo a ela houver áreas de construção/reforma ou atividades geradoras de poeira. Embora os dados evidenciados auxiliem na tomada de decisão para a implementação da assistência de enfermagem a estes pacientes, verificou-se a necessidade de realização de estudos com nível de evidência forte que comprovem ou refutem a efetividade destas medidas. / Hematopoietic stem cell transplantation (HSCT) is a complex procedure related to the occurrence of different complications, including infectious processes deriving from the long period of immunosuppression experienced after the establishment of the conditioning regimen. Countless measures have been used for infection prevention and control, but divergences are observed with regard to their use; evidence-based practice allows professionals to make decisions for practice based on current scientific research results. This integrative literature review aimed to identify and assess evidence available in literature and published in the last 20 years about the use of three infection prevention measures in patients submitted to HSCT during hospitalization: use of high-efficiency air filters, protective isolation and masks. LILACS, PUBMED, CINAHL, EMBASE and the Cochrane Library were used to select the articles. The sample comprised 15 studies, only one of which presented strong evidence (level I), while two presented moderate evidence (levels IV and V) and twelve were studies with weak evidence (levels VI and VII). Ten studies discussed the use of HEPA filters, recommended for patients submitted to allogeneic transplantation during the neutropenia period. It remains controversial whether these filters need to be used for patients submitted to autologous transplant. Nine studies addressed the use of protective isolation and, although some authors report that using this measure can be beneficial when HEPA filters are unavailable, neither the Centers for Disease Control and Prevention (CDC) nor by most of the studies under analysis indicate it any longer. With regard to the use of masks by patients, health professionals or visitors inside HSCT hospitalization units, no studies with strong evidence were found that justify its use. However, it is recommended that CDC recommendations be followed regarding the use of special respirators (like N95 masks) by immunocompromised patients submitted to HSCT when they leave the transplantation unit with a HEPA filter in case of nearby construction/reform areas or activities that generate dust. Although the evidenced data support decision making with a view to nursing care delivery to these patients, research with strong evidence is needed to prove or reject the efficacy of these measures.