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 (doctoral)--University of Uppsala, 1984. / Includes bibliographical references (p. 28-33).

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1991.

Thesis (M.S.)--University of Michigan, 1988.

Thesis (M.S.)--University of Michigan, 1988.

Among the many occupational hazards to which Army rotary-wing aviators are exposed is intense noise generated from the aircraft. The potential for permanent hearing loss and difficulty communicating in helicopter noise is well known; an appropriate way to evaluate a hearing-impaired pilot's safety risk due to hearing loss is not as well known. Previous research has studied communication ability in helicopter cockpit noise under different headsets, but there are not conclusive data on the combined effects of degraded speech intelligibility due to noise and flight workload under the headset technology currently available to Army helicopter pilots. In particular, there is a scarcity of information on pilots with hearing loss. Currently, Army Aeromedical standards stipulate audiometric threshold criteria for rated helicopter pilots to ensure their safe flying. If the standard is not met, a flight waiver for hearing is generally granted if the pilot demonstrates good (at least 84%) binaural word recognition ability in a quiet environment. A research study was conducted to evaluate Army helicopter pilot performance with regard to flight workload, communication signal quality, headset configuration, and pilot hearing ability. Objectives of the study included the ability to refine current Army audiometric hearing waiver criteria, and to yield data on which to base flight and headset selection recommendations for pilots. In general, it was believed that flight performance and ratings of situation awareness (SA) would decrease as flight workload increased and communication signal quality decreased, and that assistive communication devices coupled with headsets would afford improved flight performance over their passive counterpart. It was also hypothesized that normal-hearing pilots would perform better than hearing-impaired pilots would. Twenty Army helicopter pilots (one group of 10 pilots without a hearing waiver and one group of 10 pilots with a hearing waiver) participated in this study. The pilots flew three flights in a Black Hawk flight simulator, each with a different headset configuration and with varying flight workload levels and varying air traffic control (ATC) communication signal quality. Objective flight performance parameters of heading, altitude, and airspeed deviation and ATC command readbacks were measured. Additionally, measurements were taken on subjective measures of workload, SA, and headset comfort/speech intelligibility. Experimental results partially supported the research hypotheses. Results indicated that flight performance and ratings of SA were negatively affected by increased flight workload and decreased communication signal quality for both groups of pilots. Results also showed that a passive headset/passive earplug combination use by the hearing-impaired group of pilots led to degradation of certain flight performance parameters and lower ratings of SA than the headsets equipped with assistive communication technology; however, the same headset effect was not seen with the group of normal-hearing pilots. This study yielded results that support a conclusion that factors other than hearing thresholds and word recognition ability in a quiet environment should be considered when evaluating Army helicopter pilots flight safety with regard to hearing sensitivity. Rather, the synergistic effects of flight workload and communication signal quality with individual hearing levels should be considered when making continued flight recommendations and headset choice recommendations. Results also support a recommendation requiring hearing-impaired pilots to use assistive communication technology and not be permitted to fly with passive headset devices. Further research should include a functional hearing assessment in which pilot hearing requirements are determined and individual hearing abilities are compared to the requirements. / Ph. D.

Bakgrund: Att arbeta i en miljö där hälsofarlig rök och risk för smitta förekommer innebär en risk för operationssjuksköterskans hälsa. På universitetssjukhuset finns riktlinjer om när mun- och andningsskydd ska användas. Syfte: Att undersöka om operationssjuksköterskorna på universitetssjukhuset har fullgoda kunskaper om sjukhusets riktlinjer angående mun- och andningsskydd. Att undersöka förutsättningarna för operationssjuksköterskorna att kunna följa riktlinjerna, deras upplevelse av riktlinjernas tillgänglighet samt vilka faktorer som avgör operationssjuksköterskornas val av mun- och andningsskydd. Metod: Studien är en deskriptiv enkätstudie med tvärsnittsdesign och kvantitativ ansats. Enkäter delades ut till operationssjuksköterskor på universitetssjukhuset vilka är verksamma på operationssal. För att bli godkänd i sin kunskap krävdes att respondenten hade 100 % rätta svar på kunskapsfrågorna. Data från enkäterna hanterades deskriptivt och analyserades med Mann Whitney u-test och Chi-två-test. Resultat: Hos 62 % fanns inte fullständiga kunskaper om universitetssjukhuset riktlinjer angående mun- och andningsskydd. Vidare upplevde 60 % att riktlinjerna inte är lättillgängliga. Resultatet visade att 24 % ansåg sig alltid kunna följa riktlinjerna. Slutsats: Resultatet visar att kunskapen gällande riktlinjerna är ofullständig vilket innebär att en stor del av operationssjuksköterskorna i studien riskerar sin hälsa i sitt arbete. För att operationssjuksköterskorna ska kunna uppdatera sina kunskaper bör universitetssjukhuset utforma tydligare riktlinjer angående mun- och andningsskydd i ett samlat dokument. / Background: OR nurses work in a place where there is hazardous smoke and contagion. This represents a risk to their health. The teaching hospital has guidelines for when to use facial protective devices. Aim: To see if the OR nurses at the teaching hospital have complete knowledge about the hospital guidelines regarding facial protective devices, and to study the OR nurses’ ability to follow the guidelines. The study will also determine the nurses’ perception of the availability of the guidelines and which factors determine the OR nurses’ choice of facial protective devices. Method: This is a descriptive questionnaire study with a cross-sectional design and a quantitative approach. The questionnaires were distributed to OR nurses who work in the operating room. In order to pass the test about the guidelines the respondent had to get 100 % correct answers. Data from the questionnaire were described and analyzed using Mann Whitney U test and Chi-square test. Result: Of the OR nurses, 62 % were lacking complete knowledge about the guidelines regarding facial protective devices. Furthermore, 60 % perceived the guidelines as not easily accessible. The result showed that 24 % always considered themselves to be able to follow the guidelines. Conclusion: The result shows a lack of knowledge regarding the guidelines. This means that a big part of the OR nurses in this study risk their health at work. To enable the OR nurses to update their knowledge, the teaching hospital should develop clearer guidelines on facial protective devices in one single document.

A proteção respiratória é largamente utilizada como medida de controle da exposição dos trabalhadores a particulados em suspensão no ar ambiente de trabalho em mineração. A composição química desses particulados influi nos efeitos sobre a saúde dos trabalhadores expostos e também pode afetar o desempenho do material filtrante dos respiradores. Materiais particulados oleosos suspensos no ar encontrados em ambientes de mineração podem afetar desfavoravelmente as cargas eletrostáticas comumente adicionadas às fibras dos filtros para particulados. Por essa razão os testes de laboratório dos filtros procuram simular algumas condições desfavoráveis encontradas nos ambientes de trabalho e incluem nos procedimentos de testes ensaios com substancias oleosas como o óleo de parafina ou o óleo de DOP. Os particulados não oleosos são representados nos ensaios por partículas de cloreto de sódio. O objetivo desta dissertação é comparar três métodos de ensaios para aprovação de filtros para particulados utilizados em respiradores purificadores de ar não motorizados e relacionar as condições de ensaios com as condições onde os filtros são usados em trabalhos de minerações. Para chegar a esse objetivo foram realizadas pesquisas bibliográficas sobre os riscos da exposição a particulados na indústria mineral, o uso de equipamentos de proteção respiratória e mecanismos usados para filtração de particulados; estudados os métodos de teste descritos em três normas (EN 143 européia, 42 CFR 84 norte americana e NBR 13697 brasileira), comparados os princípios de funcionamento dos equipamentos de testes Moore´s e TSI 8110/8130, e analisados resultados de estudos comparativos realizados com esses equipamentos. Conclui que os métodos de testes de desempenho submetem os filtros a condições bem mais agressivas que aquelas encontradas na maioria das condições de trabalho de mineração; que os métodos de testes europeus e norte-americanos submetem os filtros a condições semelhantes, enquanto o método brasileiro é mais brando, uma vez que não requer que a eficiência do filtro seja medida durante e após a deposição de quantidades definidas de aerossol de teste; que equipamentos de testes mais modernos que os utilizados para aprovação de filtros no Brasil incorporam progressos tecnológicos que permitem melhor repetitividade de resultados; que resultados de estudos comparativos realizados entre laboratórios mostram boa correlação entre as medições da eficiência obtidas por equipamentos Moore\'s utilizados na comunidade européia e Brasil, TSI 8110 e TSI 8130, este último utilizado pelo NIOSH nos EUA. / Respiratory protection is widely used in mining operations in order to control the worker\'s exposure to airborne particulates present in the workplaces. Chemical composition of these particulates impacts on the worker\'s health and can also affect the respirator filter media. Oily aerosols found in mining environments affect the electrostatic filter media with enhanced performance over mechanical filters. Therefore, filters laboratory tests include oily substances such as paraffin oil and DOP (Di-octil phthalate) in the test procedures, simulating some workplace unfavorable conditions. Non-oily particulates are represented by sodium chloride particles. This dissertation compares the test methods described in following standards: the European standard EN 143, the document 42 CFR 84 adopted by NIOSH (National Institute for Occupational Safety and Health) in United States of America (USA), and the Brazilian ABNT NBR 13697 adopted by Ministry of Labor of Brazil (MTE) and Fundação Jorge Duprat de Figueiredo (Fundacentro). This dissertation also compares the test methods conditions with the environemntal conditions likely found in mineral industry. The applied methodology includes a bibliographic research about workplace environmental risk in mining industry, the use of respiratory protective devices and particulate filters technology. Also includes a study of the three test methods (EN 143, 42CFR 84 and NBR 13697), principles of Moore´s and TSI 8110/8130 test instruments and analysis of inter- laboratory test studies made in Europe and USA. The conclusion shows that the test methods mentioned above subject the filters to conditions which are much more aggressive than the typical minig environments; that the European and USA test methods subject filters to comparable test conditions, while tests specified in Brazilian standards are more moderate compared to the European and North American, because filter loading is not required during the test; that new technologies incorporated in the test instruments improve repeatability and accuracy of test results; that comparison data obtained with many test instruments, made by various instrument makers allow one to conclude that there is good correlation between these instruments, in general and between the European´s Moore´s 4400 Tester Rig and the two TSI, AFT 8110 and AFT 8130, specifically.