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Background - Communicable respiratory illness is a serious occupational threat to healthcare workers. A key reason for occupational transmission is failure to implement appropriate barrier precautions. Facial protective equipment, including surgical masks, respirators and eye/face protection, is the least adhered to type of personal protective equipment used by healthcare workers, yet it is an important barrier precaution against communicable respiratory illness. Objectives - To describe nurses’ adherence to recommended use of facial protective equipment and to identify the factors that influence adherence. Methods - A two-phased study was conducted. Phase 1 was a cross-sectional survey of nurses in selected units of six acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses. Results – Of the 1074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of facial protective equipment. Multivariable analysis revealed four organizational predictors of adherence: ready availability of equipment, regular training and fit testing, organizational support for health and safety, and good communication. Following the survey, 112 observations in 14 intensive care units were conducted that showed a 44% competence rate with proper use of N95 respirators. Common gaps included failure to verify the seal and touching the face piece. Multivariable analysis revealed knowledge of recommended use of facial protective equipment as a significant predictor of competence. Discussion – Despite the SARS experience and the resulting investment in our public health system, nurses’ adherence to recommended use of facial protective equipment and competence in effective use of N95 respirators remains suboptimal. To improve adherence, organizational leaders should focus on equipment availability, training and fit testing, organizational support for health and safety, and positive communication. To improve competence in effective use of N95 respirators, strategies to increase knowledge should be implemented. These efforts should assist to reduce occupational transmission of communicable respiratory illness and foster a healthier and safer working environment for nurses.

Background - Communicable respiratory illness is a serious occupational threat to healthcare workers. A key reason for occupational transmission is failure to implement appropriate barrier precautions. Facial protective equipment, including surgical masks, respirators and eye/face protection, is the least adhered to type of personal protective equipment used by healthcare workers, yet it is an important barrier precaution against communicable respiratory illness. Objectives - To describe nurses’ adherence to recommended use of facial protective equipment and to identify the factors that influence adherence. Methods - A two-phased study was conducted. Phase 1 was a cross-sectional survey of nurses in selected units of six acute care hospitals in Toronto, Canada. Phase 2 was a direct observational study of critical care nurses. Results – Of the 1074 nurses who completed surveys (82% response rate), 44% reported adherence to recommended use of facial protective equipment. Multivariable analysis revealed four organizational predictors of adherence: ready availability of equipment, regular training and fit testing, organizational support for health and safety, and good communication. Following the survey, 112 observations in 14 intensive care units were conducted that showed a 44% competence rate with proper use of N95 respirators. Common gaps included failure to verify the seal and touching the face piece. Multivariable analysis revealed knowledge of recommended use of facial protective equipment as a significant predictor of competence. Discussion – Despite the SARS experience and the resulting investment in our public health system, nurses’ adherence to recommended use of facial protective equipment and competence in effective use of N95 respirators remains suboptimal. To improve adherence, organizational leaders should focus on equipment availability, training and fit testing, organizational support for health and safety, and positive communication. To improve competence in effective use of N95 respirators, strategies to increase knowledge should be implemented. These efforts should assist to reduce occupational transmission of communicable respiratory illness and foster a healthier and safer working environment for nurses.

No description available.

Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

Certified Athletic Trainers (ATCs) are expected to perform cardiopulmonary resuscitation (CPR) on athletes experiencing cardiac arrest, regardless of whether the athlete is wearing protective athletic equipment. The goal of this research was to determine if ATCs were able to deliver high-quality CPR over and under football shoulder pads. Forty-one ATCs completed CPR according to 2015 AHA guidelines over and under shoulder pads fitted on a manikin. CPR quality was measured with the Resusci Anne Wireless SkillReporter. Data were analyzed to compare CPR performed over and under the shoulder pads. Overall CPR score, chest compression depth, and ventilation volume were statistically significant when CPR was performed over the equipment. Equipment removal revealed to cause a delay in compression initiation. Although the data from CPR measures suggest the removal of equipment is indicated, the prolonged delay of compressions due to equipment removal should be taken into consideration before establishing best-practice recommendations.

Objective: To assess the effects of wearing a protective mouthguard during exercise on ventilation and oxygen consumption. Design and Setting: All participants performed a graded maximal exercise test on a cycle ergometer to determine peak oxygen consumption (VO2peak). Each participant also performed 6 submaximal exercise tests while wearing one of two facemasks (nasal or non-nasal breathing) and one of three mouthguard conditions (no mouthguard, boil and bite, custom-fit). Steady-state VO2, rate of perceived exertion (RPE), and other ventilatory values were measured at 60% and 80% of VO2max during each submaximal exercise test. All 6 submaximal exercise tests were completed within a 2-week period using a randomized 6x6 balanced Latin square design. Subjects: Twenty-four subjects (age = 20.41 ± 1.99) who were members of the Brigham Young University lacrosse team participated in this study. Measurements: Data were analyzed using a random coefficients growth curve. The full models for all variables included fixed effects for mask, work level, mouthguard, time, and all interactions of the above. Full models were also assumed to have random subject coefficients for the intercepts and slopes relative to time. Results: For VO2 there was a significant effect for facemask type (p<.0001, F = 24.30, df = 1680), mouthguard (p = .0177, F = 4.04, df = 1680), and work (p<.0001, F = 5428.16, df = 1680). For VO2 there was also a significant interaction for mask*work (p = .0280, F = 4.84, df = 1680). For RPE there was a significant effect for facemask type (p = .0005, F = 12.28, df = 1657) and for work (p<.0001, F = 4040.53, df = 1657). For RPE there were also significant interactions for mask*mouthguard (p<.0001, F = 11.82, df = 1657) and for mask*work (p<.0001, F = 18.88, df = 1657). For VE there were significant interactions for mask (p< 0.0001, F = 16.49, df = 1680), mouthguard (p < 0.0001, F = 19.98, df = 1680), and work (p < 0.0001, F = 9122.33, df = 1680). For VE there were also significant interactions for mask*mouthguard (p < 0.002, F = 6.25, df = 1680), and mask*work (p < 0.0001, F = 17.77, df = 1680). Conclusions: Although statistical significance was found for a number of effects, we speculate that the very small differences in the physiological responses to wearing a mouthguard are of little practical significance and would not effect performance. Wearing a mouthguard during exercise does not alter physiological responses and complaints of reduced ventilation are probably psychological.