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Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators

Educational Objective
Review study on ability for training and fit testing healthcare workers in using EHMRs
1 Credit CME

The demand for disposable respiratory protective devices needed to protect health care personnel may exceed supply during large outbreaks of respiratory infectious diseases.1,2 Concerns are growing over global shortages of respiratory protective devices during the novel coronavirus disease 2019 (COVID-19) pandemic.3 A reusable alternative to N95 respirators for which health care personnel can be rapidly assessed for fit (fit testing) and trained for use is needed. Elastomeric half-mask respirators (EHMRs), which provide the same level of respiratory protection as N95 respirators, are one alternative4 (eFigure in Supplement 1). These reusable respirators are used in construction and manufacturing, but not widely used in health care4 because of uncertainty about disinfection methods and upfront costs.5 The goal of this demonstration study was to test the feasibility of rapidly training and fit testing health care workers to EHMRs.

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Article Information

Corresponding Author: Lisa A. Pompeii, PhD, Department of Pediatrics, Center for Epidemiology & Population Health, Baylor College of Medicine, 1 Baylor Plaza, BCM 622, Houston, TX 77030-3411 (lisa.pompeii@bcm.edu)

Published Online: March 25, 2020. doi:10.1001/jama.2020.4806

Author Contributions: Dr Radonovich had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Pompeii, Kraft, Brownsword, Rios, Radonovich.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Pompeii, Kraft, Brownsword, Lane, Rios, Radonovich.
Critical revision of the manuscript for important intellectual content: Pompeii, Kraft, Brownsword, Benavides, Rios, Radonovich.
Statistical analysis: Kraft, Brownsword, Lane, Benavides.
Obtained funding: Pompeii, Brownsword, Radonovich.
Administrative, technical, or material support: Pompeii, Kraft, Brownsword, Rios, Radonovich.
Supervision: Pompeii, Brownsword, Rios, Radonovich.

Conflict of Interest Disclosures: Dr Pompeii reported receiving grants from the Centers for Disease Control and Prevention during the conduct of the study. Dr Kraft reported receiving grants from the National Institute for Occupational Safety and Health during the conduct of the study and serving on a scientific advisory board for Rebiotix outside the submitted work. Dr Lane reported receiving grants from the Centers for Disease Control and Prevention during the conduct of the study. Dr Benavides reported receiving grants from the Centers for Disease Control and Prevention during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was funded by the Centers for Disease Control and Prevention’s National Personal Protective Technology Laboratory (contract numbers 75D30118C02646 and 75D30118C02645).

Role of the Funder/Sponsor: Members of the study team employed by the National Institute of Occupational Safety and Health at the Centers for Disease Control and Prevention (the funding organization) contributed to the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Scientists at the Centers for Disease Control and Prevention (the funding organization) who were not members of the study team reviewed and approved the manuscript for publication. The funding organization did not participate in data collection or management of the study.

Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. Mention of specific products does not imply endorsement.

Additional Contributions: Patrick L. Yorio, PhD, provided statistical support for these analyses. He is affiliated with and funded by the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention.

Additional Information: This study was registered with ClinicalTrials.gov (NCT03888898). Institutional review board approval was provided by the University of Texas Health Science Center (HSC-18-0834), Baylor College of Medicine (H-46459), and Emory University (109854).

References
1.
Patel  A , D’Alessandro  MM , Ireland  KJ , Burel  WG , Wencil  EB , Rasmussen  SA .  Personal protective equipment supply chain: lessons learned from recent public health emergency responses.   Health Secur. 2017;15(3):244-252. doi:10.1089/hs.2016.0129PubMedGoogle ScholarCrossref
2.
Murray  M , Grant  J , Bryce  E , Chilton  P , Forrester  L .  Facial protective equipment, personnel, and pandemics: impact of the pandemic (H1N1) 2009 virus on personnel and use of facial protective equipment.   Infect Control Hosp Epidemiol. 2010;31(10):1011-1016. doi:10.1086/656564PubMedGoogle ScholarCrossref
3.
Healthcare supply of personal protection equipment. Centers for Disease Control and Prevention website. Updated March 12, 2020. Accessed March 24, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/healthcare-supply-ppe-index.html
4.
Wizner  K , Stradtman  L , Novak  D , Shaffer  R .  Prevalence of respiratory protective devices in U.S. health care facilities: implications for emergency preparedness.   Workplace Health Saf. 2016;64(8):359-368. doi:10.1177/2165079916657108PubMedGoogle ScholarCrossref
5.
Hines  SE , Brown  C , Oliver  M ,  et al.  User acceptance of reusable respirators in health care.   Am J Infect Control. 2019;47(6):648-655. doi:10.1016/j.ajic.2018.11.021PubMedGoogle ScholarCrossref
6.
1910.134: Respiratory protection. Occupational Safety and Health Administration website. Accessed February 5, 2020. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134
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