Download L.M. Brosseau, University of Minnesota L.M. Conroy, University of Illinois Chicago

L.M. Brosseau, University of Minnesota
L.M. Conroy, University of Illinois
Chicago
NIOSH NPPTL Meeting
March, 2012
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Minnesota
◦ Karilyn Cline, RN, COHN – OHN program*
◦ Kara Durski – HPM program
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Illinois
◦ Margaret Sietsema – IH program*
◦ Jason Lotter - IH program*
◦ Lasbat Erogbogbo – IH program*
* Also received support from their NIOSHfunded Education and Research Training Center
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15 hospitals in Minnesota
◦ 7 small & 8 large (cut-pt = 90.5 beds)
◦ 2 city/county, 1 district, 12 private non-profit
◦ 6 rural & 9 urban
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13 hospitals in Illinois
◦ 3 small & 10 large (cut-pt = 8022 admissions)
◦ 2 government-owned, 2 investor-owned, 9 nonprofit
◦ 5 teaching & 8 non-teaching
◦ 2 rural & 11 urban
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363 healthcare workers
◦ 180 Illinois & 183 Minnesota
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82 unit managers
◦ 35 Illinois & 47 Minnesota
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88 hospital managers
◦ 46 Illinois & 43 Minnesota
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Half were registered nurses (48-61%)
◦ Also nursing or personal care assistants (9-12%)
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4-year college degree (30-42%) or associate
education (31-34%)
More belonged to a union in Minnesota
◦ 62% in Minnesota vs. 21% in Illinois
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39-49% belonged to a professional
organization
Almost all (95-98%) were employees of the
facility (not contract)
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Managers were more likely than HCW to have
a graduate degree
Unit managers were from:
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Emergency department (21-31%)
Intensive care (15-29%)
Medical/surgery department (13-20%)
Pediatrics (6-11%)
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Infection control (30-33%)
Employee & occupational health (26-33%)
Nursing administration (17-28%)
Environmental health and safety (7-12%)
Hospital managers were from:
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Most managers (95-98%) and employees (8083%) said their hospital had a written
respiratory protection program.
CDC guidelines were most frequently used to
identify infectious disease risks
◦ Many hospital programs were focused on TB
◦ Most written programs did not address seasonal
influenza as an infectious disease risk
◦ Some programs addressed pandemic influenza
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Most managers said their facility had
performed a risk assessment to determine
who should be in the program
◦ Most written programs were missing important
details about hazards, types of exposures, levels of
risk, types of respiratory protection matched to risk
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Many respondents didn’t know if there were
employees with patient contact not included
in the program.
◦ Food services personnel most frequently
mentioned.
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Most hospitals appear to be conducting
medical evaluation prior to respirator wear
Records appear to be managed properly
◦ Employee and occupational health most frequentlymentioned department
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Many written programs, however, did not
contain adequate information about:
◦ Medical evaluation procedures
◦ Frequency of medical evaluation
◦ Where and how long records are maintained
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Most employees appear to have received fit
testing at least once
◦ 9% MN HCW had not been fit tested (0% IL)
◦ 15% MN HCW said a fit test was not required before
wearing a respirator (6% IL)
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A small fraction (12-14%) reported problems
wearing an N95 FFR:
◦ Moisture build-up
◦ Difficulty speaking
◦ Feeling uncomfortably warm
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Most common methods of communication were:
◦ Verbal information from fit tester
◦ Receive copy of fit test results
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Some employees received a sample of the
respirator
Some hospitals had only one manufacturer,
model and size available
18% IL HCW and 7% MN HCW said their hospital
was used a better method:
◦ Badge stickers
◦ Pocket cards
◦ On-line or printed lists
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Most hospitals are using qualitative tests
◦ Saccharin used most often in Illinois
◦ Bitrex used most often in Minnesota
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If cannot pass fit test:
◦ Given a PAPR in Minnesota
◦ Assigned a lower risk job class in Illinois
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Illinois hospitals more likely to provide and
require training
Illinois hospitals more likely to provide
training with regular frequency
Training format:
◦ Managers were more likely to say training was online
◦ Healthcare workers were more likely to say training
was in-person or via lecture
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Managers were more positive than healthcare
workers that their facility conducts a regular
program evaluation
Illinois respondents more positive than
Minnesota respondents about program
evaluations
◦ 42% IL and 20% MN hospitals did not address
program evaluation in their written program
◦ 17% IL and no MN hospitals addressed all
components of program evaluation
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Seasonal flu = droplet disease
◦ Surgical mask most likely choice (contact & aerosolgenerating procedures)
◦ Fraction selecting respirator increased for aerosol
generating procedure exposures
 MN hospital managers more likely to pick respirator
than surgical mask for aerosol generating procedures
◦ Higher fraction of all respondents selected a
respirator for seasonal flu (AGP) than for droplet
diseases (AGP)
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Airborne diseases
◦ Almost all healthcare workers in Illinois selected a
respirator (contact & AGP)
◦ Minnesota HCW much less likely to select a
respirator (50%)
◦ Managers (in both states) were 7-9 times more
likely to pick a respirator than a surgical mask
(contact & aerosol)
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Medical evaluation generally adequately
managed
Respirator programs most often deficient in:
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Designating a program administrator
Availability of respirators
Training
Recordkeeping
Program evaluation
Most hospitals have not considered
hazardous biological exposures beyond TB
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Areas most in need of improvement:
◦ Communicating fit test results so employees know
what respirator to wear
◦ Conducting training
◦ Conducting annual evaluations that address all
aspects of the program, including user input
◦ More clearly communicating information about
appropriate types of protection for different types
of infectious disease