Respirator Evaluation in Acute Care Hospitals Study (REACH)

REACH I (2009 – 2010)

This project assessed the usage of respiratory protection for influenza exposure among healthcare workers (HCWs) in 16 California hospitals during the H1N1 influenza. 204 HCWs participated in this study representing a variety of clinical specialties (i.e., ER, ICU, Peds) and roles including unit managers, respiratory protection administrators, and direct care providers. Observational methods were also employed to better understand donning and doffing practices.

Relevance to worker safety and health – Findings from REACH I serve as a ‘snap shot’ of: 1) the extent to which hospitals in California have implemented required elements of a respiratory protection program for influenza; and 2) the usage of personal respiratory protection for influenza exposure among California healthcare workers.

Key Findings

  • 50% of the hospital managers reported that their facility had experienced a shortage of respirators between April 2009 and the survey period (January 20 – February 23, 2010).
  • The observational data indicates improper use of respiratory protective equipment as evidenced by donning and doffing practices.
      • Not performing a seal check
      • Improper strap placement
    • Touching the face piece upon doffing
  • In response to the question what healthcare workers believe, 65% felt that they were at a high risk of becoming ill with influenza due to their work, 96% felt that wearing an N95 or better respirator could help protect them from on-the-job exposures to influenza and 94% indicated that N95 respirators are more effective at protecting them from influenza than surgical masks.
  • Inresponse to a question related to how respondents knew that they needed to wear a respirator, the top two responses indicated that they waited to be “cued” by signage on the door or to be told during shift report.

Reference -A paper summarizing this work has been published in the American Journal of Infection Control:

Beckman S, Materna B, Goldmacher S, Zipprich J, D’Alessandro M, Novak D, Harrison R [2013]. Evaluation of respiratory protection programs and practices in California hospitals during the 2009-2010 H1N1 influenza pandemic. Am J Infect Control 41(11):1024-1031.

Status – Completed.

REACH Intervention and Evaluation
The objective of this project is to extend and build upon the work previously completed under REACH I by examining the effectiveness of various interventions for improving respiratory protection programs in California acute care facilities.
Relevance to worker safety and health – Findings from REACH I suggest that N95 respirators are being widely used, although gaps in training, appropriate donning and evaluation have been identified. This project identified and evaluated effective interventions and best practices to strengthen California hospitals’ respiratory protection programs and reinforce healthcare workers’ proper use of respiratory protection.
Key Findings – A toolkit of effective strategies was developed and tested in 14 California hospitals. The California Respirator Program Administrators toolkit can be accessed at: icon

Status – Completed

REACH II (2011 – 2012)

Expanded upon REACH I to evaluate hospitals’ written respiratory protection programs and assess healthcare workers’ usage of respiratory protection for influenza (droplet) and aerosol-transmissible exposures in five regions of the United States (Northeast, Southeast, Midwest, Southwest, and West).

Relevance to worker safety and health – Findings from REACH II serve as a ‘snap shot’ of: 1) the extent to which hospitals across the United States have implemented required elements of a respiratory protection program for influenza and 2) the usage of personal respiratory protection for seasonal influenza exposure among healthcare workers.

View the Required Labeling of NIOSH-Approved N95 Filter Facepiece Respiratorimage icon.

Key Findings

  • Data collection completed in five regions and six sates of the U.S. The final data set included 98 hospitals, over 1500 participants (i.e., HCWs, Hospital and Unit Managers) as well as over 300 demonstrations of respirator donning and doffing.
  • Over 80% of participating hospitals reported adherence to many of the OSHA required respiratory protection program elements, such as:
    • Medical evaluations and fit testing prior to initial respirator use
    • Employee training on how and when to use respiratory protection
    • Respiratory protection guidelines regarding close contact with a patient with suspected or confirmed infectious disease or seasonal influenza
  • The lowest levels of adherence concerned factors, such as:
    • Frequency of medical evaluations
    • Informing staff about the model and size of respirator they have been fit tested for
    • Formal evaluations of respiratory protection programs
  • Similarly to REACH I findings, HCWs demonstrated improper donning and doffing procedures:
    • 46% used incorrect strap placement
    • 85% did not perform a seal check
    • 57% did not use straps during doffing
    • 45% used improper respirator disposal methods
  • Hospital and Unit Managers reported overall higher adherence rates to respiratory protection guidelines than HCWs. In other words, those closest to the “bedside” (i.e., more contact with patients) were less likely to provide correct survey responses with regards to respiratory protection recommendations or requirements for selected diseases.

Reference – A paper summarizing findings from New York State has been published in the American Journal of Infection Control

REACH II Published Manuscripts

  1. Peterson K, Roger B, Brosseau L ,Payne J, Cooney J, Joe L, & Novak D. (2016). Differences in Hospital Managers’, Unit Managers’, and Health Care Workers’ Perceptions of the Safety Climate for Respiratory Protection. Workplace Health and Safety 64 (7), 326-336.
  2. Peterson K, Novak D, Stradtman L, Wilson D, & Couzens L (2015). Hospital respiratory protection practices in 6 U.S. states: A public health evaluation study. AJIC 43(1),63-71.
  3. Brosseau LM, Conroy LM, Sietsema M, Cline K, & Durski K. (2015). Evaluation of Minnesota and Illinois hospital respiratory protection programs and health care worker respirator use. JOEH 12(1), 1-15.
  4. Sietsema M, Conroy LM, & Brosseau LM. (2015). Comparing Written Programs and Self-Reported Respiratory Protection Practices in Acute Care Hospitals. JOEH 12(3),189-198.
  5. Hines L, Rees E, & Pavlechak N (2014). Respiratory protection policies and practices among the health care workforce exposed to influenza in New York State: Evaluating emergency preparedness for the next pandemic. AJIC 42(3), 240-45.
  6. The Joint Commission. Implementing Hospital Respiratory Protection Programs: Strategies from the Fieldpdf iconexternal icon. Oakbrook Terrace, IL: The Joint Commission, Dec 2014.
  7. OSHA, NIOSH. Hospital Respiratory Protection Toolkit: Resources for Respiratory Protection Administratorspdf iconexternal icon, May 2015.

Status – Completed

Page last reviewed: January 12, 2018