Health and Safety Practices Survey of Healthcare Workers

Use of Respirators and Surgical Masks for Protection Against Healthcare Hazards

Here you will learn what we found regarding self-reported use of respirators and surgical masks for hazards where respondents were asked about the use of these device for the following ten potential respiratory hazard scenarios:

Compounding antineoplastic drugs
Administering antineoplastic drugs
Administering aerosolized antibiotics (tobramycin, amikacin, colistin)
Administering aerosolized pentamidine
Administering aerosolized ribavirin
Handling chemical sterilants (ethylene oxide, hydrogen peroxide gas plasma)
Handling high-level disinfectants (glutaraldehyde, orthophthaldehyde, peracetic acid, hydrogen peroxide)
Proximity to surgical smoke generated by laser techniques
Proximity to surgical smoke generated by electrosurgical techniques
Exposure to seasonal influenza or patients with influenza-like illness (ILI)

Overview

Respirators and surgical masks are widely used in healthcare settings. Both types of personal protective equipment (PPE) can be used for infection control; however, only respirators can be used for respiratory protection against airborne chemical hazards. Because both, respirators and surgical masks, are used in healthcare settings, it is important that employers and workers understand the differences between them.^1-3 A respirator is designed to protect the wearer from inhaling airborne contaminants such as dusts, fumes, vapors, and infectious agents associated with inhaling small and large particle droplets; guidance on appropriate selection and use is covered by OSHA’s respiratory protection and PPE standards.^4-5 In comparison, a surgical mask only provides barrier protection against large-particle droplets and does not effectively filter inhaled small particles, fumes, or vapors.^6-7 A surgical mask is primarily used to protect patients and healthcare workers from people who may have a respiratory infection or to protect sterilized or disinfected medical devices and supplies.

This study examined the use of respirators and surgical masks among 10,383 healthcare workers who reported hazard-specific respiratory protection behaviors. Respondents were classified as respirator users if they wore an N95 respirator, powered air purifying respirator (PAPR), or half- or full-facepiece respirator for at least one hazard, and respirator non-users if they only used surgical masks or did not wear any respirators or masks. Information on barriers to using respirators for hazardous chemicals was also collected.

Study findings

In this analysis, 1,904 (18%) healthcare respondents reported wearing respiratory protection and were classified as respirator users. The proportion of respirator users was highest for aerosolized medications (ribavirin, 79%; pentamidine, 56%; and antibiotics, 26%) and lowest for chemical sterilants (0%). The proportion of respirator users caring for patients with ILI symptoms was 21%, and less than 11% for all other hazards. Use of an N95 respirator was reported the most often (93%) of the respirator types. The most common reasons for not using a respirator when potentially exposed to the hazardous chemicals were “not part of our protocol” and “exposure was minimal.” Only 25% of respirator users reported that they had been fit tested.

Most (78%) respondents reported using surgical masks for one or more of the hazards, ranging from 14% for ribavirin to >90% for surgical smoke. Surgical masks were used in situations where respiratory protection is recommended, for example, when compounding or administering antineoplastic drugs and working in the vicinity of surgical smoke.

What can be done to improve selection and use of respirators and surgical masks

An assessment of the workers’ specific work environment must be performed by the employer to determine if hazards are present, or likely to be present, which necessitate the use of a respirator or surgical mask as well as other PPE.^2,4-5 Surgical masks do not provide respiratory protection from chemical hazards.
If hazards are present, or likely to be present based on the hazard assessment, the employer needs to select appropriate and properly fitted PPE that will protect workers from the hazards and communicate selection decisions to each affected worker.
All workers who are required to wear tight-fitting respirators (e.g., N95 respirators, elastomerics) must have a medical evaluation to determine the worker’s ability to wear a respirator, and if medically cleared, a respirator fit test needs to be performed using the same model available in the workplace.

References

Survey and report

To request a copy of this survey, please email jmb4@cdc.gov

Journal article

(The free full text article will be available in Pub Med Central one year after the article has published)