Pre-Pandemic Survey Data Reveal Healthcare Workers' Opinions of Respirators

By Carolyn Crist

July 07, 2020

NEW YORK (Reuters Health) - Personal protective equipment (PPE) such as respirators often interfere with patient care, according to survey results collected before the COVID-19 pandemic.

The findings may add to the conversation about creating more comfortable, user-friendly respirators for healthcare workers, researchers write in the American Journal of Infection Control.

"PPE interference with job tasks has always been a concern - for any industry. For PPE to provide the desired impact for workers, it needs to function as it is supposed to, but you also have to have people wear it effectively," lead author Dr. Stella Hines of the University of Maryland School of Medicine in Baltimore told Reuters Health by email.

Dr. Hines and colleagues surveyed 1,152 healthcare workers in 2016 about their perceptions of respirators. They evaluated three types: N95s, which are disposable tight-fitting masks that filter out 95% of particles in the air; elastomeric respirators, which can be half or full face-piece respirators that use synthetic rubber and replaceable filters; and powered air-purifying respirators (PAPRs), which have a battery-powered fan that pulls air through filters. The survey was part of a larger study to evaluate whether elastomeric respirators could address N95 shortages.

The researchers told the healthcare workers to imagine they were entering a room with a patient who likely had active tuberculosis and had "airborne precautions" on their medical chart. The survey participants, who were predominantly female nurses at large academic medical centers who used N95 masks, said masks didn't usually create conflict with patients or families, especially once they explained what masks do and why masks should be worn.

Close to two-thirds (62%) said respirators did not impact their ability to perform patient care, while 19% said the devices do interfere and 19% neither agreed nor disagreed.

Roughly half said wearing the respirators while caring for patients was not inconvenient, about one-third said it was inconvenient, and 17% were neutral.

At the time, most nurses said that if respirators interfered with their ability to provide care, it could influence their decision to use one.

Among those who said respirators did affect patient care, about 27% said PAPRs interfere, as compared with 17% of N95 users and 16% of elastomeric users.

Opinions differed by staff position. About 28% of doctors said respirators interfere with patient care, compared to 22% of nurses, 9% of respiratory therapists and 10% of patient-support staff.

Respondents also said respirators limited their ability to show emotions and smile, and a transparent mask could be better.

"When doctors wear a face mask during consultations, it has a significant negative impact on the patient's perceived empathy and diminishes the positive effects of relational continuity," Dr. Benjamin Hon Kei Yip of the Chinese University of Hong Kong told Reuters Health by email. Dr. Yip, who wasn't involved with this study, has researched the effect of face masks on empathy and relationships in healthcare.

Of course, healthcare workers must take care of themselves to be able to take care of patients, Dr. Hines added. During the COVID-19 pandemic, in particular, healthcare workers likely accept cumbersome and uncomfortable respirators and protective gear to care for patients.

New masks that allow for visible face expressions, small mask sizes and better voice transmission could reduce the challenges and boost healthcare workers' compliance, the study authors write. As the COVID-19 pandemic continues, PPE could be redesigned to do this.

"Just like on an airplane, 'put your oxygen on first before assisting others,'" Dr. Hines said. "Strategies that will healthcare workers 'put their oxygen on first' in a way that is easy and does not interfere with the ability to do their jobs are critical to successful protective equipment use."

SOURCE: American Journal of Infection Control, online June 11, 2020.