Hospital adherence to respiratory protection guidelines: The REACH 2 evaluation

Background and Objective(s)

Effective use of respiratory protection helps minimize the risk of disease for healthcare staff, patients, their families and caregivers. The purpose of REACH 2 is to assess hospitals' respiratory protection programs (RPPs) and healthcare workers use of respiratory protection. The study focuses on adherence to standards and recommendations for employee medical evaluations, fit testing and training; the selection, use, maintenance, and inspection of respirators; and regular program evaluation and risk assessments.

Methods:

This study is based on surveys conducted during 2011-2012 in 98 acute care hospitals in six states across the United States. Survey interviews were conducted with 215 hospital managers, 245 unit managers and 1105 healthcare workers. 356 formal structured observations were also made of healthcare workers' respirator use.

Hospital-level indicators of adherence to CDC-recommended and OSHA-required RPP elements were constructed and analyzed with descriptive statistics, cross-tabulations, and multinomial logistic modeling. Independent variables included hospital size, state, union membership, employment status, and vaccination status.

Results

Multiple gaps in knowledge and behavior were identified. They involved knowledge of proper respiratory protection in the presence of patients with seasonal influenza and infectious disease, best practices for monitoring and evaluating the hospital's RPP, and requirements for medical evaluation, fit testing and training. Adherence to guidelines was often correlated with state, but not with the other factors.

Conclusion(s)

Based on the findings, hospital staff need to be made more aware of recommended respiratory protection guidelines. Efforts to improve adherence to guidelines should be tailored to the geographical location.