Infection Control & Hospital Epidemiology (2019), 40,476–481 doi:10.1017/ice.2018.361
Concise Communication
Opportunities to bridge gaps between respiratory protection guidance and practice in US health care Barbara I. Braun PhD1
, Brette A. Tschurtz MPH1, Hasina Hafiz MPH1, Debra A. Novak PhD2,
Maria C. Montero MPH, MT(ASCP)SM, CIC3, Cynthia M. Alexander EdD, MS, RRT, NPS4, Loretta Litz Fauerbach MS, FSHEA, FAPIC, CIC5, MaryAnn Gruden MSN, CRNP, NP-C, COHN-S/CM6, Marcia T. Isakari MD, MPH7, David T. Kuhar MD8,
Lisa A. Pompeii PhD, COHN-S, FAAOHN9, Melanie D. Swift MD, FACOEM10 and Lewis J. Radonovich MD11 1Division of Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois, 2National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety Health (NIOSH) (Retired), Pittsburgh, Pennsylvania, 3Healthcare Epidemiology and Infection Prevention, Northwestern
Medicine Kishwaukee Hospital, Dekalb, Illinois, 4Respiratory Care, Grady Health System, Atlanta, Georgia, 5Fauerbach & Associates, Gainesville, Florida, 6Occupational Health Consultant, Pittsburgh, Pennsylvania, 7Occupational and Environmental Medicine, University of California San Diego Health System, San Diego, California, 8Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, 9Center for Epidemiology & Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, 10Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, Minnesota and 11National Personal Protective Technology Laboratory (NPPTL), National Institute for Occupational Safety Health (NIOSH), Pittsburgh, Pennsylvania
Abstract
Healthcare organizations are required to provide workers with respiratory protection (RP) to mitigate hazardous airborne inhalation expo- sures. This study sought to better identify gaps that exist between RP guidance and clinical practice to understand issues that would benefit from additional research or clarification.
(Received 3 October 2018; accepted 13 December 2018)
In the hierarchy of Centers for Disease Control and Prevention/ National Institute of Occupational Safety and Health (CDC/ NIOSH) infection prevention and control measures, respiratory protection (RP) is an important means of mitigating healthcare per- sonnel (HCP) airborne exposures. The Occupational Safety and Health Administration (OSHA) 1998 Respiratory Protection stan- dard (29 CFR 1910.134) requires that employers provide workers with respirators “when such equipment is necessary to protect the health of such employee[s]” and “shall be responsible for the establishment and maintenance of a respiratory protection program.”1 Several government agencies, professional, and trade organiza-
tions have issued guidance about the proper use of RP in the health- care workplace (Table 1). Despite an abundance of information about what organizations must do (regulatory) and what organiza- tions should be doing (guidance), evidence suggests inconsistentRP practices and programmatic adherence.2–4 Between 2009 and 2016,
Author for correspondence: Barbara I. Braun, Email:
BBraun@jointcommission.org PREVIOUS PRESENTATIONS: The results of this study were presented at the follow-
ing conferences: (1) The Society for Healthcare Epidemiology of America (SHEA) Spring 2018 Conference on April 19, 2018, in Portland, Oregon; (2) The Association of Occupational Health Professionals in Healthcare (AOHP) 2018 National Conference on September 8, 2018, in Glendale, Arizona; and (3) The International Society for Respiratory Protection (ISRP) 2018 Conference on September 17, 2018, in Denver, Colorado. Cite this article: Braun BI, et al. (2019). Opportunities to bridge gaps between
respiratory protection guidance and practice in US health care. Infection Control & Hospital Epidemiology, 40: 476–481,
https://doi.org/10.1017/ice.2018.361
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
the increased number of CDC/NIOSH queries led to a NIOSH- funded study undertaken by The Joint Commission to identify clinical RP issues needing additional guidance or clarification.
Methods
To guide the project, an 8-member expert Technical Advisory Panel (TAP) was convened. Issues were gathered through e-mail queries, interviews, and an electronic questionnaire. A project webpage was developed with the questionnaire link for direct submission. To solicit traffic to the webpage, several methods were used, including e-mail blasts, postings on social media, professional listservs, and flyer distribution at 5 national healthcare conferences. Structured interviews were conducted with each TAP member
and expert clinicians. All submitted data were entered into Microsoft Excel (Redmond,WA) for content analysis; each issue was counted as a discrete record. Staff grouped issues by topic area and reviewed existing guidance to identify issue-specific available answers. A list of issues was sent to each TAP member for determination as to whether the issue was a “clinical conun- drum” or an “operational issue.” A clinical conundrum was defined as an issue for which there was no specific recommenda- tion in an existing evidence- or consensus-based guideline, or where there was conflicting guidance. An operational issue was one causing practical, or programmatic implementation challenges. Descriptive frequencies were calculated for each topic area.
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