Lee M C, Takaya S, Long R, Joffe A M
Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Infect Control Hosp Epidemiol. 2008 Dec;29(12):1149-56. doi: 10.1086/591860.
Respiratory protection programs, including fit testing of respirators, have been inconsistently implemented; evidence of their long-term efficacy is lacking. We undertook a study to determine the short- and long-term efficacy of training for fit testing of N95 respirators in both untrained and trained healthcare workers (HCWs).
Prospective observational cohort study.
A group of at-risk, consenting HCWs not previously fit-tested for a respirator were provided with a standard fit-test protocol. Participants were evaluated after each of 3 phases, and 3 and 14 months afterward. A second group of previously fit-tested nurses was studied to assess the impact of regular respirator use on performance.
Of 43 untrained fit-tested HCWs followed for 14 months, 19 (44.2%) passed the initial fit test without having any specific instruction on respirator donning technique. After the initial test, subsequent instruction led to a pass for another 13 (30.2%) of the 43 HCWs, using their original respirators. The remainder required trying other types of respirators to achieve a proper fit. At 3 and 14 months' follow-up, failure rates of 53.5% (23 of 43 HCWs) and 34.9% (15 of 43 HCWs), respectively, were observed. Pass rates of 87.5%-100.0% were observed among regular users.
Without any instruction, nearly 50% of the HCWs achieved an adequate facial seal with the most commonly used N95 respirator. Formal fit testing does not predict future adequacy of fit, unless frequent, routine use is made of the respirator. The utility of fit testing among infrequent users of N95 respirators is questionable.
包括呼吸器适合性测试在内的呼吸防护计划实施情况并不一致；缺乏其长期有效性的证据。我们开展了一项研究，以确定在未经培训和经过培训的医护人员中进行N95呼吸器适合性测试培训的短期和长期效果。
前瞻性观察队列研究。
为一组有风险且同意参与的、此前未进行过呼吸器适合性测试的医护人员提供标准的适合性测试方案。在3个阶段的每个阶段之后以及之后的3个月和14个月对参与者进行评估。对另一组此前已进行过适合性测试的护士进行研究，以评估定期使用呼吸器对性能的影响。
在43名接受适合性测试的未经培训的医护人员中，随访14个月，19名（44.2%）在未接受任何关于呼吸器佩戴技术的具体指导的情况下通过了初始适合性测试。初始测试后，后续指导使43名医护人员中的另外13名（30.2%）使用其原来的呼吸器通过了测试。其余人员需要试用其他类型的呼吸器以达到合适的贴合度。在3个月和14个月的随访中，观察到失败率分别为53.5%（43名医护人员中的23名）和34.9%（43名医护人员中的15名）。在经常使用者中观察到的通过率为87.5% - 100.0%。
在没有任何指导的情况下，近50%的医护人员使用最常用的N95呼吸器实现了足够的面部密封。正式的适合性测试并不能预测未来的适合度是否足够，除非经常、常规地使用呼吸器。对于不经常使用N95呼吸器的人员，适合性测试的效用值得怀疑。
