Qualitative Analysis of Origins and Evolution of an Elastomeric Respirator-based Hospital Respiratory Protection Program.

Elastomeric respirators (elastomerics) may serve as one alternative to disposable N95 respirator use in healthcare. We explored factors which drove elastomeric adoption and continued use in a large academic medical center. We conducted semi-structured and focus group interviews in 2015 with a) 11 leadership key informants (KIs) with involvement in the respiratory protection program (RPP) when elastomerics were introduced and b) 11 healthcare workers (HCWs) recruited from hospital departments assigned to use elastomerics. Interview transcripts and responses were open-coded to capture emergent themes, which were collapsed into broader categories and iteratively refined. Factors identified by leadership KIs as influencing elastomeric adoption included: 1) N95 shortages during 2009's H1N1 influenza pandemic and 2) the presence of trained, certified safety professionals who were familiar with respiratory protection requirements. Factors identified as influencing ongoing use of elastomerics included: 1) cleaning/decontamination practices, 2) storage, 3) safety culture, 4) HCW respirator knowledge, and 5) risk perception. HCW users expressed dissatisfaction related to breathing, communication and cleaning of elastomerics. Other themes included convenience use of N95s rather than assigned elastomerics, despite perceptions that elastomerics are more protective. Through semi-structured and focus group interviews, we learned that 1) leadership introduced elastomerics due to necessity but now face challenges related to ongoing use, and 2) HCWs were not satisfied with elastomerics for routine care and preferentially used N95s because they were conveniently available at point of use. Although the impetus behind incorporation of elastomerics was clear, the most complex themes related to sustainability of this form of RPP. These themes were used to inform a broader questionnaire and will address the utility of elastomerics as a feasible and acceptable practical alternative to N95s in healthcare.