title: The effect of high-efficiency particulate air respirator design on occupational health: a pilot study balancing risks in the real world.
abstract: OBJECTIVE
  To quantify specific factors believed to increase healthcare worker (HCW) risk for contaminated sharps injuries (eg, visibility, communication, and range of motion); to quantify the degree to which respirators of various designs impacted those same factors; and to assess HCW opinions about the suitability of selected respirators with respect to patient care and user compliance criteria.
  
  
  METHODS
  Sharps injury data from seven hospitals were analyzed to determine the potential contribution of visibility, communication, and range of motion to reported injuries. Healthcare workers representing various clinical specialties and physical characteristics were examined at baseline and while wearing five different respirators to quantify the impact of respirator design on visibility, communication, and range of motion. Healthcare workers were interviewed and completed a survey assessing each respirator.
  
  
  METHODS
  Hospital and ambulatory-care settings.
  
  
  METHODS
  Population-based and convenience sample.
  
  
  RESULTS
  Communication, visibility, and range of motion were found to affect contaminated sharps injuries significantly. Selected high-efficiency particulate air (HEPA) respirators were found to have a negative impact on each of these variables. Healthcare workers involved in the study also reported compliance criteria problems with selected HEPA respirators, which may effect implementation of respiratory precautions adversely.
  
  
  CONCLUSIONS
  Current HEPA respirators, because of their design, potentially increase the risk of bloodborne pathogen exposure through sharps injuries. We conclude that mandating respirators without regard to the potential impact of their design to the sharps injuries may be counterproductive to HCW safety, because they may increase, rather than decrease, overall occupational risk to HCWs.
authors.affiliation: Regional Hospital Administration, Kaiser Permanente Southern California Region, North Hollywood 91188, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Eck
authors.forename: A
authors.initials: A
authors.lastname: Vannier
mesh_terms: D016902:Air Pollution, Indoor; D004867:Equipment Design; D006282:Health Personnel; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D016272:Occupational Health; D010865:Pilot Projects; D011363:Professional Impairment; D012134:Respiratory Protective Devices / Q000592:standards*; D012449:Safety; D014481:United States; D014489:United States Occupational Safety and Health Administration