Lisa M. Brosseau

Evaluation of single-use masks and respirators for protection of health care workers against mycobacterial aerosols.

BACKGROUND The recent increase in multidrug-resistant tuberculosis has spawned a major controversy concerning the degree of respiratory protection needed by health care workers, particularly during sputum-inducing procedures. The objective of this study was to measure the filtration efficiencies of a single-use submicron surgical mask, two disposable dust/mist respirators, a dust/mist/fume respirator, and a high-efficiency particulate air respirator against aerosolized mycobacteria. Facial fit was not addressed. METHODS In a specially designed enclosed test apparatus, an aerosol was generated with a Collison nebulizer from a known concentration of Mycobacteria chelonae, used as a surrogate for Mycobacterium tuberculosis. Aerosol concentrations were measured with Anderson samplers upstream and downstream of the test masks and respirators, which were heat sealed to a metal plate. RESULTS Mean efficiencies ranged from approximately 97% for the surgical mask and a dust/mist respirator to more than 99.99% for the high-efficiency particulate air respirator. Measurements of filter efficiency with an Aerodynamic Particle Sizer for the M. chelonae aerosol and independent challenge tests with latex spheres correlated closely with measurements of M. Chelonae collection efficiency determined with Andersen samplers. CONCLUSIONS Analysis of variance and Tukeys method for multiple comparisons indicated that the dust/mist/fume respirator and the HEPA respirator collected M. chelonae with significantly greater efficiency than did either the surgical mask or the dust/mist respirator. Even the least efficient mask tested, however, had a filter efficiency of more than 97% against particles averaging less than 1 micron in aerodynamic diameter.

Surgical mask filter and fit performance.

Background Surgical masks have been used since the early 1900s to minimize infection of surgical wounds from wearer-generated bacteria. There is ongoing debate, however, whether surgical masks can meet the expectations of respiratory protection devices. The goal of this study was to evaluate the filter performance and facial fit of a sample of surgical masks. Methods Filter penetration was measured for at least 3 replicates of 9 surgical masks using monodisperse latex sphere aerosols (0.895, 2.0, and 3.1 μm) at 6 L/min and 0.075-μm sodium chloride particles at 84 L/min. Facial fit was measured on 20 subjects for the 5 masks with lowest particle penetration, using both qualitative and quantitative fit tests. Results Masks typically used in dental settings collected particles with significantly lower efficiency than those typically used in hospital settings. All subjects failed the unassisted qualitative fit test on the first exercise (normal breathing). Eighteen subjects failed the assisted qualitative fit tests; 60% failed on the first exercise. Quantitative fit factors ranged from 2.5 to 9.6. Conclusion None of these surgical masks exhibited adequate filter performance and facial fit characteristics to be considered respiratory protection devices.

Differences in Detected Fluorescence Among Several Bacterial Species Measured with a Direct-Reading Particle Sizer and Fluorescence Detector

Naturally-contained fluorescing chemicals (such as riboflavin or NADPH) can be used to detect the presence of biological organisms. A new instrument from TSI Incorporated measures fluorescence of particles using an ultraviolet laser operating at an excitation wavelength of 355 nm. We have employed this instrument (Model 3312 Ultraviolet Aerodynamic Particle Sizer (tm) Spectrometer) to assess the degree of fluoresence associated with a variety of biological aerosols. Nonfluorescent and fluorescent latex sphere and sodium chloride aerosols were first used to assure proper operation of the instrument and to obtain correct instrument settings. Biological aerosols were then generated by combining organisms with double distilled and filtered water in a Collison nebulizer operated at low pressure. After passage through a charge neutralizer and dilution with humidified air (45%RH), the aerosol was measured downstream for both particle size and fluorescence distributions. Bacterial aerosols generated include Bacillus subtilis subsp. niger (spores and vegetative cells), Staphylococcus epidermidis, Eschericia coli, and Mycobacterium abscessus (a surrogate for M. tuberculosis). Cladosporium spp. fungal spores were also evaluated, and the effect of heat treatment on fluorescence was tested using B. subtilis spores. For each test the percentage of organisms that produced a fluorescence signal above a threshold was recorded. The organisms demonstrated considerable differences in percent fluorescence, ranging from means of 11% for S. epidermidis to 44% for B. subtilis spores. Vegetative cells of B. subtilis were generally less fluorescent (mean of 33%) than the spores, while the highest level of fluorescence was associated with heat-treated spores (averaging about 75%). This instrument has some potential for use in settings where immediate detection of biological organisms is important. Work remains to be done on understanding the effect on fluorescence of organism viability, presence of nonbiological particles, and interferences from mixtures.

Effectiveness of a Worksite Intervention to Reduce an Occupational Exposure: The Minnesota Wood Dust Study

OBJECTIVES This study assessed the effectiveness of an intervention to reduce wood dust, a carcinogen, by approximately 26% in small woodworking businesses. METHODS We randomized 48 businesses to an intervention (written recommendations, technical assistance, and worker training) or comparison (written recommendations alone) condition. Changes from baseline in dust concentration, dust control methods, and worker behavior were compared between the groups 1 year later. RESULTS At follow-up, workers in intervention relative to comparison businesses reported greater awareness, increases in stage of readiness, and behavioral changes consistent with dust control. The median dust concentration change in the intervention group from baseline to follow-up was 10.4% (95% confidence interval = -28.8%, 12.7%) lower than the change in comparison businesses. CONCLUSIONS We attribute the smaller-than-expected reduction in wood dust to the challenge of conducting rigorous intervention effectiveness research in occupational settings.

COLLECTION OF THREE BACTERIAL AEROSOLS BY RESPIRATOR AND SURGICAL MASK FILTERS UNDER VARYING CONDITIONS OF FLOW AND RELATIVE HUMIDITY

A variety of respirator filters and surgical masks were challenged with three aerosolized bacteria: Mycobacterium abscessus (M.a.) (a rod), Staphylococcus epidermidis (S.e.) (a sphere), and Bacillus subtilis (B.s.) (a rod). Tests were conducted at two flow rates (45 and 85 l./min) and two humidity levels (30 and 70%). Aerosols were measured with a total-particle, direct-reading, spectrometer and a viable particle cascade impactor. Measurements up- and downstream of the filter or mask were used in determining aerosol penetration; respirator or surgical mask fit was not evaluated. Bioaerosol penetration measured with two aerosol sampling instruments was found to correlate. Additionally, bioaerosol test parameters were evaluated with respect to their effect on penetration. Increasing flow resulted in increased penetration of all organisms while an increase in relative humidity did not exert a consistent effect on all organisms. Of the respirators approved by the National Institute for Occupational Safety and Health (NIOSH), filter efficiency was as expected with dust/mist respirators having the lowest and HEPA filters the highest efficiency. Surgical masks were the least efficient of all filters tested; these are not certified by NIOSH. Bioaerosol penetration was compared to that of a polystyrene latex sphere (PSL) aerosol. Penetration of the test aerosols was predicted on the basis of particle aerodynamic diameter and was expected to be in this order: PSL > M.a. > S.e. = B.s. The PSL aerosol was the most penetrating, as predicted. However, results showed that B.s. was more penetrating than S.e. The aerodynamic diameter may not be the best parameter for predicting aerosol penetration of non-spherical particles in these filters.

Mycobacterial Aerosol Collection Efficiency of Respirator and Surgical Mask Filters under Varying Conditions of Flow and Humidity

Collection efficiency was measured for a wide range of surgical masks and certified respirator filters using a 0.55-μm latex sphere aerosol at 45 L/min. Results were used to select representative f...

Aerosol transmission of infectious disease.

Objective: The concept of aerosol transmission is developed to resolve limitations in conventional definitions of airborne and droplet transmission. Methods: The method was literature review. Results: An infectious aerosol is a collection of pathogen-laden particles in air. Aerosol particles may deposit onto or be inhaled by a susceptible person. Aerosol transmission is biologically plausible when infectious aerosols are generated by or from an infectious person, the pathogen remains viable in the environment for some period of time, and the target tissues in which the pathogen initiates infection are accessible to the aerosol. Biological plausibility of aerosol transmission is evaluated for Severe Acute Respiratory Syndrome coronavirus and norovirus and discussed for Mycobacterium tuberculosis, influenza, and Ebola virus. Conclusions: Aerosol transmission reflects a modern understanding of aerosol science and allows physically appropriate explanation and intervention selection for infectious diseases.

A randomized, controlled intervention of machine guarding and related safety programs in small metal-fabrication businesses.

Objectives. Metal fabrication employs an estimated 3.1 million workers in the United States. The absence of machine guarding and related programs such as lockout/tagout may result in serious injury or death. The purpose of this study was to improve machine-related safety in small metal-fabrication businesses. Methods. We used a randomized trial with two groups: management only and management-employee. We evaluated businesses for the adequacy of machine guarding (machine scorecard) and related safety programs (safety audit). We provided all businesses with a report outlining deficiencies and prioritizing their remediation. In addition, the management-employee group received four one-hour interactive training sessions from a peer educator. Results. We evaluated 40 metal-fabrication businesses at baseline and 37 (93%) one year later. Of the three nonparticipants, two had gone out of business. More than 40% of devices required for adequate guarding were missing or inadequate, and 35% of required safety programs and practices were absent at baseline. Both measures improved significantly during the course of the intervention. No significant differences in changes occurred between the two intervention groups. Machine-guarding practices and programs improved by up to 13% and safety audit scores by up to 23%. Businesses that added safety committees or those that started with the lowest baseline measures showed the greatest improvements. Conclusions. Simple and easy-to-use assessment tools allowed businesses to significantly improve their safety practices, and safety committees facilitated this process.

Bacterial Survival on Respirator Filters and Surgical Masks

The Centers for Disease Control and Prevention recently developed recommendations for respirators worn to minimize exposures to Mycobacterium tuberculosis. These recommendations include criteria for filters and facial fit, but do not address how respirators are worn or disposed of. Handling may increase the risk of infection if loaded organisms remain viable. Respirator filters were challenged with aerosols containing three bacteria: Mycobacterium abscessus, Staphylococcus epidermidis, and Bacillus subtilis subsp. niger. Elution and surface contact sampling were used to recover organisms from filters after loading and following 5 days storage at 85% RH. Almost all filters showed culturable organisms immediately after loading. After storage, filters showed the least culturability for M. abscessus (20% of all filters) followed by S. epidermidis (61%), while B. subtilis remained highly culturable (98%). A slimilar trend was seen for the number of organisms recovered before and after storage (M abscessus demonstrated the least survival and B. subtilis the most).

A qualitative evaluation of owner and worker health and safety beliefs in small auto collision repair shops

BACKGROUND About 223,000 people are employed in approximately 34,500 auto collision repair businesses. In general, employees and owners in these establishments lack knowledge of health and safety practices and do not have the technical expertise to make their place of work safer. METHODS Three employee and three owner focus groups were conducted. The goal of these focus groups was to characterize health and safety beliefs of owners and employees and to determine the best methods for motivating safety improvements in collision repair shops. RESULTS A total of 11 owners and 19 workers participated in these focus groups. Employees and owners were aware of a wide range of hazards. Both groups noted difficulty in staying informed. Employers were hesitant to set and enforce safety and health rules. Employees perceive owners to be unwilling to dedicate the resources to make the workplace safer and provide personal protective equipment. Both groups felt insurance reimbursement practices placed undue pressure on employees. CONCLUSIONS Focus groups provide important insights into intervention development in very small enterprises in general and auto collision shops in specific. Employers were conflicted about allowing employees a certain level of independence while also maintaining a safe workplace. From the employee perspective, owners frequently fail to provide adequate personal protective equipment and make improvements needed to ensure safe work. The unique managerial needs of very small enterprises must be accounted for if health and safety programs are to be implemented in these establishments.