Last data update: Sep 23, 2024. (Total: 47723 publications since 2009)
Records 1-7 (of 7 Records) |
Query Trace: Radonovich LJ Jr [original query] |
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Outpatient Healthcare Personnel Knowledge and Attitudes Towards Infection Prevention Measures for Protection from Respiratory Infections
Bessesen MT , Rattigan S , Frederick J , Cummings DAT , Gaydos CA , Gibert CL , Gorse GJ , Nyquist AC , Price CS , Reich NG , Simberkoff MS , Brown AC , Radonovich LJ Jr , Perl TM , Rodriguez-Barradas MC . Am J Infect Control 2021 49 (11) 1369-1375 BACKGROUND: Healthcare personnel (HCP) knowledge and attitudes toward infection control measures are important determinants of practices that can protect them from transmission of infectious diseases. METHODS: Healthcare personnel were recruited from Emergency Departments and outpatient clinics at seven sites. They completed knowledge surveys at the beginning and attitude surveys at the beginning and end of each season of participation. Attitudes toward infection prevention and control measures, especially medical masks and N95 respirators, were compared. The proportion of participants who correctly identified all components of an infection control bundle for seven clinical scenarios was calculated. RESULTS: The proportion of participants in the medical mask group who reported at least one reason to avoid using medical masks fell from 88.5% on the pre-season survey to 39.6% on the post-season survey (odds ratio [OR] for preseason vs. postseason 0.11, 95% CI 0.10-0.14). Among those wearing N95 respirators, the proportion fell from 87.9% to 53.6% (OR 0.24, 95% CI 0.21-0.28). Participants correctly identified all components of the infection control bundle for 4.9% to 38.5% of scenarios. CONCLUSIONS: Attitudes toward medical masks and N95 respirators improved significantly between the beginning and end of each season. The proportion of HCP who correctly identified the infection control precautions needed for clinical scenarios was low, but it improved over successive years of participation in the study. |
Take-home kits to detect respiratory viruses among healthcare personnel: Lessons learned from a cluster randomized clinical trial
Los J , Gaydos CA , Gibert CL , Gorse GJ , Lykken J , Nyquist AC , Price CS , Radonovich LJ Jr , Rattigan S , Reich N , Rodriguez-Barradas M , Simberkoff M , Bessesen M , Brown A , Cummings DAT , Perl TM . Am J Infect Control 2021 49 (7) 893-899 BACKGROUND: Healthcare personnel (HCP) working in outpatient settings routinely interact with patients with acute respiratory illnesses. Absenteeism following symptom development and lack of staff trained to obtain samples limit efforts to identify pathogens among infected HCP. METHODS: The Respiratory Protection Effectiveness Clinical Trial assessed respiratory infection incidence among HCP between 2011 and 2015. Research assistants (RAs) obtained anterior nasal and oropharyngeal swabs from HCP in the workplace following development of respiratory illness symptoms and randomly while asymptomatic. Participants received take-home kits to self-collect swabs when absent from work. Samples mailed to a central laboratory were tested for respiratory viruses by reverse transcription polymerase chain reaction. RESULTS: Among 2,862 participants, 3,467 swabs were obtained from symptomatic participants. Among symptomatic HCP, respiratory virus was detected in 904 of 3,467 (26.1%) samples. Self-collected samples by symptomatic HCP at home had higher rates of viral detection (40.3%) compared to 24% obtained by trained RAs in the workplace (P < 0.001). CONCLUSIONS: In this randomized clinical trial, take-home kits were an easily implemented, effective method to self-collect samples by HCP. Other studies have previously shown relative equivalence of self-collected samples to those obtained by trained healthcare workers. Take-home kit self-collection could diminish workforce exposures and decrease the demand for personnel protective equipment worn to protect workers who collect respiratory samples. |
N95 Respirators vs Medical Masks in Outpatient Settings-Reply
Radonovich LJ Jr , Simberkoff MS , Perl TM . JAMA 2020 323 (8) 789-790 Dr McDiarmid and colleagues comment on the design and conduct of our study, the Respiratory Protection Effectiveness Clinical Trial (ResPECT).1 They note, and we agree, that a number of laboratory and simulated workplace studies have shown respirators to have superior performance compared with medical masks; however, the results of clinical trials have not been definitive. The complexities of delivering health care introduce behavioral factors that may influence the effectiveness of infection prevention measures, including adherence to procedures that have been shown in laboratory settings to optimize efficacy. ResPECT was designed as a pragmatic clinical trial2 comparing the effectiveness of N95 respirators with medical masks as worn by health care personnel who are exposed to patients with respiratory infections in outpatient clinical practice settings. Our goal was to assess the incidence of viral respiratory infection and illness among these frontline health care personnel using laboratory-confirmed and clinical end points. Cluster randomization was used to balance exposures and behavioral characteristics in the intervention groups. Precise quantification of exposures in terms of viral loads of particles was beyond the scope of the study. Despite limitations, we believe our study contributes valuable information to the body of literature about prevention of respiratory infections in clinical settings and calls attention to challenges that remain when implementing broader respiratory protection efforts.3 Health systems need to weigh the full spectrum of scientific evidence, including laboratory studies and randomized clinical trials, when making decisions about the protection of health care personnel against influenza and other viral respiratory infections.3 |
Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators.
Pompeii LA , Kraft CS , Brownsword EA , Lane MA , Benavides E , Rios J , Radonovich LJ Jr . JAMA 2020 323 (18) 1849-1852 This study examines the feasibility of rapidly training and fit testing health care workers to use elastomeric half-mask respirators (EHMRs), widely used in construction and manufacturing, as an alternative to N95 respirators during periods of shortage. |
N95 respirators vs medical masks for preventing influenza among health care personnel: A randomized clinical trial
Radonovich LJ Jr , Simberkoff MS , Bessesen MT , Brown AC , Cummings DAT , Gaydos CA , Los JG , Krosche AE , Gibert CL , Gorse GJ , Nyquist AC , Reich NG , Rodriguez-Barradas MC , Price CS , Perl TM . JAMA 2019 322 (9) 824-833 Importance: Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections. Objective: To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP. Design, Setting, and Participants: A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups. Interventions: Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness. Main Outcomes and Measures: The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed. Results: Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group. Conclusions and Relevance: Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza. Trial Registration: ClinicalTrials.gov Identifier: NCT01249625. |
The Respiratory Protection Effectiveness Clinical Trial (ResPECT): A cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel
Radonovich LJ Jr , Bessesen MT , Cummings DA , Eagan A , Gaydos C , Gibert C , Gorse GJ , Nyquist AC , Reich NG , Rodrigues-Barradas M , Savor-Price C , Shaffer RE , Simberkoff MS , Perl TM . BMC Infect Dis 2016 16 (1) 243 BACKGROUND: Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts. METHODS: The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team. DISCUSSION: ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems. TRIAL REGISTRATION: The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010). |
B95: a new respirator for health care personnel
Gosch ME , Shaffer RE , Eagan AE , Roberge RJ , Davey VJ , Radonovich LJ Jr . Am J Infect Control 2013 41 (12) 1224-30 BACKGROUND: Respiratory protection relies heavily on user compliance to be effective, but compliance among health care personnel is less than ideal. METHODS: In 2008, the Department of Veterans Affairs formed the Project Better Respiratory Equipment using Advanced Technologies for Healthcare Employees (BREATHE) Working Group, composed of a variety of federal stakeholders, to discuss strategies for improving respirator compliance, including the need for more comfortable respirators. RESULTS: The Working Group developed 28 desirable performance characteristics that can be grouped into 4 key themes: (1) respirators should perform their intended function safely and effectively; (2) respirators should support, not interfere, with occupational activities; (3) respirators should be comfortable and tolerable for the duration of wear; and (4) respiratory protective programs should comply with federal/state standards and guidelines and local policies. As a necessary next step, the Working Group identified the need for a new class of respirators, to be called "B95," which would better address the unique needs of health care personnel. CONCLUSION: This article summarizes the outputs of the Project BREATHE Working Group and provides a national strategy to develop clinically validated respirator test methods, to promulgate B95 respirator standards, and to invent novel design features, which together will lead to commercialized B95 respirators. |
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