Development of a qualitative respirator fit testing program for BSN students

Elsevier

Available online 25 November 2022

Teaching and Learning in NursingAuthor links open overlay panelAbstract

The COVID-19 pandemic has impacted the nursing student clinical experience. At the time of this project, hospitals hosting students for clinical experiences had a high population of COVID-19 positive patients. University and hospital policies at the time prohibited students from caring for COVID-19 patients due to the inability to safely ensure that students could access the proper protective equipment (PPE) necessary when caring for patients in airborne precautions. Infection control guidelines for patients in airborne precautions require a N95 respirator to be always worn by healthcare providers. These respirators require yearly fit test following OSHA (Occupational Safety and Health Administration) standards. Hospitals do have the resources to complete N95 fit tests for nursing students. The solution was to provide qualitative N95 mask fit testing, performed by university faculty, staff, and students using OSHA guidelines and standards. Within 3 months, over 50% of the student population had been fit tested, which increased the clinical opportunities for the students.

Introduction

During the COVID-19 pandemic, nursing students had limited sometimes no clinical experiences. This was due to hesitation from clinical partners trying to prevent increased spread of the virus and efforts to prioritize personal protective equipment (PPE) for individuals deemed essential workers. As the pandemic has continued, nursing schools have realized that students need to be prepared to care for COVID-19 patients post-graduation, and that students can be a helpful resource to units caring for patients in airborne isolation.

Currently, patients who test positive for COVID-19 are placed in airborne isolation and healthcare providers are required to use a N95 filtering facepiece respirator (FFR) or powered air purifying respirator (PAPR) while providing care. The United States Department of Labor Occupational Safety and Health Administration (OSHA) requires a thorough mask fit test prior to use. N95 respirators are named for their “ability to filter 95% or more of tiny 0.3-μm particles” and are the “mainstay of protection against airborne pathogens” (Dugdale & Walensky, 2020). Sickbert-Bennett et al. (2020) provide reassuring evidence of the performance of National Institute for Occupational Safety and Health (NIOSH)-approved N95 respirators outperforming alternatives in terms of filtration efficiency. Their research and testing prove that N95 masks reprocessed using ethylene oxide sterilization, as well as masks that are up to 11 years past expiration, maintain remarkably high filtration efficiency under laboratory conditions. N95 masks with suboptimal fit still had comparable filtration efficiency of more than 90%.

To keep students and patients safe and to abide by OSHA guidelines an evidenced based, financially fiscal N95 fit testing program was developed by nursing faculty and staff at a liberal arts university in Louisville, Kentucky. This program was developed to ensure that students had access to the recommended PPE and could safely care for patients in airborne precautions.

Section snippetsProblem

The first challenge was the nursing department's initial policy prohibited nursing students caring for COVID-19 patients or providing COVID-19 screenings due to the risk of exposure and the inability of students to be fit tested for an N95 respirator. The second challenge was related to the logistics of fit testing all nursing students. Clinical partners were unable to provide this for students, but willing to change their affiliation agreements and policies to allow the university to perform

Solution

As the pandemic continued, the department recognized the need to modify the policy to give students the opportunity to care for COVID-19 patients, as they would be doing post-graduation and to broaden the number of units which students could do clinical rotations. Faculty voted to change the policy to allow students to care for COVID-19 patients if proper PPE was provided and used, these changes were reflected in the BSN handbook and course syllabi.

Once the policy was changed, faculty and staff

Methods

There are two commonly used methods to fit test individuals to a N95 respirator, a qualitative or quantitative fit test. A qualitative fit test determines whether the respirator user can detect a taste using either isoamyl acetate (banana oil), saccharin (sweet), denatonium benzoate (Bitrex) (bitter), and irritant smoke. Irritant smoke is the least used option as it is more dangerous and less reliable than the others. Denatonium benzoate (Bitrex) aerosol is the most widely used in the United

Implementation

To implement the N95 fit testing procedure, students were prioritized to be fit tested based on their clinical placements. Students who were most likely to be on units with COVID-19 patients were prioritized. First some units required N95 masks to be always worn, such as the local Labor and Delivery units. Accelerated, 1-year nursing students were also given precedence due to their limited time in each clinical rotation. Fit testing events were held by faculty, staff, and trained students

Challenges

Many of the hospital systems in our area only approved certain N95 masks, based on contracts between the hospital organization and particular mask manufacturers. Hospitals only approving certain masks available within their organization will require students to be fit tested multiple times depending on clinical rotations. This also created additional costs, as the department must supply multiple types of masks to fit test students.

Initially, there was some miscommunication between the

Conclusion

The COVID-19 pandemic has brought about many challenges and opportunities for nursing schools. During the height of COVID-19 hospital admissions, nursing students were often on units but limited with assignments due to policies prohibiting care of patients in airborne isolation, lack of mask fit testing, or available PPE. The opportunity to update current policies, review OSHA guidelines, train on how to perform fit testing, and communication with clinical partners was necessary to provide

Declaration of Competing Interest

We have no conflict of interest to disclose.

References (5)Dugdale, C. M., & Walensky, R. P. (2020, September 11). Filtration efficiency, effectiveness, and availability of n95...C.Y. Hon et al.Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector

Journal of Occupational and Environmental Hygiene

(2017)

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© 2022 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights reserved.

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