Online Program

Hospital adherence to respiratory protection guidelines: The REACH 2 evaluation

Monday, November 4, 2013

K. Kristina Peterson, PhD, Program for Occupational Safety and Health, RTI International, Research Triangle Park, NC
Debra Novak, RN, DSN, CDC/NIOSH NPPTL, Pittsburgh, PA
Background and Objective(s)

Effective use of respiratory protection helps minimize the risk of disease for healthcare staff, patients, their families and caregivers. The purpose of REACH 2 is to assess hospitals' respiratory protection programs (RPPs) and healthcare workers use of respiratory protection. The study focuses on adherence to standards and recommendations for employee medical evaluations, fit testing and training; the selection, use, maintenance, and inspection of respirators; and regular program evaluation and risk assessments.


This study is based on surveys conducted during 2011-2012 in 98 acute care hospitals in six states across the United States. Survey interviews were conducted with 215 hospital managers, 245 unit managers and 1105 healthcare workers. 356 formal structured observations were also made of healthcare workers' respirator use.

Hospital-level indicators of adherence to CDC-recommended and OSHA-required RPP elements were constructed and analyzed with descriptive statistics, cross-tabulations, and multinomial logistic modeling. Independent variables included hospital size, state, union membership, employment status, and vaccination status.


Multiple gaps in knowledge and behavior were identified. They involved knowledge of proper respiratory protection in the presence of patients with seasonal influenza and infectious disease, best practices for monitoring and evaluating the hospital's RPP, and requirements for medical evaluation, fit testing and training. Adherence to guidelines was often correlated with state, but not with the other factors.


Based on the findings, hospital staff need to be made more aware of recommended respiratory protection guidelines. Efforts to improve adherence to guidelines should be tailored to the geographical location.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Occupational health and safety
Public health or related laws, regulations, standards, or guidelines

Learning Objectives:
Identify gaps in healthcare staff's knowledge and behavior regarding required and recommended respiratory protection.

Keyword(s): Health Care Workers, Infectious Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: RTI Project Director for the study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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