Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses

Abstract

Background: Long-term use of respiratory protection may be necessary, but compliance may be low, and physiologic effects have not been well evaluated.

Methods: Ten nurses participated; physiologic effects, subjective symptoms, and compliance with wearing an N95 alone or with a surgical mask overlay were assessed. Longitudinal analysis based on multivariate linear regression models assessed changes in outcome variables (CO2, O2, heart rate, perceived comfort items, compliance measures, and others). Analyses compared changes over time, and compared wearing only an N95 to wearing an N95 with a surgical mask overlay.

Results: Most nurses (90%, n = 9) tolerated wearing respiratory protection for two 12-hour shifts. CO(2) levels increased significantly compared with baseline measures, especially when comparing an N95 with a surgical mask to only an N95, but changes were not clinically relevant. Perceived exertion; perceived shortness of air; and complaints of headache, lightheadedness, and difficulty communicating also increased over time. Almost one-quarter (22%) of respirator removals were due to reported discomfort. N95 adjustments increased over time, but other compliance measures did not vary by time. Compliance increased on day 2, except for adjustments, touching under the N95, and eye touches.

Conclusion: Long-term use of respiratory protection did not result in any clinically relevant physiologic burden for health care personnel, although many subjective symptoms were reported. N95 compliance was fairly high.

Keywords: Disaster; Filtering face piece respirator; Influenza; N95 respirator; Pandemic; Preparedness.