Factors influencing N95 respirator use among healthcare workers in a TB specialized hospital, Bangladesh

BackgroundTuberculosis (TB) infection prevention and control (IPC) guidelines recommend that healthcare workers (HCWs) wear N95 respirators in pulmonary TB patient areas. To ensure appropriate use of respirators by HCWs, an understanding of the barriers and facilitators associated with respiratory protection is needed. This study explored factors influencing N95 respirator use among HCWs in a TB-specialized, tertiary-care hospital in Bangladesh. MethodsBetween February 1, 2014 and March 14, 2014, a field team consisting of five social scientists and three epidemiologists conducted this qualitative study in a tertiary-care, specialized TB hospital in Dhaka, Bangladesh. Initially, we held a day long training workshop on respirator use, re-use, and storage, and conducted N95 respirator fit tests. After the workshop, we provided a two-month supply of N95 respirators for HCWs assigned to two multi-drug resistant (MDR) TB inpatient wards. Finally, we conducted in-depth interviews with the HCWs to explore their risk perceptions regarding TB and airborne infections, and reported advantages and disadvantages of N95 respirator uses. We used the HBM health belief model to understand the factors that influence respirator use. ResultsDoctors and ancillary workers reported that discomfort, demotivation from the senior colleagues, and cumbersome storage of respirators for re-use were the primary barriers to respirator use. In addition, communication difficulties, fogging up corrective lenses, eight hours of respirator use are considered factors that also impacted respirator use. However, compared to doctors and ancillary workers, the nurses are more likely to use N95 respirators. ConclusionWorkshops on TB transmission and prevention strategies, and easy access to those strategies, might improve the use among the nurses. Interventions that target educating HCWs on TB transmission and the role of personal protective equipment in TB prevention, as well as hanging posters on the wards as reminders, supplying and ensuring easy access to N95 respirators inside the ward, and developing communications targeted at behavioral change, including advocacy and counseling, can also be implemented.