Demonstration and Sentinel Surveillance System for Ongoing and Continuous Monitoring of PPE
(Respirator) Usage by Healthcare Workers (HCW) in the US.
Charles A. Oke, VMD, MPH,
1
FACE ;
Mary Yarbrough, MD, MPH,
2
FACOEM
NIOSH/National Personal Protective Technology Laboratory1; Vanderbilt University2
Objectives
• Utilize the Vanderbilt Occupational Health Information
System (VOHIS) to gather data about HCW protection
related to PPE: selection, usage, supply, ordering,
defects, fitting, safety programs and implementation
• Determine what specific activities and resources are
utilized by the hospital systems in their hazard
prevention programs (HPP)
• Evaluate the quality and effectiveness of PPE in HPP
• Use system to demonstrate and report best practices
of PPE in HPP
Background
• 13 Million workers in healthcare
• IOM report Preparing for an Influenza Pandemic: PPE
for Healthcare Workers (2008) states PPE is a vital
component of a system safety controls and preventive
measures used in healthcare facilities
• Value of monitoring and evaluating the activities and
resources regarding PPE use among HCWs and safety
prevention programs in hospital systems not formally
assessed (Figure 1)
Methods
Results
• Examine current state of medical center PPE usage surveillance
at the national level
• Documented and described existing system at VUMC
• Survey top hospitals and state/national agencies
• Survey HCW knowledge, attitudes, and beliefs about N-95
respirators
See companion poster for more detail
• Described the process needed to monitor the operations
Figure 2 column two
• Identified data collection points to be used in the system
• Survey HCWs exposed to airborne infection
Figure 2 columns one and three
Criteria Evaluation
• Acceptability
Next Steps
• Flexibility
• Cost
• Timeliness
• Specificity
• Sensitivity
• Feasibility
• Data collection points
• Pilot expanded system at Vanderbilt
• Produce formal needs assessment document
• Roll the system out to 5 large hospital systems
• Incorporation into a national system (Figure 3)
• Standardization & Harmonization
PREVENTION
Respirator Medical Clearance and N95 Fit Testing
Employee
Community Vaccination
Programs
Employer Vaccination and Training Programs
Patient
Surveillance Reports to managers
PATIENT ADMISSION
Disease report to
state/federal public health
agencies
Patient airborne infectious
disease identified
Laboratory Identification
Medical Provider orders isolation
Patient placed on
Airborne Precautions
Negative pressure
room
Treatment plan implemented
HCW implements isolation and dons PPE (N95 )
INFECTION
SURVEILLANCE
Central Supply manages supply and recall of PPE
Recognition of unprotected
exposure to patient
Unprotected HCW notification
Signs on doorway
Visitors informed
HCW tested and PPE given
Friends and family
notified and advised to
seek medical follow-up
Periodic surveillance to identify disease in HCW
Ongoing surveillance
Report injury / illness to OSHA
Report to Workers’ Compensation
Report to hospital IC
committee
Figure 3. Simplified Flow Chart of a National Surveillance System
Report to hospital committees (JCAHO)
Disclaimer
Figure 1. Simplified example of steps in a surveillance system
Figure 2 is a model of how a respiratory safety program is enacted in a hospital, what happens
at each stage of the safety program, what measures could be used to assess the effectiveness
of the safety program, and what database sources could be used here to provide information on
those measures.
The findings and conclusions in this poster have not been formally disseminated
by the National Institute for Occupational Safety and Health and should not be
construed to represent any agency determination or policy.