Determinants of healthcare workers' compliance with infection control procedures.

The purpose of this study was to assess determinants of healthcare worker (HCW) self-reported compliance with infection control procedures. A survey was conducted of HCWs in 16 healthcare facilities. A strong correlation was found between both environmental and organizational factors and self-reported compliance. No relationship was found with individual factors. Only 5% of respondents rated their training in infection control as excellent, and 30% felt they were not offered the necessary training. We concluded that compliance with infection control procedures is tied to environmental factors and organizational characteristics, suggesting that efforts to improve availability of equipment and promote a safety culture are key. Training should be offered to high-risk HCWs, demonstrating an organizational commitment to their safety.

Filtration of respired gases: theoretical aspects.

The filtration of aerosols and the behavior of aerosolized particles are less intuitive and more complex than commonly indicated in the medical literature, but once the basic principles are presented, they are not difficult to understand or apply. Particles with diameters close to the most penetrating particle size are clearly the particles of greatest concern, interest, and value in considering the performance of different filtration devices, and this size has been identified as the standard particle size for testing respirators and breathing system filters. Although almost every level of health care now mandates the N95 (NIOSH rating) as the minimum rating for medical respirators, there is no such mandate regarding minimum efficiencies of breathing system filters. At least in North America, it still falls to each individual purchaser to ensure that these standardized tests are performed, because manufacturers adhere to these standards only on a voluntary basis. Government regulations similar to NIOSH 42 CFR 84 are needed for breathing system filters and should include a rating system such as N95, N99, or N100. For breathing system filters, the BFE and VFE tests are misleading and should be abandoned (or even better, banned) in favor of internationally recognized sodium chloride tests. Until then, manufacturers will be hesitant to abandon their BFE and VFE data, which give the appearance of vastly better performance than does the sodium chloride test.

The impact of severe acute respiratory syndrome on the use of and requirements for filters in Canada.

This article begins with a brief look at the epidemiology of SARS in Canada and then discusses barrier use and potential containment strategies that could be applied to the respiratory equipment and supportive procedures that have been implicated in the spread of SARS or other respiratory infections. The article ends with a discussion of how practice and regulations have changed in Canada since SARS and some suggestions on how practice or regulations could further improve.