Prospective observational study of gender and ethnicity biases in respiratory protective equipment for healthcare workers in the COVID-19 pandemic.

OBJECTIVE: To describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit. DESIGN: Prospective observational study of RPE fit testing according to health and safety, and occupational health requirements. SETTING: A large tertiary referral UK healthcare facility. POPULATION: 1443 healthcare workers undergoing quantitative fit testing. MAIN OUTCOME MEASURES: Quantitative fit test success (pass/fail) and the count of tests each participant required before successful fit. RESULTS: Healthcare workers were fit tested a median (IQR) 2 (1-3) times before successful fit was obtained. Males were tested a median 1 (1-2) times, while females were tested a median 2 (1-2) times before a successful fit was found. This difference was statistically significant (p<0.001). Modelling each fit test as its own independent trial (n=2359) using multivariable logistic regression, male healthcare workers were significantly more likely to find a well-fitting respirator and achieve a successful fit on first attempt in comparison to females, after adjusting for other factors (adjusted OR=2.07, 95% CI): 1.66 to 2.60, p<0.001). Staff who described their ethnicity as White were also more likely to achieve a successful fit compared with staff who described their ethnicity as Asian (OR=0.47, 95% CI: 0.38 to 0.58, p<0.001), Black (OR=0.54, 95% CI: 0.41 to 0.71, p<0.001), mixed (OR=0.50 95% CI: 0.31 to 0.80, p=0.004) or other (OR=0.53, 95% CI: 0.29 to 0.99, p=0.043). CONCLUSIONS: Male and White ethnicity healthcare workers are more likely to achieve RPE fit test success. This has broad operational implications to healthcare services with a large female and Black, Asian and minority ethnic group population. Fit testing is imperative in ensuring RPE effectiveness in protecting healthcare workers during the COVID-19 pandemic and beyond.

Can a tool developed for industry be used to assess fatigue risk in medical rotas? A pilot study of foundation doctors' rotas in a tertiary centre.

OBJECTIVES: To determine the feasibility and ease of using a pre-existing health and safety executive fatigue risk calculator to assess doctors' rotas. DESIGN: Observational. SETTING: A large tertiary-referral teaching hospital in the UK. PARTICIPANTS: 95 anonymised foundation years 1 and 2 rotas in General Medicine, General Surgery and Emergency Medicine covering a 4-month period. All rotas provided by rota coordinators were included and assessed. INTERVENTIONS: Rotas were assessed for two indices: relative risk of fatigue-related errors compared with a '2-day, two-night, four-off' shift pattern and percentage chance of a high score on a standardised sleepiness scale. PRIMARY AND SECONDARY OUTCOME MEASURES: Fatigue index (percentage chance of a high score on a standardised sleepiness scale) and risk index (relative risk of fatigue-related errors compared with a '2-day, two-night, four-off' shift pattern) of all shifts on all rotas. RESULTS: Nearly half of all shifts demonstrated increased risk of fatigue-related errors and increased probability of high levels of sleepiness. There was significant interspeciality variation in both indices. These results are based on rotas as opposed to 'work as done' and are therefore likely to slightly universally underestimate actual fatigue risks. CONCLUSIONS: This preliminary study demonstrates that this tool can be used to compare rotas and guide rota design to minimise risk wherever possible. The calculator guidance clearly states there is no 'ideal risk' but that values should be minimised, and a maximum fatigue risk agreed which is deemed acceptable given the nature of work undertaken. This study is intended to demonstrate that fatigue can and should be considered during rota design. We do not suggest that it is used to hold either individuals or organisations to account as there is no evidence for it being used in this way. Further work should assess the practicality of designing medical rotas using this tool to minimise fatigue risk.