•  
  •  
 

Abstract

Background: Little is known about Malaysian workers' tolerance for respirators in the workplace. This study aimed to assess Malaysian workers' perceptions of respirator tolerability and its relationship to socio-demographics and compliance.

Method : This cross-sectional study was conducted between October and December 2021 among respirator users in the agricultural, industrial, and service sectors. Background information and respirator compliance were collected using a structured online questionnaire. A R-COMFI questionnaire was used to measure respirator tolerability.

Results: This study recruited 340 participants, but only 278 of them met the inclusion criteria. More than half reported that wearing respirators was uncomfortable, impacted focus, and hindered communication. Few had health concerns from respirators. Malay ethnicity (β = -2.604, 95% CI = -4.983, -0.225) and respirator training (β = -2.213, 95% CI = -4.339, -0.088) were found to be associated with better respirator tolerability.

Conclusion: This study showed that Malay ethnicity and respirator training predicted better respirator tolerance. Policy aimed at emphasizing the need of respirator training programs, particularly for non-Malay workers, should be thoroughly considered in order to improve worker tolerance of respirator wear and prevent hazardous health effects by inhalation.

Keywords: Respirator, Tolerability, Worker, R-COMFI, Malaysia

References

[1] Occupational Safety and Health Administration. Fit testing procedures (mandatory)e1910.134 [updated 2004; cited 2021 Feb 2]. Available from: https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134AppA.

[2] Venesoja A, Gronman K, Tella S, Hiltunen S, Koljonen K, Butylina S, et al. Healthcare workers' experiences and views of using surgical masks and respirators, and their attitudes on the sustainability: a semi-structured survey study during covid-19. Nurs Rep 2021;11(3):615-28. https://doi.org/10.3390/nursrep11030059.

[3] Centers for Disease Control and Prevention [CDC]. National personal protective technology laboratory (NPPTL), NIOSH approved N95 particulate filtering facepiece respirators. 2021 [cited 2021 Feb 2]. Available from: https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/N95list1.html.

[4] Wizner K, Nasarwanji M, Fisher E, Steege AL, Boiano JM. Exploring respiratory protection practices for prominent hazards in healthcare settings. J Occup Environ Hyg 2018;15(8):588-97. https://doi.org/10.1080/15459624.2018.1473581.

[5] Zhuang Z, Benson S, Lynch S, Palmiero A, Roberge R. Laboratory study to assess causative factors affecting temporal changes in filtering facepiece respirator fit: part I – pilot study. J Occup Environ Hyg 2011;8(12):729-39. https://doi.org/10.1080/15459624.2011.627294.

[6] Hua W, Zuo Y, Wan R, Xiong L, Tang J, Zou L, et al. Shortterm skin reactions following use of N95 respirators and medical masks. Contact Dermatitis 2020;83(2):115-21. https://doi.org/10.1111/cod.13601.

[7] Robertsen O, Hegseth MN, Føreland S, Siebler F, Eisemann M, Vangberg HCB. The effect of a knowledge based intervention on the use of respirators in the Norwegian smelter industry. Front Psychol 2020;11:270. https://doi.org/10.3389/fpsyg.2020.00270.

[8] Fukakusa J, Rosenblat J, Jang B, Ribeiro M, Kudla I, Tarlo SM. Factors influencing respirator use at work in respiratory patients. Occup Med (Lond) 2011;61(8):576-82. https://doi.org/10.1093/occmed/kqr132.

[9] Lan J, Song Z, Miao X, Li H, Li Y, Dong L, et al. Skin damage among health care workers managing coronavirus disease-2019. J Am Acad Dermatol 2020;82(5):1215-6. https://doi.org/10.1016/j.jaad.2020.03.014.

[10] Foo CC, Goon AT, Leow YH, Goh CL. Adverse skin reactions to personal protective equipment against severe acute respiratory syndrome–a descriptive study in Singapore. Contact Dermatitis 2006;55(5):291-4. https://doi.org/10.1111/j.1600-0536.2006.00953.x.

[11] Malaysia, Department of Occupational Safety and Health [DOSH]. Guidelines on the use of personal protective equipment against chemical hazards [updated 2005 Oct; cited 2021 Feb 2]. Available from: https://www.dosh.gov.my/index.php/legislation/guidelines/chemical/618-04-guidelines-on-the-use-of-personal-protective-equipmentagainst-chemicals-hazards-2005?path=chemical.

[12] Hamzah R, Ain Zali N, Yusoff NH. Overcoming challenges in respirator fit testing in upstream Malaysia. In: SPE Asia Pacific health, safety, security, environment and social responsibility conference. Malaysia: Kuala Lumpur; 2017 Apr 4-6.

[13] Radonovich LJ, Wizner K, LaVela SL, Lee ML, Findley K, Yorio P. A tolerability assessment of new respiratory protective devices developed for health care personnel: a randomized simulated clinical study. PLoS One 2019;14(1):e0209559. https://doi.org/10.1371/journal.pone.0209559.

[14] LaVela SL, Kostovich C, Locatelli S, Gosch M, Eagan A, Radonovich L. Development and initial validation of the respirator comfort, wearing experience, and function instrument [R-COMFI]. J Occup Environ Hyg 2017;14(2):135-47. https://doi.org/10.1080/15459624.2016.1237025.

[15] IBM. IBM SPSS statistics for windows. Armonk, NY: IBM; 2016.

[16] Taber KS. The use of Cronbach's alpha when developing and reporting research instruments in science education. Res Sci Educ 2018;48(6):1273-96. https://doi.org/10.1007/s11165-016-9602-2.

[17] Kheir O, Watts R, Verlinden J, Jacoby A, Smedts S, Vleugels J, et al. Evaluating filtering facepiece respirator wearing-comfort of lebanese red cross healthcare providers. Med Devices (Auckl) 2022;15:153-61. https://doi.org/10.2147/mder.S362198.

[18] Purushothaman PK, Priyangha E, Vaidhyswaran R. Effects of prolonged use of facemask on healthcare workers in tertiary care hospital during covid-19 pandemic. Indian J Otolaryngol Head Neck Surg 2021;73(1):59-65. https://doi.org/10.1007/s12070-020-02124-0.

[19] Roberge RJ, Kim JH, Coca A. Protective facemask impact on human thermoregulation: an overview. Ann Occup Hyg 2012;56(1):102-12. https://doi.org/10.1093/annhyg/mer069.

[20] Scarano A, Inchingolo F, Lorusso F. Facial skin temperature and discomfort when wearing protective face masks: thermal infrared imaging evaluation and hands moving the mask. Int J Environ Res Publ Health 2020;17(13):4624. https://doi.org/10.3390/ijerph17134624.

[21] Hu K, Fan J, Li X, Gou X, Li X, Zhou X. The adverse skin reactions of health care workers using personal protective equipment for COVID-19. Medicine (Baltim) 2020;99(24):e20603. https://doi.org/10.1097/md.0000000000020603.

[22] Johnson AT. Respirator masks protect health but impact performance: a review. J Biol Eng 2016;10:4. https://doi.org/10.1186/s13036-016-0025-4.

[23] Cheok GJW, Gatot C, Sim CHS, Ng YH, Tay KXK, Howe TS, et al. Appropriate attitude promotes mask wearing in spite of a significant experience of varying discomfort. Infect Dis Health 2021;26(2):145-51. https://doi.org/10.1016/j.idh.2021.01.002.

[24] Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, et al. Headaches associated with personal protective equipment a cross-sectional study among frontline healthcare workers during covid-19. Headache 2020;60(5):864-77. https://doi.org/10.1111/head.13811.

[25] Kisielinski K, Giboni P, Prescher A, Klosterhalfen B, Graessel D, Funken S, et al. Is a mask that covers the mouth and nose free from undesirable side effects in everyday use and free of potential hazards? Int J Environ Res Publ Health 2021;18(8):4344. https://doi.org/10.3390/ijerph18084344.

[26] Rebmann T, Carrico R, Wang J. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. Am J Infect Control 2013;41(12):1218-23. https://doi.org/10.1016/j.ajic.2013.02.017.

[27] Fix GM, Reisinger HS, Etchin A, McDannold S, Eagan A, Findley K, et al. Health care workers' perceptions and reported use of respiratory protective equipment: a qualitative analysis. Am J Infect Control 2019;47(10):1162-6. https://doi.org/10.1016/j.ajic.2019.04.174.

[28] Yang L, Shen H, Wu G. Racial differences in respirator fit testing: a pilot study of whether American fit panels are representative of Chinese faces. Ann Occup Hyg 2007;51(4):415-21. https://doi.org/10.1093/annhyg/mem005.

[29] Kim H, Han DH, Roh YM, Kim K, Park YG. Facial anthropometric dimensions of Koreans and their associations with fit of quarter-mask respirators. Ind Health 2003;41(1):8-18. https://doi.org/10.2486/indhealth.41.8.

[30] Purmal K, Alam MK, Zam Zam NM. Cephalometric norms of Malaysian adult Chinese. Int Med J 2013;20(1):87-91.

[31] Othman SA, Majawit LP, Wan Hassan WN, Wey MC, Mohd Razi R. Anthropometric study of three-dimensional facial morphology in Malay adults. PLoS One 2016;11(10):e0164180. https://doi.org/10.1371/journal.pone.0164180.

[32] Ngeow WC, Aljunid ST. Craniofacial anthropometric norms of Malaysian Indians. Indian J Dent Res 2009;20(3):313-9. https://doi.org/10.4103/0970-9290.57372.

[33] Nichol K, McGeer A, Bigelow P, O'Brien-Pallas L, Scott J, Holness DL. Behind the mask: determinants of nurse's adherence to facial protective equipment. Am J Infect Control 2013;41(1):8-13. https://doi.org/10.1016/j.ajic.2011.12.018.

[34] Locatelli SM, LaVela SL, Gosch M. Health care workers' reported discomfort while wearing filtering face-piece respirators. Workplace Health & Saf 2014;62(9):362-8. https://doi.org/10.3928/21650799-20140804-03.

[35] Çiris¸ Yildiz C, Ulas¸li Kaban H, Tanriverdi F. COVID-19 pandemic and personal protective equipment: evaluation of equipment comfort and user attitude. Arch Environ Occup Health 2022;77(1):1-8. https://doi.org/10.1080/19338244.2020.1828247.

[36] Or PP, Chung JW, Wong TK. A study of environmental factors affecting nurses' comfort and protection in wearing N95 respirators during bedside procedures. J Clin Nurs 2018; 27(7e8):e1477-84. https://doi.org/10.1111/jocn.14268.

[37] Lee K, Slavcev A, Nicas M. Respiratory protection against Mycobacterium tuberculosis: quantitative fit test outcomes for five type N95 filtering-facepiece respirators. J Occup Environ Hyg 2004;1(1):22-8. https://doi.org/10.1080/15459620490250026.

[38] Foereland S, Robertsen O, Hegseth MN. Do various respirator models fit the workers in the Norwegian smelting industry? Saf Health Work 2019;10(3):370-6. https://doi.org/10.1016/j.shaw.2019.06.004.

[39] Zhuang E, Chen HH, Kolesnik O, Hines SE. Tolerability, user acceptance and preference for a novel reusable respirator among healthcare workers. Am J Infect Control 2022. https://doi.org/10.1016/j.ajic.2022.09.006 (in press).

[40] Cramer ME, Wendl MJ, Sayles H, Duysen E, Achutan C. Knowledge, attitudes, and practices for respiratory and hearing health among midwestern farmers. Publ Health Nurs 2017;34(4):348-58. https://doi.org/10.1111/phn.12306.

[41] Hegseth MN, Ø Robertsen, Aminoff A, Vangberg HCB, Føreland S. Reasons for not using respiratory protective equipment and suggested measures to optimize use in the Norwegian silicon carbide, ferro-and silicon-alloy industry. In: Jones RT, den Hoed, editors. Infacon XV: international ferroalloys congress; 2018 Feb 25-28. Cape Town, South Africa.

[42] Gutierrez AMJA, Galang MD, Seva RR, Lu MC, Ty DRS. Designing an improved respirator for automotive painters. Int J Ind Ergon 2014;44(1):131-9. https://doi.org/10.1016/j.ergon.2013.11.004.

[43] Garcia Godoy LR, Jones AE, Anderson TN, Fisher CL, Seeley KML, Beeson EA, et al. Facial protection for healthcare workers during pandemics: a scoping review. BMJ Glob Health 2020;5(5):e002553. https://doi.org/10.1136/bmjgh-2020-002553.

Download

Share

COinS