Graduation Date

Summer 8-9-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Epidemiology

First Advisor

Kendra Ratnapradipa, PhD

Second Advisor

Brandon Grimm, PhD

Third Advisor

Gwenn Porter, PhD

Fourth Advisor

Ishrat Kamal-Ahmed, PhD

Abstract

Background: Ensuring the proper fit of N95 respirators used by healthcare workers in long-term care facilities (LTCF) is essential for their safety. The Nebraska Department of Health and Human Services launched a LTCF strike team project (STP) in the summer of 2022, focused on increasing the number of staff trained in infection control and building internal capacity for LTCFs to fit test their employees. This study describes the N95 fit-testing initiative for Nebraska LTCFs.

Methods: Staff from all 19 local health departments (LHD) received “train-the-trainer” training to prepare LTCF staff to perform qualitative fit testing. LTCF administrators were requested to complete an online REDCap survey to assess their willingness to participate. The survey also collected information on facility demographics and the N95 fit testing status of current employees. LHD trainers visited LTCFs to train at least two staff members on performing fit testing and assist with worker fit testing. Following the training, participating LTCFs and LHDs were asked to complete a post-survey regarding their experiences. Descriptive, inferential, and thematic analyses were performed through the lens of RE-AIM to better understand how fit testing programs are implemented and adopted within Nebraska LTCFs to mitigate the spread of respiratory pathogens.

Results: Nebraska has a total of 476 licensed LTCFs (193 nursing homes [NH], 283 assisted living facilities [ALF]), with (62%) located in rural areas. A total of 330 LTCFs completed the baseline survey. Among responding facilities, 55% lacked staff trained in performing N-95 fit testing, and most (57%) did not have the necessary fit testing supplies. Over 67% of LTCFs reported not having any staff fit tested in the past year. As a result of the STP, Nebraska LTCFs now have an additional 3,438 N95 fit tested frontline healthcare workers. The results of statistical testing indicated that the mean numbers of staff fit tested before and after the training was statistically significant (p < 0.05). The results of the thematic analysis revealed many different barriers and facilitators related to the adoption and implementation of the fit testing training. The barriers included the preparation of LTCFs, physiological issues related to COVID-19, equipment issues, availability of staff, scheduling issues, and staff compliance. Alternatively, the facilitators included the organization of LTCFs, the staff’s openness to learning, the flexibility of LHDs, and the delivery of fit testing equipment to LTCFs.

Conclusion: This study highlights an important disparity in LTCFs where the majority of healthcare workers are still not fit tested more than three years into the COVID-19 pandemic. Public health must prioritize increasing LTCF capabilities for initial and annual N95 fit testing.

Comments

Copyright 2024, the author

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