醫護人員佩戴拋棄式口罩之密合狀況調查

Fitting Characteristics of Filtering Facepiece Respirators for Health Care Workers

拋棄式口罩是目前醫護人員最常用來防止由呼吸感染之病原的工具，其防護程度取決於口罩的濾材及與使用者的密合程度。在美國，對於呼吸防護具的選擇、使用及保養，都必須遵守職業安全衛生署（OSHA）的標準進行，然而台灣卻沒有相關的標準可參考。因此，本研究預計對醫護人員使用拋棄式口罩的密合度進行調查，並推廣呼吸防護具計畫之概念。計畫中利用 TSI 之定量密合度測試儀（PortaCount Plus Model 8020）以評估參與測試之醫療人員在實際作業時所佩戴之呼吸防護具的密合度。在實際測試之前，會先使受測者瞭解並熟悉定量密合度測試的程序。其次，也透過問卷的方式以瞭解受測者在該計畫執行前、後對於呼吸防護具計畫之態度與認知。研究結果顯示，在參與計畫的醫療人員中只有 9% 有定量密合度測試之經驗，有 94% 擔心口罩是否有洩漏。在定量密合度測試的結果中，醫療人員佩戴口罩後所測得之密合係數在 100（美國相關單位判斷佩戴拋棄式防塵口罩密合度合格與否之判定參考值）以上共有 63.2%。測試結果也發現，知名的廠牌並不能保證有較高的通過率。因此，密合度測試的執行是拋棄式防塵口罩使用者能夠獲得有效防護的保障。

Filtering facepiece respirators are the devices most frequently used in health care settings to prevent inhalation of infectious agents. The level of protection provided by a respirator is determined by the efficiency of the filter material and how well the facepiece fits to the worker’s face. In America, the Occupational Safety and Health Administration standard for respiratory protection must be followed to ensure that respirators are properly selected, used, and maintained. However, there is no relevant standard in Taiwan. This study, therefore ,investigated the fitting characteristics of disposable masks used by health care workers. Three institutions, including 2 of the 8 hospitals of the Infection Prevention Network and 1 of the 10 BSL3 laboratories located in northern Taiwan, volunteered to participate in this study. A TSI PortaCount Plus Model 8020 was used to evaluate the fitting characteristics of the respirators. Prior to the start of the test, the subjects were trained to perform the modified quantitative fit test protocol. The subjects’ attitude and cognition change in regard to the respiratory protection program were evaluated before and after the test by using a questionnaire. In addition, a laboratory study was conducted to investigate the fitting characteristics of 7 models of N95 filtering facepiece respirators that are commonly used in Taiwan. The results showed that only 9 (%) of the 209 subjects used in of this study undergone quantitative fit testing previously, and 94(%) of them doubted the effectiveness of the respirators. This indicates that there is an urgent need to implement a respiratory protection program. The results of quantitative fit testing showed that 63.2 (%) of the subjects obtained a fit factor greater than 100, which is the fit test pass/fail level for filtering facepieces recommended by the respirator authority in America. Popular models did not necessarily have a higher passing rate. Therefore, a fit test for filtering facepiece respirators is necessary to ensure that the users receive the level of protection they expect.