Why N95s Are Underused in a Bangladesh TB Hospital

Tuberculosis (TB) spreads through the air, so international infection prevention and control guidelines recommend that healthcare workers (HCWs) wear N95 respirators in areas where patients with pulmonary TB are treated. To understand why staff do or do not use this protection, Sakabe Tarannum and colleagues carried out a focused study in a TB-specialized, tertiary-care hospital in Dhaka, Bangladesh. Between February 1, 2014 and March 14, 2014, a field team made up of five social scientists and three epidemiologists ran a one-day training workshop that covered respirator use, re-use, and storage, and they performed N95 respirator fit tests. After that workshop the team supplied a two-month stock of N95 respirators for HCWs assigned to two multi-drug resistant (MDR) TB inpatient wards. The study then explored staff views by conducting in-depth interviews to find out how HCWs perceived their risk from TB and other airborne infections, and to list the advantages and disadvantages they experienced when using N95 respirators. The work aimed to pinpoint practical barriers and possible solutions so hospitals could better protect their staff and patients.

The investigators used qualitative methods to gather detailed, personal accounts of respirator use. They ran a day-long training and conducted N95 respirator fit tests, then gave a two-month supply of respirators to staff in the two multi-drug resistant (MDR) TB inpatient wards before doing in-depth interviews. To interpret what they heard, the researchers applied the HBM health belief model to understand factors that influence whether staff wore N95s. Results showed clear differences by role: doctors and ancillary workers listed primary barriers such as discomfort, demotivation from senior colleagues, and cumbersome storage for re-use of respirators. They also reported practical problems like difficulty communicating, fogging up corrective lenses, and the strain of wearing a respirator for eight hours. By contrast, nurses were more likely to use N95 respirators. These findings are reported directly from the interviews and framed by the HBM health belief model, highlighting both practical and cultural influences on protective behavior.

The study points to straightforward steps that could raise respirator use and strengthen infection control in TB wards. The authors suggest that workshops about TB transmission and prevention strategies, combined with easy access to those strategies, could improve uptake among nurses and other staff. Practical changes include supplying and ensuring easy access to N95 respirators inside the ward and improving storage approaches for safe re-use. Behavioral interventions are also recommended: hanging posters on wards as reminders, educational efforts that explain the role of personal protective equipment in TB prevention, and communications targeted at behavioral change such as advocacy and counseling. Addressing demotivation from senior colleagues and the practical problems of comfort, communication, and lens fogging could remove important barriers. Taken together, these measures could help hospitals translate guidelines into everyday practice, protecting both healthcare workers and patients in settings that treat drug-resistant TB.