{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T18:08:15Z","timestamp":1779127695403,"version":"3.51.4"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"USAID","award":["PR-12067"],"award-info":[{"award-number":["PR-12067"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare workers (HCWs) in public tertiary care hospitals, including chest diseases hospitals, experience a substantial tuberculosis (TB) burden, with 40\u221248% demonstrating baseline TB infection and incidence rates of 4.2\u20134.8 per 100 person-years, indicating occupational exposure in high TB-burden settings. TB infection prevention and control (IPC) guidelines recommend that HCWs wear N95 respirators in pulmonary TB patient areas. To ensure appropriate use of N95 respirators by HCWs, an understanding of the barriers and facilitators associated with respiratory protection is needed. This study explored factors influencing N95 respirator use and reuse among HCWs in a TB-specialized tertiary care hospital in Bangladesh.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Between December 1, 2013, and June 05, 2014, a field team consisting of five social scientists conducted a qualitative study to explore the factors influencing N95 respirator use and reuse among HCWs in a TB-specialized, tertiary care hospital in Bangladesh. We initially conducted a day long training workshop with 28 HCWs (doctors, nurses and ancillary workers) working in two multi-drug resistant (MDR) TB inpatient wards on the proper use, reuse, and storage of respirators. Participants also underwent N95 respirator fit testing and received a two-month supply (60 days) of N95 respirators. We also conducted observations with 22 HCWs before and after the workshop to document use of N95 respirators and in-depth interviews with the 24 HCWs to explore TB risk perceptions, and the reported barriers and facilitators of N95 respirator uses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At baseline, N95 respirators use was high among nurses (8\/9), whereas none of the doctors and ancillary workers used N95 respirators. Post-workshop observation findings showed that the use of N95 respirators remained highest among nurses (11\/12) compared to doctors (1\/5) and ancillary workers (2\/5). Perception that N95 prevents germs from entering the body, the feeling of increased confidence when wearing them and concerns about MDR-TB were identified as key motivators for respirator use. In contrast, misperceptions that long-term exposure to TB confer immunity against infection, discomfort, lack of motivation from senior colleagues, pain, difficulties in accessing respirators, communication challenges, fogging of spectacles and cumbersome storage for reuse were identified as the main barriers to consistent N95 respirator use by HCWs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>N95 respirator use among HCWs was feasible but varied substantially across professional groups, with consistently higher uptake among nurses. Persistent behavioral, structural, and institutional barriers limited consistent use. Addressing misconceptions, improving access and storage systems, strengthening leadership support, and reinforcing institutional policies may enhance adherence to respirator use in high TB-burden settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0331726","type":"journal-article","created":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:27:53Z","timestamp":1779125273000},"page":"e0331726","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors influencing N95 respirator use among healthcare workers in a TB specialized hospital, Bangladesh"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3519-2132","authenticated-orcid":true,"given":"Sayeeda","family":"Tarannum","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2529-3685","authenticated-orcid":true,"given":"Abu-Hena Mostofa","family":"Kamal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad Tauhidul","family":"Islam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md. Ariful","family":"Islam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamal","family":"Ibne Amin Chowdhury","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirina","family":"Akhter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Afsana","family":"Sharmin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily S.","family":"Gurley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sayera","family":"Banu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md. Saiful","family":"Islam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"pone.0331726.ref001","volume-title":"Global Tuberculosis Report","author":"World Health Organization","year":"2024"},{"key":"pone.0331726.ref002","volume-title":"Global tuberculosis report","author":"World Health Organization","year":"2024"},{"key":"pone.0331726.ref003","unstructured":"Coulter C, The National Tuberculosis Advisory Committee. Infection control guidelines for the management of patients with suspected or confirmed pulmonary tuberculosis in healthcare settings. Canberra: Department of Health and Aged Care, 2019."},{"key":"pone.0331726.ref004","article-title":"Tuberculosis Prevention, Control, and Elimination. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Talha Jilani declares no relevant financial relationships with ineligible companies. Disclosure: Ellis Tobin declares no relevant financial relationships with ineligible companies","author":"HM Swinkels","year":"2025","journal-title":"StatPearls Publishing"},{"issue":"2","key":"pone.0331726.ref005","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/S1473-3099(15)00499-5","article-title":"The transmission of Mycobacterium tuberculosis in high burden settings","volume":"16","author":"TA Yates","year":"2016","journal-title":"Lancet Infect Dis"},{"issue":"12","key":"pone.0331726.ref006","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.2217\/fmb-2016-0185","article-title":"Mechanisms of mycobacterial transmission: How does Mycobacterium tuberculosis enter and escape from the human host","volume":"11","author":"MU Shiloh","year":"2016","journal-title":"Future Microbiol"},{"issue":"9","key":"pone.0331726.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0291484","article-title":"Prevalence and incidence of tuberculosis infection among healthcare workers in chest diseases hospitals, Bangladesh: Putting infection control into context","volume":"18","author":"MS Islam","year":"2023","journal-title":"PLoS One"},{"key":"pone.0331726.ref008","volume-title":"WHO guidelines on tuberculosis infection prevention and control","author":"World Health Organization","year":"2019"},{"key":"pone.0331726.ref009","first-page":"1","article-title":"Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, 2005","volume":"54","author":"PA Jensen","year":"2005","journal-title":"MMWR Recomm Rep"},{"key":"pone.0331726.ref010","volume-title":"National Guidelines for Tuberculosis Infection Control","author":"National Tuberculosis Control Programme","year":"2011"},{"issue":"2","key":"pone.0331726.ref011","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0196-6553(98)80033-3","article-title":"Tuberculosis control through respirator wear: Performance of National Institute for Occupational Safety and Health-regulated respirators","volume":"26","author":"K Willeke","year":"1998","journal-title":"Am J Infect Control"},{"issue":"50","key":"pone.0331726.ref012","article-title":"Determination of the optimal time for N95 respirator for aerosol infection control","volume":"99","author":"J Du","year":"2020","journal-title":"Medicine (Baltimore)"},{"issue":"3","key":"pone.0331726.ref013","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/j.jiph.2020.02.032","article-title":"Use of personal protective equipment to protect against respiratory infections in Pakistan: A systematic review","volume":"13","author":"AA Chughtai","year":"2020","journal-title":"J Infect Public Health"},{"issue":"2","key":"pone.0331726.ref014","doi-asserted-by":"crossref","DOI":"10.1128\/cmr.00124-23","article-title":"Masks and respirators for prevention of respiratory infections: A state of the science review","volume":"37","author":"T Greenhalgh","year":"2024","journal-title":"Clin Microbiol Rev"},{"issue":"1","key":"pone.0331726.ref015","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1017\/ice.2020.1243","article-title":"Extended use or reuse of single-use surgical masks and filtering face-piece respirators during the coronavirus disease 2019 (COVID-19) pandemic: A rapid systematic review","volume":"42","author":"EC Toomey","year":"2021","journal-title":"Infect Control Hosp Epidemiol"},{"key":"pone.0331726.ref016","doi-asserted-by":"crossref","first-page":"100003","DOI":"10.1016\/j.hfh.2021.100003","article-title":"Decontamination and reuse of personal protective masks and respirators in healthcare: Human-centered investigation and implementation considerations","volume":"1","author":"SM Simmons","year":"2021","journal-title":"Hum Factors Health"},{"issue":"8","key":"pone.0331726.ref017","doi-asserted-by":"crossref","first-page":"4613","DOI":"10.1111\/jan.16590","article-title":"Assessment of the Psychometric Properties of the Mask Usability Scale: A measure of the perceived usability of N95 Respirators Among Healthcare Students and Staff","volume":"81","author":"LKP Suen","year":"2025","journal-title":"J Adv Nurs"},{"issue":"2","key":"pone.0331726.ref018","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1007\/s10156-012-0490-8","article-title":"Frequency of extensively drug-resistant tuberculosis (XDR-TB) among re-treatment cases in NIDCH, Dhaka, Bangladesh","volume":"19","author":"R Noor","year":"2013","journal-title":"J Infect Chemother"},{"issue":"1","key":"pone.0331726.ref019","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/anae.15261","article-title":"The role of fit testing N95\/FFP2\/FFP3 masks: A narrative review","volume":"76","author":"A Regli","year":"2021","journal-title":"Anaesthesia"},{"key":"pone.0331726.ref020","article-title":"The Health Belief Model of Behavior Change. StatPearls. Treasure Island (FL) ineligible companies. Disclosure: Raul Easton-Carr declares no relevant financial relationships with ineligible companies","author":"A Alyafei","year":"2025","journal-title":"StatPearls Publishing LLC"},{"issue":"10","key":"pone.0331726.ref021","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.ajic.2024.06.005","article-title":"Factors influencing self-reported facial-protective equipment adherence among home care nurses and personal support workers: A multisite cross-sectional study","volume":"52","author":"EC King","year":"2024","journal-title":"Am J Infect Control"},{"key":"pone.0331726.ref022","article-title":"Barriers to implementation of tuberculosis infection control amongst South African health care workers","author":"O Adeleke","year":"2012","journal-title":"University of Cape Town"},{"issue":"22","key":"pone.0331726.ref023","doi-asserted-by":"crossref","first-page":"12133","DOI":"10.3390\/ijerph182212133","article-title":"Organisational culture and mask-wearing practices for tuberculosis infection prevention and control among health care workers in primary care facilities in the Western Cape, South Africa: A qualitative study","volume":"18","author":"II Kallon","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0331726.ref024","article-title":"A study of environmental factors affecting nurses\u2019 comfort and protection in wearing N95 respirators during bedside procedures","volume":"27","author":"PP Or","year":"2018","journal-title":"J Clin Nurs"},{"issue":"2","key":"pone.0331726.ref025","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1002\/jhrm.21286","article-title":"Effective factors on not using the N95 respirators among health care workers: Application of Fuzzy Delphi and Fuzzy Analytic Hierarchy Process (FAHP)","volume":"37","author":"M Honarbakhsh","year":"2017","journal-title":"J Healthc Risk Manag"},{"key":"pone.0331726.ref026","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jhin.2025.02.008","article-title":"Barriers and facilitators to the use of personal protective equipment in long-term care: A qualitative study","volume":"162","author":"CC Tsang","year":"2025","journal-title":"J Hosp Infect"},{"issue":"1","key":"pone.0331726.ref027","doi-asserted-by":"crossref","first-page":"1872340","DOI":"10.1080\/21645515.2021.1872340","article-title":"Influence of social media on parents\u2019 attitudes towards vaccine administration","volume":"18","author":"KA Al-Regaiey","year":"2022","journal-title":"Hum Vaccin Immunother"},{"issue":"1","key":"pone.0331726.ref028","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ajic.2011.12.018","article-title":"Behind the mask: Determinants of nurse\u2019s adherence to facial protective equipment","volume":"41","author":"K Nichol","year":"2013","journal-title":"Am J Infect Control"},{"key":"pone.0331726.ref029","doi-asserted-by":"crossref","DOI":"10.1017\/ice.2020.1083","article-title":"Using a critical safety behavior scoring tool for N95 respirator use to evaluate training interventions","volume":"41","author":"E Beam","year":"2020","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"17","key":"pone.0331726.ref030","doi-asserted-by":"crossref","DOI":"10.3390\/su151712822","article-title":"Examining the roles of training, fit testing, and safety climate on user confidence in respiratory protection: A case example with reusable respirators in health delivery settings","volume":"15","author":"M Edirisooriya","year":"2023","journal-title":"Sustainability"},{"key":"pone.0331726.ref031","first-page":"153","article-title":"Evaluating filtering facepiece respirator wearing-comfort of lebanese red cross healthcare providers","volume":"15","author":"O Kheir","year":"2022","journal-title":"Med Devices (Auckl)"},{"issue":"9","key":"pone.0331726.ref032","doi-asserted-by":"crossref","first-page":"362","DOI":"10.3928\/21650799-20140804-03","article-title":"Health care workers\u2019 reported discomfort while wearing filtering face-piece respirators","volume":"62","author":"SM Locatelli","year":"2014","journal-title":"Workplace Health Saf"},{"issue":"4","key":"pone.0331726.ref033","doi-asserted-by":"crossref","first-page":"231","DOI":"10.36518\/2689-0216.1321","article-title":"CO2 levels behind and in front of different protective mask types","volume":"3","author":"H Akhondi","year":"2022","journal-title":"HCA Healthc J Med"},{"key":"pone.0331726.ref034","doi-asserted-by":"crossref","first-page":"106158","DOI":"10.1016\/j.buildenv.2019.05.036","article-title":"Thermoregulation and thermal sensation in response to wearing tight-fitting respirators and exercising in hot-and-humid indoor environment","volume":"160","author":"Y-C Lin","year":"2019","journal-title":"Building and Environment"},{"issue":"5","key":"pone.0331726.ref035","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e27118","article-title":"Extreme weather events and Spatio-temporal characterization of climate change variables in Bangladesh during 1975-2019","volume":"10","author":"S Haider","year":"2024","journal-title":"Heliyon"},{"issue":"8","key":"pone.0331726.ref036","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/j.ajic.2024.04.006","article-title":"Factors influencing nursing professionals\u2019 adherence to facial protective equipment usage: A comprehensive review","volume":"52","author":"TA Van Belle","year":"2024","journal-title":"Am J Infect Control"},{"issue":"4","key":"pone.0331726.ref037","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.jhin.2020.09.034","article-title":"Under-mask beard cover (Singh Thattha technique) for donning respirator masks in COVID-19 patient care","volume":"106","author":"R Singh","year":"2020","journal-title":"J Hosp Infect"},{"issue":"5","key":"pone.0331726.ref038","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1017\/dmp.2020.160","article-title":"Strategies for optimizing the supply of N95 filtering facepiece respirators during the coronavirus disease 2019 (COVID-19) pandemic","volume":"14","author":"MA de Perio","year":"2020","journal-title":"Disaster Med Public Health Prep"},{"issue":"4","key":"pone.0331726.ref039","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s11051-022-05460-0","article-title":"Improvement of performance and function in respiratory protection equipment using nanomaterials","volume":"24","author":"A Damokhi","year":"2022","journal-title":"Journal of Nanoparticle Research"},{"issue":"6","key":"pone.0331726.ref040","doi-asserted-by":"crossref","first-page":"327","DOI":"10.11622\/smedj.2017054","article-title":"Comfort and exertion while using filtering facepiece respirators with exhalation valve and an active venting system among male military personnel","volume":"59","author":"M Seng","year":"2018","journal-title":"Singapore Med J"},{"issue":"1","key":"pone.0331726.ref041","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.jhin.2019.03.014","article-title":"Improving healthcare worker adherence to the use of transmission-based precautions through application of human factors design: A prospective multi-centre study","volume":"103","author":"VR Williams","year":"2019","journal-title":"J Hosp Infect"},{"key":"pone.0331726.ref042","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jhin.2024.08.011","article-title":"Determinants of compliance with infection prevention measures by physicians: A scoping review","volume":"153","author":"M Schutte","year":"2024","journal-title":"J Hosp Infect"},{"issue":"10","key":"pone.0331726.ref043","doi-asserted-by":"crossref","first-page":"2003","DOI":"10.1177\/1420326X241286888","article-title":"Impact of wearing indoor masks on occupant\u2019s thermal comfort under different room temperature conditions in winter","volume":"33","author":"R Seo","year":"2024","journal-title":"Indoor and Built Environment"},{"issue":"1","key":"pone.0331726.ref044","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s13756-022-01161-4","article-title":"Infection prevention and control in tertiary care hospitals of Bangladesh: Results from WHO infection prevention and control assessment framework (IPCAF)","volume":"11","author":"MGD Harun","year":"2022","journal-title":"Antimicrob Resist Infect Control"},{"issue":"2","key":"pone.0331726.ref045","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0246923","article-title":"Implementation status of national tuberculosis infection control guidelines in Bangladeshi hospitals","volume":"16","author":"A Nazneen","year":"2021","journal-title":"PLoS One"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331726","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T17:28:02Z","timestamp":1779125282000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331726"}},"subtitle":[],"editor":[{"given":"Wondwossen Amogne","family":"Degu","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,18]]},"references-count":45,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,18]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331726","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,18]]}}}