Pandemic Influenza Preparedness

1
Pandemic Influenza Preparedness

• Response Guidance forHealthcare Workers and
  Healthcare Employers

Educational material developed through
funding from OSHA Susan Harwood Grant
SH-16624-07-60-F-54
2
Introduction

• Any Pandemic Disease
• is a global disease outbreak
• occurs when a new virus emerges
• spreads where people have no immunity
• is a disease for which there is no vaccine
• spreads easily person-to-person
• causes serious illness
• sweeps around the world in a short time

3
Initial Control Measures

• After a pandemic disease starts, everyone in the
  world is at risk
• Countries might try to delay or stop the arrival
  of the virus through
• border closures
• travel restrictions
• quarantines

4
Effects of A Severe Pandemic

• Everyday life would come to a standstill due to
• high levels of illness, death, social disruption,
  and economic loss
• everyone being ill at the same time
• interruptions of basic services such as public
  transportation and food delivery

5
History of Flu Pandemics

• Deaths in USA from past influenza pandemics
• 1918 500,000
• 1957 70,000
• 1968 34,000

6
The Public Health Service

• By 1918, most PHS officers understood how
  diseases spread
• Without antibiotics, PHS officers were limited in
  their ability to fight disease

7
Devastation of 1918 Avian Flu

• The Influenza Pandemic occurred in three waves
  in the United States throughout 1918 and 1919.

http//www.pandemicflu.gov/
8
1918 Rapid-paced Outbreaks

• The 1918 influenza pandemic occurred too rapidly
  for the PHS to develop a detailed study of the
  pandemic
• After the pandemic, they developed a map with
  approximate dates of the outbreak

9

• Credit Office of the Public Health Service
  Historian

10
Effects on Healthcare System

• Healthcare facilities would be overwhelmed
  including shortage of
• hospital staff
• beds
• ventilators
• supplies

11
Healthcare Worker Demands

• Healthcare will be affected since healthcare
  workers will be ill, too
• (including first responders, nurses, physicians,
  pharmacists, technicians and aides, building
  maintenance, security and administrative
  personnel, social workers, laboratory employees,
  food service, housekeeping, and mortuary
  personnel)

12
Healthcare Facility Demands

• Healthcare will be affected since healthcare
  resources will be expected to meet non-pandemic
  associated healthcare needs in a variety of
  workplace settings
• (including medical and dental offices, schools,
  physical and rehabilitation therapy centers,
  health departments, occupational health clinics,
  and prisons, free-standing ambulatory care and
  surgical facilities, and emergency response
  settings)

13
Cornerstones of Preparedness

• Cornerstones of effective pandemic influenza
  preparedness and response
• Risk Assessment
• Policy Development
• Procedure Execution

14
Each Facility is Unique

• To insure adequate preparation of healthcare
  workers
• make preparations for each facility
• collaborate with local, state, and federal
  partners
• follow related standards and guidelines
  

15
Specific Areas for Planning

• Infection Control Plans
• Risk Communication Tools
• Self-triage
• Instructions for Home Care of Flu Patients
• Diagnosis and Treatment of Staff During a
  Pandemic
• Technical Information Available Through Internet
  Sources
• Supply Checklists

16
Permission of Gary Brookins and the Richmond
Times-Dispatch
17
Summit for Pandemic Planning

• January 12, 2006
  Pandemic planning summit
• The state of West Virginia
• HHS and other federal agencies
• Public health officials
• Emergency management and response leaders

18
North America

• The United States Northern Command has a role in
  protecting our health
• Resources are available at their website
• Information Sheet
• Personal Training Brief
• Readiness Guide
• Newsletter
• Department of Defense Influenza Watchboard

http//www.northcom.mil/Avian20Flu/index.html
19
PandemicFlu.gov

• State Pandemic Plans
• http//www.pandemicflu.gov/plan/states/stateplans
  .html
• Site contains list of pandemic plans that are
  currently available on state websites

20
WV Pandemic Planning

• Agreement - WV U.S. Dept. of Health and Human
  Services
• January 12, 2006 HHS Secretary Mike
  Leavitt and Governor Joe Manchin III signed a
  Planning Resolution detailing HHSs and West
  Virginia's shared and independent
  responsibilities for pandemic planning

21
WV for Pandemic Planning

• WV Federal Funding - 2006
• 940,502 - Phase One funding from U. S. Dept. of
  Health and Human Services (HHS) for pandemic
  planning activities
• 1,688,192 - revised Phase Two of Health and
  Human Services local and state allocations
• 620,408 - awarded to help strengthen the state's
  capacity to respond to a pandemic influenza
  outbreak.

22
WV Agencies Involved in Planning

• Bureau for Public Health
• Health and Human Resources
• WV Department of Military Affairs and Public

23

• WV Pandemic Flu Website
• http//www.wvflu.org/
• West Virginia Bureau for Public Health - Threat
  Preparedness505 Capitol Street Suite 200
  Charleston, WV 25301Phone [phone] ext.
  2005 Fax [phone]

24
(No Transcript)
25
WV Pandemic Flu Brochure
26
Influenza
27
Influenza - History

• Clinical Background
• Three pandemics in the 20th Century
• Three types A, B, C
• Only Type A influenza viruses cause pandemics
• Influenza A virus variations
• Virulence
• Infectivity to specific hosts
• Modes of transmission
• Clinical presentation of infection

28
Influenza Type A Subtypes

• Only Type A is divided into subtypes
• Based on presence of two viral surface proteins
  (antigens)
• Hemagglutin (H)
• Neuraminidase (N)
• Number of surface proteins identified in
  influenza A viruses
• 16 hemagglutinin
• 9 neuraminidase

29
Pandemic Subtypes

• In the 20th Century, 3 different subtypes have
  caused pandemics
• H1N1
• H2N2
• H3N2
• Subtypes are designated as H protein type (1-16)
  solely, OR followed by the N protein type (1-9)

30
Terminology

• Avian (bird) flu is caused by influenza A viruses
  that occur naturally among birds
• Different subtypes of these viruses exist because
  of changes in certain proteins on the surface of
  the influenza A virus and the way the proteins
  combine
• hemagglutinin HA
• neuraminidase NA
• Each combination represents a different subtype
• All known subtypes of influenza A viruses can be
  found in birds
• The avian flu currently of concern is the H5N1
  subtype

31
H5N1 Virus

• H5N1
• spreading rapidly
• first appeared in Asia
• epizootic (an epidemic in nonhumans)
• panzootic (affecting animals of many species,
  especially over a wide area)
• killing tens of millions of birds
• spurring the culling of hundreds of millions of
  birds to stem its spread
• Most references to "bird flu" and H5N1 in the
  popular media refer to this strain

http//en.wikipedia.org/wiki/H5n1
32
Seasonal Influenza

• Refers to periodic outbreaks of acute onset viral
  respiratory infection caused by circulating
  strains of human influenza A and B viruses
• Between 520 percent of the population may be
  infected annually
• Most people have some immunity to the currently
  circulating strains of influenza virus
• Thus, the severity and impact of seasonal
  influenza is substantially less than during
  pandemics

33
Avian Influenza Bird Flu

• Caused by type A influenza viruses that infect
  wild birds and domestic poultry
• Some forms of the avian influenza are worse than
  others
• Generally divided into two groups
• low pathogenic avian influenza
• highly pathogenic avian influenza

34
Low Pathogenic Avian Influenza

• Naturally occurs in wild birds and can spread to
  domestic birds
• In general, poses little threat to human health
• Has the potential to mutate into highly
  pathogenic avian influenza and is, therefore,
  closely monitored

35
High Pathogenic Avian Influenza

• Can spread rapidly
• Has a high death rate in birds
• H5N1
• now rapidly spreading in birds in some parts of
  the world
• one of the few avian influenza viruses to have
  crossed the species barrier to infect humans
• the most deadly of those viruses that have
  crossed the barrier

36
Humans and H5N1

• Most cases of H5N1 infections in humans have
  resulted from contact with infected poultry or
  surfaces contaminated with secretion/excretions
  from infected birds
• Spread of H5N1 from person to person has been
  limited to rare, sporadic cases
• H5N1 does not commonly infect humans
• In humans, there is little or no immune
  protection against H5N1
• (Information from November 2006)

37
Influenza Pandemic Patterns

• Many scientists believe that since no pandemic
  has occurred since 1968, it is only a matter of
  time before another pandemic occurs
• A pandemic may occur in waves of outbreaks with
  each wave in a community lasting 8 to 12 weeks
• One-to-three waves may occur

38
Critical Response Elements

• Rapid detection of unusual influenza outbreaks
• Isolation of possible pandemic viruses
• Immediate notification of national and
  international health authorities

39

• URL http//www.who.int/en/
• WHO is the directing and coordinating authority
  for health within the United Nations system.
  It is responsible for providing leadership on
  global health matters, shaping the health
  research agenda, setting norms and standards,
  articulating evidence-based policy options,
  providing technical support to countries and
  monitoring and assessing health trends.
• WHO URL for Avian Influenza http//www.who.int/top
  ics/avian_influenza/en/

40
Public Health Map/GIS Map Library
World Areas reporting confirmed occurrence of
H5N1 avian influenza in poultry and wild birds
between January and June 2007
41
Public Health Map/GIS Map Library
World Areas reporting confirmed occurrence of
H5N1 avian influenza in poultry and wild birds
Since 2003, status as of Dec. 7, 2007 (latest
available update)
42
WHO Pandemic Alert Response System

• URL http//www.who.int/csr/en/
• Purpose The world requires a global system that
  can rapidly identify and contain public health
  emergencies and reduce unneeded panic and
  disruption of trade, travel and society in general

43
WHO Pandemic Alert System

• Phase 1 2
• The Inter-Pandemic Period
• There is a novel influenza A virus in animals but
  no human cases have been observed
• Phase 2 indicates that an animal influenza
  subtype that poses a risk to humans has been
  detected

44
WHO Pandemic Alert System

• Phase 3, 4 5
• The Pandemic Alert Period
• A novel influenza virus causes human infection
  with a new subtype, but does not exhibit
  efficient and sustained human-to-human
  transmission

45
WHO Pandemic Alert System

• Phase 6
• The Pandemic Period
• A new influenza A virus develops the capacity for
  efficient and sustained human-to-human
  transmission in the general population
• The WHO declares that an influenza pandemic is in
  progress

46
Sentinel Provider Network

• Operated by the CDC (Centers
  for Disease Control and Prevention
• URL http//www.cdc.gov/

47
CLINICALDIAGNOSIS
48
Clinical Presentation of Influenza

• Varies from no symptoms at all in seasonal
  influenza to fulminant (fully symptomatic)
  disease in pandemic strains that result in severe
  illness and death (even among previously healthy
  adults and children)

No Symptoms --------------------- gt Fulminant
49
Clinical Diagnosis

• Clinical Diagnosis of Seasonal Influenza
• sudden onset of fever
• respiratory illness
• muscle aches
• headaches
• nonproductive cough
• sore throat
• runny nose
• ear infections
• gastrointestinal symptoms

50
Accuracy of Diagnosis

• It has been reported that the use of the
  influenza-like case definition is
• 63 to 78 accurate in identifying
  culture-confirmed cases of influenza
  (a sensitivity of 63 to 78)
• 55 to 71 accurate in excluding influenza
  (specificity of 55 to 71)

51
Clinical Signs Symptoms

• Sensitivity - The likelihood of a clinical sign
  or symptom to accurately detect influenza
  infection in a group of patients
• Specificity - The likelihood of a clinical sign
  or symptom to exclude influenza infection in a
  group of patients who do not have influenza

52
Laboratory DiagnosisSeasonal Influenza

• Seasonal Influenza
• Commercial rapid testing can detect seasonal
  influenza virus in less than 30 minutes
• Some tests not very sensitive
• False negative results are common
• Not all of these tests can distinguish between
  influenza A and B viruses
• HHS/CDC Influenza Laboratory Diagnostic
  Procedures
• http//www.cdc.gov/flu/professionals/labdiagnosis.
  htm

53
Clinical DiagnosisPandemic Influenza

• Patients will likely have clinical signs and
  symptoms similar to seasonal influenza
• Clinical presentation and course of illness may
  be severe in a higher percentage of the cases of
  pandemic influenza

54
Laboratory Diagnosis Avian Influenza

• HHS/CDC developed a 4-hour RT-PCR assay to
  detect gene coding for H5 surface protein of
  Asian lineage of the highly pathogenic H5N1 avian
  influenza virus
• RT-PCR reagents distributed to approximately 140
  designated laboratories of the Laboratory
  Response Network (LRN)
• Laboratories located in all 50 states

55
Modes of TransmissionSeasonal Influenza

• 1- Droplet Transmission
• coughing, sneezing, or talking
• therapeutic manipulations i. e. suctioning or
  bronchoscopy
• 2 - Airborne Transmission
• disseminated by air currents to susceptible
  individuals
• can travel significant distances
• penetrate deep into the lung to the alveoli
• can establish an infection
• 3 - Contact Transmission
• Direct contact - touching skin-to- skin

56
Modes of TransmissionPandemic Influenza

• Transmission - Past Pandemics
• Person-to-person
• Airborne
• Transmission - Future Pandemics
• May be possible by
• contact with blood
• CSF (cerebrospinal fluid)
• feces
• respiratory secretions
• mucous membranes of the eye

57
Treatment and PreventionSeasonal Influenza

• Antiviral medications
• Vaccinations
• Intranasal live attenuated vaccine
• Injectable, inactivated trivalent vaccine

58
Treatment and PreventionPandemic Influenza

• Antiviral medications
• HHS recommends use of neuraminidase inhibitors
  zanamivir and oseltamivir because of influenza
  resistance to amantadine and rimantadine

59
Poster

• A printable poster on the sequences for putting
  on and taking off PPE, which can be used for
  employee training and can be posted outside
  respiratory isolation rooms, is available at
  http//www.cdc.gov/ncidod/sars/ic.htm

60
Patient Screening Plan

• Screen all patients for influenza-like illness
• Routinely implement strategies

61
Surveillance ActivitiesHealthcare Workers

• Keep a register of healthcare workers who have
• provided care for pandemic influenza-infected
  patients
• recovered from pandemic influenza
• Encourage self-reporting by symptomatic
  healthcare workers
• Exclude symptomatic healthcare workers from duty

62
EpidemicRespiratoryInfection

• Six levels of alert corresponding to the type of
  transmission, the location of the cases, and the
  presence and type of cases at a particular
  medical center

63
Alert Levels

• Determined by Readiness Committee
• use matrix and data collected through
  surveillance activities
• Can be upgraded (or downgraded) by the committee
  depending on
• number of cases
• other compelling circumstances
• At each level of alert Readiness Committee will
  consider implementing certain actions
• As level of alert becomes higher, additional
  actions are added to actions initiated at lower
  level

64
Level READY

• Baseline activities to ensure preparedness in the
  absence of known active epidemic of ERI in the
  world
• ERI
• Epidemic
• Respiratory
• Infection

65
Level GREEN

• Confirmed efficient human-to-human transmission
  of potentially epidemic contagious respiratory
  infection present outside the U.S. and bordering
  countries (Canada and Mexico)

66
Level YELLOW

• Confirmed human-to-human transmission of
  potentially epidemic contagious respiratory
  infection (ERI) documented in the U.S. or
  bordering countries (Canada or Mexico)

67
Level CONTROLLED ORANGE

• A case of ERI has been diagnosed at a particular
  medical center or in an inpatient at a medical
  center but there has been no documented
  nosocomial or community spread from this person
  to others

68
Level ORANGE

• There is evidence of nosocomial transmission of
  ERI from known infected patients to other
  patients, employees, or visitors at a particular
  medical center, OR there is human-to-human
  transmission in specified region, or nearby

69
Level RED

• There is evidence of untraceable or uncontrolled
  nosocomial transmission of ERI
• OR there is widespread human-to-human
  transmission in a particular region or nearby

70
Epidemic Respiratory Infections

• Patient Flow
• This chart shows possible patient responses to
  risk factor screening questions

71
ERI Outpatient Management Protocol

• For patients with new cough and risk factors
  associated with epidemic respiratory infection
  (ERI)
• Key points
• Give patient a mask
• Require PPE for anyone visiting patient
• Evaluate risk factors

• Consult with physician
• Move patient to room with negative air pressure
• Administer tests
• Coordinate medical followup if patient is
  released
• Activate ERI plan if patient is admitted

72
PrinciplesCare of ERI Patients

• Minimize Health Care Workers (HCW) contact with
  the patient
• Protect HCWs during contact with patient
• Minimize opportunities for exposure to other
  patients or visitors

73
ERI Inpatient Management Protocol

• This plan will be put into effect when a patient
  is believed to
• meet the criteria for an Epidemic Respiratory
  Infection by one of the Infectious Disease
  Physicians, and
• needs hospitalization

74
Self-Triage

• Question You may have influenza
• When should you seek additional help from a
  healthcare provider?

75
Home Care Guide for Influenza

• Common symptoms
• Supplies to have on hand
• Caring for a person with influenza
• When to seek additional medical advice

76
Symptom and Care Log for Home Care

• Copy, fill out, and bring log sheets to
  healthcare provider visits

77
Influenza Diagnostic Table

• This table contains references for diagnosis and
  treatment of staff during an influenza pandemic
• Please refer to www.pandemicflu.gov or
  http//www.pandemicflu.gov/vaccine/testing
  for current information and recommendations

78
Planning Checklists and Example Plans

• Many government and private organizations have
  developed viable resources including
• planning checklists
• example plans
• communication plans

79
Assistance Available from

• Safety and Health Program Management Guidelines
• Management leadership and employee involvement
• Worksite analysis
• Hazard prevention and control
• Safety and health training

80
INFECTIONCONTROL
81
Infection Control

• Use same strategies implemented for any
  infectious agent
• facility and environmental controls
• engineering controls
• standard operating procedures
• administrative controls
• personal protective clothing and equipment
• safe work practices

82
Standard Precautions

• Apply to
• blood
• all body fluids, secretions, and excretions
  except sweat, regardless of whether or not they
  contain visible blood
• non-intact skin
• mucous membranes

83
First, Conduct Risk Assessment

• Conduct to determine necessary PPE and work
  practices to avoid contact with blood, body
  fluids, excretions, and secretions
• Will help to customize standard precautions to
  the healthcare setting of interest

84
Next, Implement Procedures

• Include
• Gloves and facial (nose, mouth, and eye)
  protection
• Hand hygiene before and after patient contact,
  and after removing gloves or other PPE
• Handling and disinfection of patient care
  equipment, patient rooms, and soiled linen

85
Then, Use Precautions

• Contact Precautions
• Use PPE, dedicated patient care equipment,
  limitation of patient movement, private rooms
• Droplet Precautions
• Use surgical masks within 3 feet of a patient
• Airborne Precautions
• Place patient in a negative pressure room and
  follow associated precautions

86
Compliance with Infection Control

• Weak Links
• Adherence to hand hygiene
• Consistent and proper use of PPE
• Influenza vaccination of healthcare workers
• Perform serologic and other testing for pandemic
  influenza on healthcare workers with
  influenza-like illness and who have had likely
  exposures to pandemic influenza-infected patients

87
Personal Protective EquipmentGloves

• HHS recommends the use of gloves when there is
  contact with blood and bodily fluids, including
  respiratory secretions
• latex
• vinyl
• nitrile
• other synthetic materials

88
Personal Protective EquipmentGowns

• Healthcare workers should wear an isolation gown
  when clothes will come into contact with blood or
  other bodily fluids (respiratory secretions)
• during procedures such as intubation
• when closely holding a pediatric patient
• Isolation gowns can be
• disposable and made of synthetic material
• reusable and made of washable cloth

89
Personal Protective EquipmentGoggles/Face Shields

• Wear goggles and/or face shields if
• sprays or splatters of infectious material are
  likely
• if a pandemic influenza patient is coughing
• For additional information about eye
  protection for infection control, visit NIOSHs
  website at http//www.cdc.gov/niosh/topics/eye/
  eyeinfectious.html

90
Personal Protective EquipmentRespiratory
Protection

• Comply with OSHAs Respiratory Protection
  standard (29 CFR 1910.134) to achieve high levels
  of protection
• All respirators used by employees are required to
  be tested and certified by NIOSH
• For a list of all NIOSH-certified respirators
  (the Certified Equipment List), see
  http//www.cdc.gov/niosh/celintro.html

91
Personal Protective EquipmentNIOSH-Certified
Respirators

• NIOSH-certified respirators are marked with the
• manufacturers name
• part number
• protection provided by the filter (e.g., N95)
• NIOSH
• This information is printed on the
• facepiece
• exhalation valve cover, or
• head straps
• If a respirator does not have these markings and
  does not appear on the Certified Equipment List,
  it has not been certified by NIOSH

92
Required Elements of an OSHA Respirator Program

• 1. Selection
• 2. Medical evaluation
• 3. Fit testing
• 4. Use
• 5. Maintenance and care
• 6. Breathing air quality and use
• 7. Training
• 8. Program evaluation

93
Filtering Facepiece
A negative pressure particulate respirator with a
filter as an integral part of the facepiece OR
with the entire facepiece composed of the
filtering medium.
3M 1870 - P2 / N95 Flat Fold Respirator Health
Care Mask
94
Medical Evaluation

• If these masks are required, then
• Provide a medical evaluation according to the
  OSHA standard
• Required to determine employees ability to use a
  respirator before fit testing and use
• Identify a PLHCP
• Required to perform medical evaluations using a
  medical questionnaire OR an initial medical
  examination that obtains the same information

95
PLHCP
Physician or Other Licensed Health Care
Professional An individual whose legally
permitted scope of practice (i.e., license,
registration, or certification) allows him / her
to independently provide, or be delegated the
responsibility to provide, some or all of the
health care services required by paragraph (e)
Medical evaluation
96
Medical Evaluation

• Medical Evaluation
• Must obtain information requested by
  questionnaire in Sections 1 and 2,
  Part A of Appendix C
• Follow-up medical examination
• Required for employee who gives a positive
  response to any question among questions 1
  through 8 in Section 2, Part A of App. C OR
  whose initial medical examination demonstrates
  the need for a follow-up medical examination

97
OSHA Respirator Medical Evaluation
Questionnaire Page 1 of 10
98
Medical Evaluation

• Annual review of medical status is not required
• At a minimum, employer must provide additional
  medical evaluations if
• Employee reports medical signs or symptoms
• PLHCP, supervisor, or program administrator
  indicates an employee needs to be reevaluated
• Change occurs in workplace conditions that may
  increase the burden on an employee

99
Fit Testing

• Employees using tight-fitting facepiece
  respirators must pass an appropriate qualitative
  fit test (QLFT) or quantitative fit test (QNFT)
• prior to initial use
• whenever a different respirator facepiece (size,
  style, model or make) is used, and
• at least annually thereafter

100
Fit Testing
The respirator used for fit testing MUST be the
same make, model, style, and size of respirator
that will be used by the employee.
101
Quantitative Fit Test - QNFT

• An assessment of the adequacy of respirator fit
  by numerically measuring the amount of leakage
  into the respirator.
• QNFT Protocols
• Generated Aerosol
• (corn oil, salt, DEHP)
• Condensation Nuclei Counter
• (PortaCount)
• Controlled Negative Pressure
• (Dynatech FitTester 3000)

102
Qualiitative Fit Test - QLFT

• A pass/fail fit test to assess the adequacy of
  respirator fit that relies on the individuals
  response to the test agent.
• Isoamyl acetate
• Saccharin
• Bitrex
• Irritant smoke

Saccharin Fit Test Kit
103
Training and Information

• Employees who are required to use respirators
  must be trained such that they can demonstrate
  knowledge of at least
• why the respirator is necessary
• limitations and capabilities of the respirator
• effective use in emergency situations
• how to don the respirator
• How to perform user seal check (each time)
• recognition of medical signs and symptoms
• Proper disposal of the respirator

104
Personal Protective EquipmentPutting on and
Removing PPE

• HHS/CDC recommends that personal protective
  equipment be put on in the following order
• Gown
• Respirator (or mask, when appropriate)
• Face shield or goggles
• Gloves
• Upon leaving the room, HHS/CDC recommends that
  PPE be removed in a way to avoid
  self-contamination, as follows
• Gloves
• Faceshield or goggles
• Gown
• Respirator or mask

105
User Seal Check

• Check the seal each timeyou don the respirator
• Place one or both hands completely
• over the middle panel
• Inhale and exhale sharply
• If air leaks around your nose, readjust the
  nosepiece
• If air leaks between the face and face seal of
  the respirator, reposition it and adjust straps
• If you cannot achieve a proper seal, do not enter
  the contaminated area
• See your supervisor

106
Time / Use Limitation

• If the respirator becomes damaged, soiled, or
  breathing becomes difficult, leave the
  contaminated area and replace the respirator
• Wear a respirator only once
• Remove and dispose of a respirator in an
  appropriate trash receptacle
• Upon re-entry, don a new respirator

3M 1860 N95 HEALTH CARE RESPIRATOR
107
Healthcare Respirator

• NIOSH approved as an N95 particulate filter
  respirator
• Designed to be fluid resistant to splash and
  spatter of blood and other infectious materials
• Intended for use against both mechanically
  generated particulates and thermally generated
  fumes, plumes and smokes
• Applications include
• OR Laser Surgery
• Electrocautery
• Other powered medical instruments
• Exposure to Mycobacterium tuberculosis
• Aerosol droplet transfer, e.g. working with
• SARS patients
• Dental care where aerosol and particle
• exposures are possible
• Aerosols created during use and manipulation of
  chemotherapy solutions
• Removal of casts or other dust producing activity

3M Health Care Particulate Respirator and
Surgical Mask 1870
108
Healthcare Respirator

• Filter efficiency level 95 or greater against
  particulate aerosols free of oil
• Fluid resistant
• Disposable
• May be worn in surgery
• Fits a wide range of face sizes
• Meets CDC guidelines for Mycobacterium
  tuberculosis exposure control

3M Health Care Particulate Respirator and
Surgical Mask 1860
109
Healthcare Respirator

• NIOSH approved as an N95 particulate filter
  respirator
• Intended for use by operating room personnel and
  health care workers
• Meets CDC guidelines for TB control
• Helps protect patients and health care workers
  from the transfer of microorganisms, blood and
  bodily fluids

Kimberly-Clark Fluidshield PFR95 N95 Particulate
Filter Respirator and Surgical Mask
110
Healthcare Respirator

• Moldex 3200 Series N95 Particulate Respirators
• Both an N95 respirator and surgical mask
• Latex free
• First and only NIOSH-approved single strap N95
  respirator
• Meets CDC guidelines for TB exposure control
  standards

Moldex 3200 Series N95 Particulate Respirator
111
SUMMARY

• This course has covered
• Definition of Pandemic Influenza
• Transmission Routes
• Clinical Diagnosis
• Control
• Prevention

112
Questions?