Respirator Guidance

1
Respirator Guidance

• Michael A. Yarnell
• Compliance Assistant
• HCFMSNJ April 16, 2009

2
Planning

• Consider risk of exposure
• Very high, High, Medium, Low
• Apply hygiene and social distancing
• Use engineering and procedural changes
• Personal protective equipment (PPE)
• Pros and cons of different types
• Stockpiling and cost

3
Exposure Risk

• Very high HCP performing aerosol generating
  procedures or collecting samples on known or
  suspect patients
• High HCP exposed to, transporting or performing
  autopsies on these patients
• Medium High frequency contact with the general
  population
• Low Occupational-only contact

4
Estimating Exposure Risk

• Assess risk for each job classification and work
  task
• Estimate the number of employees in each category
• Estimate length of time of exposure mitigated
  event will occur in two waves, each of 12 weeks
  in duration

5
Other Controls

• Hygiene
• Cleaning hands
• Decontaminating surfaces
• Social distancing
• Reduce frequency, proximity and duration of
  contact with customers, employees and the general
  public

6
PPE

• A respirator reduces employee exposure to
  airborne contaminants
• Usually has a tight face-to-facepiece seal
• Fit testing and respirator program needed
• A facemask is a physical barrier to prevent
  contact with splash and large droplets, also
  prevents the wearer from expelling droplets
• Not designed to prevent inhalation of small
  airborne particles

7
Types of Respirators

• Typical for the health care industry
• Filtering facepieces
• N 95
• N95 with exhalation valve
• Surgical respirator
• Elastomeric facepiece
• Powered air-purifying respirator

8
Filtering Facepieces

• Facepiece is comprised of filter material
• Filtration is certified 95, 99, 100
• Disposable
• Some have an exhalation valve
• Reduces breathing resistance and moisture
  buildup increases tolerance and comfort
• Will not protect others
• Surgical model combines advantages of a
  respirator and a face mask

9
Cons

• Should be disposed of after use or when
  soiled/physically damaged
• Data on reuse after exposure not available
• May cause shortages in a pandemic
• Must be fit tested
• Cannot be worn with facepiece seal impediments
  (facial hair, scars)
• Harder to breathe through than a facemask
  re-breathe exhaled air

10
Elastomeric Facepiece

• Flexible rubber-like facepiece
• Filtration is certified
• Can be decontaminated and reused, filters can be
  replaced or used by others
• May be more cost effective than filtering
  facepieces for long-term use
• Full facepiece models offer eye protection and a
  higher level of respiratory protection

11
Cons

• Requires cleaning and disinfection between uses
• Must be fit tested
• Cannot be worn with facepiece seal impediments
  (facial hair, scars)
• Harder to breathe through than a facemask
• May interfere with voice communication

12
Powered Air

• High level of protection
• Filtration efficiency certified
• Can be decontaminated and reused or used by
  others, filters are replaceable
• Greatest ease of breathing little or no
  resistance
• Hooded models do not depend on a
  face-to-facepiece seal
• Certain models offer eye protection

13
Cons

• Requires cleaning between uses
• Fan noise can make communication difficult
• Significantly more expensive than other
  respirators (400 to 1200)
• Battery can be heavy

14
Stockpiling

• For the duration of the event, high risk
• Disposable N95 respirators - 240 per employee
• Reusable elastomeric respirators - 40 per
  employee
• Shared PAPRs by 4 employees per shift - 330 per
  employee
• Does not consider other costs (cleaning,
  fit-testing)