“Respiratory Protection for
Public Health Workers”
Infectious Diseases Division
Public Health Initiatives Branch
Department of Public Health
State of Connecticut
Acknowledgement
This presentation is a revision of a training prepared by
Anne Bracker, MPH, CIH
University of Connecticut Health Center
Division of Occupational and Environmental Medicine
Farmington, CT
Learning Objectives
• Describe respiratory hazards and
prevention methods
• Describe key types of respirators, their
indications, and limitations
• Describe proper methods of donning,
discarding, and storing N 95 masks
• Identify three key steps in the ID Section
Respiratory Protection plan
• List the steps in the fit testing procedure
Pathogen transmission routes: ID Section employee exposures
Person- toPerson
transmission
Routes
Aerosol
anthrax
smallpox
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Respiratory
droplets
Fomites
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Environmental
surfaces
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plague
Food/ water
Blood/ Fecal/
Urine
Respiratory Protection
influenza
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tularemia
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SARS
botulism
TB
VHF
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Control
• What is the pathogen, source?
• What is the route of exposure?
• How can the exposure pathway be
interrupted?
Respiratory transmission:
What is the route of exposure?
• Direct contact with mucous membranes
• Inhalation if aerosolized
How can the pathways be
interrupted
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Isolate or remove the source
Minimize the opportunities for transmission
Observe good hygiene
Make the unexposed individuals less vulnerable
Wear protective equipment
Isolate the sourceinfected people
(if person to person)
• Isolation- separate the ill in health care facilities
with isolation rooms
(community screening: temperature and symptom monitoring)
• Cough Etiquette –
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Cover the nose/mouth when coughing or sneezing.
Use tissues to contain respiratory secretions.
Dispose of tissues in the nearest waste receptacle
after use.
Perform hand hygiene after contact with respiratory
secretions and contaminated objects/materials.
During transport- use surgical masks or respirators
without exhalation valves.
Minimize the opportunities for
transmission
• Physical separation - separate presumed
exposed (and possibly infectious) from
unexposed
– Talk over the phone
– Talk through the door
Make the Unexposed Population
Less Vulnerable
• Vaccines
– Availability and distribution
– Effectiveness
– Supply
– Rely on more than one method of protection
Observe good hygiene
Hand hygiene
Avoid touching contaminated surfaces
Routinely clean contaminated surfaces
Infection Control Precautions
• Standard
• Transmission-based
–contact
–droplet
–aerosol
Respiratory Protection
• Purpose – protect from inhalation of
infectious aerosols (e.g.,
Mycobacterium tuberculosis), droplet
nuclei
• PPE types for respiratory protection
– Particulate respirators
– Half- or full-face elastomeric respirators
– Powered air purifying respirators (PAPR)
CDC: PPE Use in Healthcare Settings
Respirator type selection
Atmosphere Supplying
Air purifying
• Tight or loose fitting
• Clean the air- filters or chemical
cartridges
• Different protection factors
• Not for certain environments:
Robert Swanson www.internet-esq.com
– Immediately Dangerous to Life and Health
(IDLH),
– O2 deficient, or
– Other hazardous agents
The N95 Respirator
N:
95:
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not resistant to oil
95% efficient for 0.3
micron particles
Filter penetration
Protection factor
Fit testing
Re-use/Reaerosolization
Rengasamy et al (2004) AJIC
Surgical masks are not respirators
appropriate for cough etiquette & protection
from respiratory droplets (not aerosols)
N95 respirator features:
Which N95 respirators will you select?
• Exhalation valves
• Latex free, or not
• Nose Clips
• Prior successful fit
How to Don a Particulate
Respirator
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Select a fit tested respirator
Place over nose, mouth and chin
Fit flexible nose piece over nose bridge
Secure on head with elastic
Adjust to fit
Perform a fit check –
– Inhale – respirator should collapse
– Exhale – check for leakage around face
PPE Use in Healthcare Settings
Removing a Particulate
Respirator
• Lift the bottom
elastic over your
head first
• Then lift off the top
elastic
• Don’t touch the
mask filter
• Discard
PPE Use in Healthcare Settings
Where to Remove PPE
• Gowns, gloves at doorway, before
leaving patient room or in anteroom*
• Remove respirator outside room, after
door has been closed*
* Ensure that hand hygiene facilities are available at
the point needed, e.g., sink or alcohol-based hand
rub
CDC: PPE Use in Healthcare Settings
Hand Hygiene
• Perform hand hygiene immediately after
removing PPE.
– If hands become visibly contaminated during PPE
removal, wash hands before continuing to remove
PPE
• Wash hands with soap and water or use
an alcohol-based hand rub
* Ensure that hand hygiene facilities are available at
the point needed, e.g., sink or alcohol-based hand
rub
CDC: PPE Use in Healthcare Settings
Problems while wearing:
Words of Wisdom
To avoid exposure to the pathogen,
adjust or change respirator
outside the area of possible
exposure
Medical signs and symptoms
that limit or prevent respirator
use
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Wheezing
Shortness of breath
Dizziness
Chest pain
Discomfort wearing the respirator
The most important point!
If the risk agent (the pathogen)
is unknown or you do not know
whether the N95 protects, do
NOT enter the area!
Respiratory Protection
(OSHA:1910.134)
•
Written Respiratory Protection Program
elements;
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Hazard analysis
Selection
Medical Evaluation
Fit Testing
Use
Maintenance
Training
Evaluation
Recordkeeping
Written Respirator Program
Purpose and Scope
• Purpose - ensure that all health
department employees are protected from
person-to-person transmission of
infectious inhalational agents
• Covers employees identified as having risk
in the plans Hazard Assessment (first step
in the plan)
How to get a copy of the plan
• Accessible via:
– U drive
– Respiratory Program Administrator (Rich
Melchreit for ID Section)
Hazard assessment
• Assessment/hazard analysis
– Part of the respiratory protection plan
• Anticipated employee risk during routine work and
emergencies
• Identifies which employees should be issued
respiratory protection
– Out in the field
• Employee anticipates risk
– Unknown hazards, and avoid the location, or
– Need to don the respirator
Medical Evaluations
(before respirator use or fit testing)
• Employee completes mandatory medical evaluation questionnaire
• Questionnaire is reviewed by a Physician or Licensed Health Care
Provider (PLHCP) at UCHC to determine the employee’s ability to
wear the N95 respirator
• The PLHCP completes a clearance review form and sends copies to
DPH and employee
Training
• Respiratory hazards
• Respirators:
– choice
– proper use:
• donning
• removing
– limitations on their use
• Maintenance
Fit Testing (annual) and Use
• Qualitative or Quantitative
Methods
• Features which
compromise fit
Beard growth
Improper donning
Humidity, Sweat
Work Practices
Facial disfigurement
Eye glasses
Excessive weight gain or loss
Failure to complete a fit check
 Other considerations:
• Should/could/would the N 95s be reused?
• Not likely unless in short supply
• If so, likely advice will be to cover them with a surgical
mask
• How should I store my personal respirators ?
– Rigid tub
– Zip lock plastic bag (temporarily) with air holes
– Label with your name
• Discard after use?
– Discard in medical waste or sealed in plastic bag (no
holes) in trash
Program Evaluation and
Record Keeping
• Kept at UCHC
– Medical evaluations
• Kept at DPH
– Plan (U drive/Branch Office Folder - Public Health
Initiatives/Fit Testing Program/fit testing written
program dph 02-02-09.doc, and with the RPA)
– Employee tracking spreadsheet
– TRAINing data
– Fit testing evaluations
• Kept by staff person
– Laminated wallet cards
Fit Testing protocol:
• Very specific protocol and instructions
• Sensitivity
– Equipment
• Hood
• Sprayer
– Taste test (saccharin or bitrex® for N95)
• Fit test proper
– Choose mask
– Don mask (while wearing eyeglasses or anticipated “protective
ware”) and check for coverage and user comfort
– Don hood
– Spray of test solution, check for taste
– Go through the “paces”
• Heavy breathing
• Move head
• Talk