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Unit 7.1. Respiratory protection TB Infection Control Training for Managers at National and Subnational Level

Unit 7.1. Respiratory protection TB Infection Control Training for Managers at National and Subnational Level. Objectives. After this unit, participants will be able: To describe the differences between a surgical mask and a respirator

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Unit 7.1. Respiratory protection TB Infection Control Training for Managers at National and Subnational Level

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  1. Unit 7.1. Respiratory protectionTB Infection Control Training for Managers at National and Subnational Level

  2. Objectives After this unit, participants will be able: • To describe the differences between a surgical mask and a respirator • To name the types of respirators that protect against TB transmission, and when to use them • To list the elements of a respiratory programme

  3. Outline • WHO recommendations • Surgical mask vs. particulate respirator • Respirator standards • Respirator programme • Proper use • Fit testing

  4. WHO recommendations • When used with administrative and environmental controls, particulate respirators may provide health care workers (HCW) additional protection from TB • Respirators • Must meet or exceed standards • Be properly used • Be part of a training programme

  5. WHO recommends particulate respirators for HCWs: • Caring for patients with confirmed or suspected infectious TB (in particular MDR-TB) • Performing aerosol-generating procedures on infectious TB patients • Bronchoscopy, intubation, sputum induction • Use of high speed devices for lung surgery or autopsy

  6. Surgical masks • Reduce the spread of microorganisms from the wearer to others, by capturing large wet particles • Do not protect the wearer from inhaling small infectious aerosols.

  7. Particulate respirators • Protect the wearer from inhaling droplet nuclei • Filter out infectious aerosols • Fit closely to the face to prevent leakage around the edges

  8. Surgical masks(yes for patients)

  9. Surgical masksdo not protect staff from TB

  10. Particulate respirators used for TB exposure N95 (USA) Filter out >95% of particles FFP2, FFP3 (Europe) Filter out > 94-98% of particles

  11. USA standards* *National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC)

  12. European standards* *Comité Européen de Normalisation (CEN) (European Committee for Standardization)

  13. CEN standards • Total inward leakage • Initial filter penetration NaCL Paraffin oil <20%=P1 NA=P1 < 6%=P2 <2%=P2 < 3%=P3 <1%=P3 • Maximum breathing resistance • Loading test

  14. Air-purifying respirators Remove specific air contaminants by passing ambient air through the air-purifying filter, cartridge or canister

  15. Negative pressure respirators • air pressure inside the facepiece is negative during inhalation • contaminated air can avoid the higher-resistance filter and leak in through gaps in the face seal

  16. Types of air purifying respirators Non–powered (negative pressure) Powered air-purifying respirators (PAPR) • A blower draws air through the filter and blows it into the face piece • Pressure inside face piece reduces face-seal leakage (offers more protection) • Loose fitting PAPRs can be used for people that cannot achieve an adequate seal

  17. Respirator programme elements • Person assigned responsibility • Written procedures • Medical evaluation • Training • Selection of respirators • Fit testing • Maintenance • Programme evaluation

  18. Why is fit testing necessary? • Ensure a proper seal between respirator and wearer • Determine appropriate make/model • Determine appropriate size

  19. When should fit testing be done? Employees should pass a fit test: • Prior to initial use • Whenever a different respirator facepiece (size, type, model or make) is used • Periodically thereafter • Whenever changes in the worker’s physical condition or job description that could affect respirator fit are noticed or reported

  20. Sources of facepiece leakage • Around facepiece/skin interface • Through air-purifying element • Through exhalation valve

  21. Factors contributing to poor fit • Weight loss or gain • Facial scarring • Changes in dental configuration (dentures) • Facial hair • Cosmetic surgery • Excessive makeup • Mood of workers (smiling/ frowning) • Body movements

  22. Qualitative fit tests: • Rely on the individual’s response to the test agent to assess the adequacy of respirator fit • Are scored as pass/fail

  23. Test solutions for qualitative fit testing Four methods recognized and accepted • Isoamyl acetate • Irritant aerosol • Saccharin • BitrexTM (Denatonium benzoate)

  24. Fit tests using saccharin or BitrexTM • Can be used for all respirators (i.e. 95-, 99- and 100- series and FFP2 and FFP3) • Uses subject’s sense of taste • Requires the use of small test hood

  25. Saccharin and BitrexTM • Subject demonstrates ability to detect weak solution in the test hood • Subject dons respirator • Strong solution (~100 times) sprayed into hood • Respirator passes if subject does not taste aerosol • Assumed fit factor = 100

  26. Qualitative fit test equipment

  27. Quantitative fit tests: • Measure the amount of leakage into the respirator to assess the adequacy of respirator fit • Are scored with a number

  28. Maintenance and storage • Take care of your disposable respirator • Decontamination NO! • Cleaning NO! • Storage Clean & dry place! • Take care when re-using respirator – closely monitor service life • Inspect prior to each use • Dispose of the respirator if you question its performance

  29. Read the manufacturer’s instructions to don the respirator properly

  30. Is this respirator put on properly?

  31. Post warning sign

  32. Time to clear the air between patients

  33. Bronchoschopy room

  34. DOT room

  35. Isolation XDR-TB tent and DOT

  36. Summary • Surgical masks prevent infectious particles from being expelled by the wearer • Respirators protect the health care worker from inhaling infectious particles • When used with administrative and environmental controls, N95, FFP2 or FFP3 respirators provide additional protection when HCWs care for infectious TB patients • Whenever respirators are used, a respirator programme is necessary

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