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2. RESPIRATORY PROTECTION for TUBERCULOSIS a Health Care Worker GUIDE for RESPIRATORY PROTECTION

3. Tuberculosis is a contagious bacterial disease. Tuberculosis is spread by the respiratory route: TB bacteria contaminate droplets that get into the air when a patient with the disease speaks, coughs, or sneezes. A person breathes in these droplets from the air. If you inhale the Tuberculosis bacteria, you may get infected but not get sick with TB disease. A tuberculosis infection can be detected with a PPD (tuberculosis skin test). Tuberculosis disease is potentially severe and usually affects the lungs but may affect other organs. HCW = Healthcare Worker

4. SYMPTOMS OF TUBERCULOSIS chronic cough unexplained weight loss fever night sweats coughing up blood What is the difference between TUBERCULOSIS INFECTION and TUBERCULOSIS DISEASE? INFECTED + DISEASE INFECTED No DISEASE NOT INFECTED

5. N95 NOT INFECTED PPD NEGATIVE PPD Chest X-RAY NEGATIVE NO RESPIRATOR REQUIRED X-RAY NOT CONTAGIOUS HEALTHCARE WORKER PATIENT

6. N95 INFECTEDNO DISEASE PPD POSITIVE PPD Chest X-RAY NEGATIVE NO RESPIRATOR REQUIRED X-RAY NOT CONTAGIOUS HEALTHCARE WORKER PATIENT

7. N95 HEALTHCARE WORKER INFECTED+ DISEASE PPD POSITIVE Chest X-RAY POSITIVE RESPIRATOR REQUIRED X-RAY CONTAGIOUS

8. The FIRST STEP • in preventing the spread of TB • is to quickly identify • isolate and • treat contagious patients PREVENTION MEASURES TB patients are put in rooms with special ventilation systems BUT When you are in close contact with a contagious TB patient RESPIRATORS ARE NECESSARY TO PROTECT YOU

9. RESPIRATOR DEFINITION Respirators are protective equipment that are designed to protect the wearer against harmful airborne agents. A seal is formed between face and the respirator. A surgical mask is not a respirator Because the surgical mask does not fit tightly to the face it does not provide good protection against airborne hazards. REQUIREMENTS Wearing a respirator reduces your chances of becoming infected with TB. The Hospital Infection Control committee determines when a healthcare workermust wear a respirator. The Occupational Safety and Health Administration (OSHA) regulates the use of respirators. NIOSH approves respirators for use.

10. Respirator Types -Air purifying respirators filter out harmful agents from the air -Air supplying respirators supply clean air to the person for breathing Healthcare workers wearAIR PURIFYING respirators to protect against TB. OSHA requires the use of certified respirators when respiratory protection is needed. The National Institute for Occupational Safety and Health (NIOSH) gives each certified respirator and certification number which is usually present on the respirator or attached on an instruction sheet. AS WITH ALL PERSONAL PROTECTION EQUIPMENT RESPIRATORS MUST BE USED CORRECTLY TO PROVIDE THE HEALTHCARE WORKER WITH THE BEST PROTECTION TRAINING AND EDUCATION ARE KEY FOR YOUR PROTECTION

11. Respirator Training Procedures for selecting respirators Medical Evaluations for respirator users Fit Testing Procedures for respirator users Procedures for Proper use of respirators Procedures for Cleaning Storing Inspecting Discarding Respirators Topics to cover RESOURCES ISOLATION SIGNS for AIRBORNE PRECAUTION

12. N95 HEALTHCARE WORKER Respirator Training Procedures for selecting respirators N-95 The respirator to use when respiratory protection for Tuberculosis is needed.

13. Respirator Training Medical Evaluations for respirator users Employee Health will provide a medical evaluation to determine the HCW ability to use a respirator. This is done before the employee is fit tested or is required to use the respirator. Using a respirator may place a physiological burden on the HCW that varies with the type of respirator worn, job conditions, and medical status of the HCW. A licensed health care professional will perform the evaluation using a medical questionnaire. The contents of the medical questionnaire are mandated by OSHA. This questionnaire is administered to the HCW in a confidential manner and the HCW can request to discuss the results of the medical evaluation with the licensed health care professional. EMPLOYEE HEALTH will provide the HCW with a WRITTEN STATEMENT regarding the outcome of the MEDICAL EVALUATION.

14. Respirator Training Medical Evaluations for respirator users FOLLOW UP MEDICAL EVALUATIONS are performed: 1- if HCW reports medical signs or symptoms that are related to ability to use the respirator. 2- if the supervisor informs Employee Health of the need for re-evaluation 3- if information from the respirator program monitoring activities indicates a need for re-evaluation 4- if the workplace conditions significantly change

15. Respirator Training Fit Testing Procedures for respirator users FIT TEST procedure is done: 1- before initial use of the respirator 2- whenever a different size, style, model or make of respirator is used 3- if HCW has a change in facial structure such as: facial trauma, facial surgery, loss of body weight, or dental changes. 4- if the HCW worker notifies the employer that the respirator fit is unacceptable. 5- at least annually

16. Respirator Training Fit Testing Procedures for respirator users FIT TESTING is done using an OSHA accepted qualitative fit test procedure. HEALTHCARE WORKER puts on the RESPIRATOR -- a HOOD is applied over the head of the HCW -- sweet tasting aerosol mist is introduced into the hood -- if the seal is tight the HCW should not experience any sweet taste. The test simulates activities such as turning the head, talking, and other possible activities that might occur during job tasks. N95

17. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 1. Separate the mask to fully open 2. Gently bend the nose piece to conform the mask to face 3. Hold mask upside down to expose the two head bands 4. Separate the head bands with the index fingers 5. Cup the mask under chin - ORANGE side out 6. Bring the head bands over the head 7. Place first head band at neck - pull the second head band up and place at crown of head 8. Form nose piece across bridge of nose for tight fit

18. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 1. Separate the mask to fully open

19. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 2. Gently bend the nose piece to conform the mask to face

20. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 3. Hold mask upside down to expose the two head bands

21. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 4. Separate the head bands with the index fingers

22. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 5. Cup the mask under chin - ORANGE side out

23. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 6. Bring the head bands over the head

24. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 7. Place first head band at neck - pull the second head band up and place at crown of head

25. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR PUTTING ON THE RESPIRATOR 8. Form nose piece across bridge of nose for tight fit 8

26. N95 Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR USING THE RESPIRATOR Each time the HCW enters the contaminated area, face seal should be checked to make sure the fit is tight. Adjust the nosepiece if there is air leakage around the nose. Reposition head bands to secure facial seal around the edges of respirator. IT IS THE HEALTHCARE WORKER’S RESPONSIBILITYTO OBTAIN A PROPER FIT EACH AND EVERY TIME. IF YOU DO NOT OBTAIN A PROPER FIT, DO NOT ENTER THE ISOLATION AREA.

27. N95 HEALTHCARE WORKER Respirator Training Procedures for Proper use of respirators DIRECTIONS FOR USING THE RESPIRATOR Facial hair will make the seal loose and will not provide protection from harmful airborne hazards Even one or two days beard growth can effect the seal. Male HCWs should be clean shaven This to ensure that the respirator is fully protective.

28. Respirator Training Procedures for Cleaning Storing Inspecting Discarding Respirators

29. ISOLATION SIGN for AIRBORNE PRECAUTION Respirator Training STOP STOP An ISOLATION SIGN as this one will appear on the entrance to the patient room. Instructions for personal protective equipment are listed on the card. TAKE NOTE and FOLLOW THE INSTRUCTIONS ISOLATION PLEASE READ PRECAUTIONS BEFORE ENTERING PRECAUTIONS GLOVES GOWNS MASKS TRANSPORT ROOM AIRBORNE YES NO YES XXXX PRIVATE CONTACT YES YES NO XXXX PRIVATE DROPLET YES NO YES XXXX PRIVATE

30. RESOURCES PROGRAM ADMINISTRATOR -- Iva Jones, RN CIC INFECTION CONTROL www.osha-slc.gov/OshStd_data/1910)0134.html www.cdc.gov/nchstp/tb/pubs/corecurr.htm www.cdc.gov/niosh/tb.html American Lung Association -- 1-800-586-4872 St. Louis City Health Department -- 314-658-1128 St. Louis County Health Department -- 314-522-6410 -- 314-842-1300

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