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)