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

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

9. Surgical masks(yes for patients)

10. Surgical masksdo not protect staff from TB

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

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

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

14. 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

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

16. 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

17. 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

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

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

20. 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

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

22. 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

23. 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

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

25. 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

26. 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

27. Qualitative fit test equipment

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

29. 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

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

31. Is this respirator put on properly?

32. Post warning sign

33. Time to clear the air between patients

34. Bronchoschopy room

35. DOT room

36. Isolation XDR-TB tent and DOT

37. 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