DR JOHN WALLAART PhD, MBA, Dip. Chem., Dip. Mgt, Dip. OH&S Mgt Protective Equipment Respiratory Protective Equipment (RPE) Presentation ANZSOM Conference 2015

Overview-RPE Respiratory Protective Equipment NOTE:ISRP History of RPE Why the increasing emphasis on RPE Why is RPE “the last line of defence?” Surgical masks? The different types of RPE Some myths that persist… Limitations of RPE in such situations as “Avian Flu” or “SARS” Practical requirements of implementing a RPE programme Changing scene-ISO and AUS/NZ standards 2015 onwards Questions! Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 Last line of defence……. The respirator But it has some real issues………………… Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 Surgical masks These are not respirators, not certified, and do not meet respiratory protection standards Medical masks are not designed to protect the wearer from exposure to airborne hazards Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015

Evidence for prevention or reduction of occ asthma Numerous studies Type and use of equipment (RPE) is very important but “glossed over” Presentation ANZSOM Conference 2015

Typical current recommendations (Ebola) CDC (2014) PAPR or N95 certified respirator Training in the use of Facial fit testing Donning and removal OSHA, CDC, NIOSH (2015) Hospital Respiratory Protection Program Toolkit Most helpful document to date Presentation ANZSOM Conference 2015

Other useful reference Shaffer, R. E et al. (2014). Recommended requirements, test methods, and pass/fail criteria for a “B95” respirator for health care workers. Journal International Society for Respiratory Protection. Vol. 31. No. 1. Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 Some precautions Anything that lifts the respirator off the face will negate the protection offered. For example, beards and moustaches……… “Face Seal” is very important. Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 “Protection factor” Essentially the ratio of contaminant concentration outside the respirator versus that inside For negative pressure respirators a protection factor of 10 is considered minimal. Presentation ANZSOM Conference 2015

What are some issues (1)? TIL allowed under AUS/NZS 1716:2009 Non-powered half-face piece, with P1 filter allowed 22% leakage (About one in 5 breaths unfiltered) As above, with a Class 2 filter-8% leakage. Presentation ANZSOM Conference 2015

AEROBIOLOGY OF INFECTIOUS AGENTS (2007) Eugene C. Cole, DrPH Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 Sneezing……. Size of infectious bioaerosols probably about 0.1 to 10 micron. Diameter of droplets-95% are in the order of 2-100 micron. They dry very rapidly-0.3 to 1.3 seconds. Particles smaller than 10 micron remain in air for a few hours. (The 1 metre rule has no foundation) Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 Biological Most spread by virus-laden droplets expelled during coughing or sneezing A sneeze can generate 40,000 particles when dried are of 0.5 to 12 micron size (drying occurs between 0.3 to 1.3 seconds) Virus -range from particle size 0.08 micron to 0.12 micron. WES not applicable as for chemical exposure. Infectious bioaerosols consists of a mixture of mono-dispersed and aggregate cells, spores and viruses carried by other materials. Generally, 0.3-10 micron bacterial cells 0.02-0.30 micron viruses. The dried residuals are generally 0.5 to 12 micron. Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 Human hair about 50-150 micron diameter Dusts that cannot be seen are more critical…………(SARS and “white powder”?) Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015

SARS protective recommendations (Many cases may have been prevented) US CDC (as far back as 2003! Repeated in 2007) At least as protective as an N95 respirator should be used WHO “at least P100/FFP3 or P99/FFP2” should be provided Note terminology “Surgical N95 respirators” (OSHA) Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 2007 Useful document 1 Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015

Intervention-Respiratory Disease-overview (AS/NZS 1715:2009) Generally the most expensive/intensive effort option, e.g., Monitoring (personal and static) Health monitoring Individual assigned to the programme Medical screening (physical or psychological) Employee training (hazards, respirator, facial fit,etc) Cleaning and disinfecting the respirator Provision for storage and maintenance Inspection and maintenance Presentation ANZSOM Conference 2015

Fit testing equipment (Quantitative) Presentation ANZSOM Conference 2015

The count needs to be 200 times lower inside the mask than outside the mask to pass Fit factor=Outside concentration/ inside concentration

Saccharin Isoamyl acetate (banana oil) Bitrex

Presentation ANZSOM Conference 2015 An example A practical situation-Choice of respirator Chemical substances and biological agents-Studies and Research Projects 2007 Personnel working in the room of a patient infected with the SARS virus Expert recommendation: Personnel wear a N95 filtering, half-face respirator, alone or under another respirator offering greater protection, such as an PAPR. This related to high risk activities (e.g., intubation, induced sputum). Presentation ANZSOM Conference 2015

Respiratory protective devices-selection, use and maintenance-Part 2: New ISO Standards (2015) Respiratory protective devices-selection, use and maintenance-Part 2: Condensed guide to establishing and implementing a respiratory protective device programme Presentation ANZSOM Conference 2015

Presentation ANZSOM Conference 2015 Questions? Presentation ANZSOM Conference 2015