RESPIRATORY PROTECTION Awareness Training Educational Program

Target Audience Employees, students, contract staff, residents, and external law enforcement officers are persons who may be at risk for exposure to diverse airborne or infectious hazards while performing job related tasks. These persons should be provided with the following: Education of Respiratory Protection Appropriate Personal Protective Equipment (PPE) Health care workers exposed to patients with infectious TB require protection from that disease. Because the use of engineering controls (such as isolation rooms and ventilation) may not completely control the TB hazard, respiratory protection is needed.

Respirator Training This training is provided so you will know how to protect your health. If you don’t know how to use a respirator properly, you may get a false sense of protection. “It is not enough just to slap on a respirator and go. You need to know the reasons for the use of respirators, how they protect you, their limitations, how to use them, keep them in good condition and store them.” 4 3

LEARNING OBJECTIVES Upon successful completion of this educational program, participants will be able to: State the purpose of the Respiratory Training Program. Recognize medical signs and symptoms that may limit or prevent the effective use of respirators. Identify benefits and limitations of respirators in promoting a safe environment. Recognize items/conditions that may compromise the protective effect of respirators. State purpose of the medical questionnaire. Demonstrate competency in the usage, maintenance, and storage of respirators (Validation in clinical area).

Part 1: Selecting a Respirator The MED provides two models of N95 masks 3M1860 small & regular sizes 3M1870 folds flat & fits most people

Part 2: What is a Respirator? A PPE device used to protect workers from exposure to harmful airborne substances. The device may cover the mouth, nose, and sometimes the eyes and/or entire head. NOTE: Surgical masks are not respirators and are not certified as such.

N95 Respirator Mask NIOSH certified N95 respirators/masks are designed to help provide respiratory protection for the wearer. It is fluid resistant and disposable. Used for protection against airborne agents such as: Tuberculosis, SARS, Influenza, and other airborne infectious agents

How Does The N95 Mask Protect You? When you inhale, air is pulled in through the N95 mask and contaminants are captured on the outside of the mask. Properly used N95 masks prevent the inhalation of airborne infectious agents in the air and protects the lungs. The respirator must have a proper seal and effective valves in order to perform its job.

Limitations of N95 Respirator Ineffective when wet or soiled Does not supply oxygen Ineffective in contaminant concentrations that are immediately dangerous to life and health Ineffective when used with beards, facial hair, or anything that prevents a good seal to the face

The purpose of wearing a Part 2: Review The purpose of wearing a respirator such as a N95 is to…. INSTRUCTOR NOTES Answer: Protect you from breathing hazardous airborne substances

REVIEW If you do not use a respirator and are exposed to hazards, you may develop health problems such as bronchitis or even cancer. True False TRue

Review A respiratory protection program: Is designed to protect your health Is a team effort involving you and your employer Teaches you how to care for a respirator All of the above All of the above

Part 3: Medical Evaluations Medical evaluations are required prior to wearing a respirator. There are physiological effects of wearing a respirator

Physiological effects of wearing a respirator Significant elevated heart and respiratory rates Significant elevated blood pressure Elevated body temps (HEAT STRESS) Alterations in breathing patterns Hypoventilation Emphasizes the need for a Medical Evaluation BEFORE you can wear a respirator INSTRUCTOR NOTES hy·po·ven·ti·la·tion [ h p vent’l áysh’n ]noun slow breathing: abnormally slow and shallow breathing leading to a dangerous buildup of carbon dioxide in the blood

Medical Evaluation Process The first step of a medical evaluation is a confidential medical questionnaire. Results are only used to determine if you are FIT to wear a respirator. CONFIDENTIAL “Before you wear a respirator, you must fill out a medical questionnaire. The questions in the medical questionnaire are required. You fill out the questionnaire and bring to fit tester. We do not see the questionnaire or the results of a medical exam. We only receive notice on whether you are medically fit to wear a respirator or not.” The MED’s medical evaluation consists of the employee completing a questionnaire as a screening tool. The questionnaire is very confidential. There are no generally accepted criteria for excluding workers from wearing respirators. Several studies have shown that most workers with mild pulmonary function impairment can safely wear respirators. The MED requires medical clearance for those employees who believe they are unfit to use a respirator. NOTE: Some respirators have a latex component and should not be worn by those who are allergic to latex.

Medical Evaluation Is Required For new respirator users An employee reports medical signs or symptoms that are related to their ability to use a respirator. A Physician, Manager/Supervisor, or Program Administrator advises that an employee needs to be reevaluated. Information from the Respiratory Protection Program observations and program evaluation, indicates a need for employee reevaluation.

How To Obtain Medical Questionnaire? Ask Your instructor for the medical questionnaire or Contact The MED’s Program Administrator—Steve Chunn 901-545-7156

Part 4: Fit Testing This is the procedure to determine the correct respirator model and size for each individual. Fit testing ensures that the wearer can apply the respirator correctly to maximize the respirator’s benefits. Fit testing must take place before the respirator is used. Fit-test is a method used to select the respirator that provides an adequate and comfortable fit. Fit tests should be completed at regular, periodic intervals (e.g., annually) to ensure continued adequate fit. A fit-test must be conducted to determine which brand, model, and size of respirator fits the user adequately and to ensure that the user knows when the respirator fits properly. Such knowledge is important because TB aerosol can leak around the face piece. into the respirator and be inhaled if the respirator does not fit the user's face.

Fit Testing Methods Qualitative Quantitative Contaminants are captured outside the mask Air is pulled through the N95 mask

NOTE: Fit tests SAME MAKE SAME MODEL AND SAME SIZE Fit tests MUST be conducted with a respirator that is the SAME MAKE SAME MODEL AND SAME SIZE as the one the student is expected to use.

Fit Test Exercises Consist of… Normal breathing Deep breathing Turning head side to side Moving head up and down Talking Grimace (smile or frown) Bending over Remind employees of the fundamental reason that respirators must fit properly, which is to prevent inhalation of hazardous dust, gases, and other substances that could seriously affect their health either temporarily or permanently. Make sure they understand the specific reasons they are required to wear respirators (such as lead dust, asbestos, hazardous chemicals, etc.) and their potential health effects. And make it clear that if a respirator does not seem to fit properly, they should have it fully fit-tested or replaced rather than take any chances.

Review What Should You Do If you experience… Warning signs of taste, smell, irritation, cough Difficulty in breathing, shortness of breath, chest pain, over exertion Signs and symptoms of exposure to contaminants

Get out of area to fresh air and remove respirator Get out of area to fresh air and remove respirator Get out of area to fresh air and remove respirator Get out of area to fresh air and remove respirator Get out of area to fresh air and remove respirator Get out of area to fresh air and remove respirator Get out of area to fresh air and remove respirator

REVIEW You don't want to wear it You have a skin condition Which one of the following may prevent you from wearing a full-face mask? You don't want to wear it You have a skin condition You wear glasses The strap messes up your hair Skin condition—because may impact how the mask fits the face. They will be fit tested wearing eye glasses

REVIEW Getting dentures Getting eyeglasses Having a facial injury Which of the following may require you to be fitted for a new respirator? Getting dentures Getting eyeglasses Having a facial injury Any of the above D

What Can Prevent A Good Fit? Things that will prevent getting a proper seal Weight loss or gain (≥ 15 lbs.) Facial Hair Eye Glasses Facial deformities (scars, creases) High cheekbones Severe acne No teeth or dentures INSTRUCTOR NOTES Respirator users who are not clean-shaven, should not be fit-tested with tight-fitting respirators because facial hair between the skin and the sealing surfaces of the respirator will prevent a good seal. Tight-fitting respirators cannot be assigned to or used by workers with facial hair that interferes with the seal.

Removing a Respirator Discard contaminated gloves first Lift bottom elastic band up over your head Do not touch the front of the mask Lift top elastic band up over your head Discard contaminated respirator Perform hand hygiene

Manufactures’ instructions for inspection, cleaning and maintenance should be followed INSTRUCTOR NOTES Wearing a poorly maintained or malfunctioning respirator may be more dangerous than not wearing one at all……

Respirator Inspection Check General good condition Shape Holes Soiled Band elasticity Cartridges/Filters Click here Inspection Checklist

When to Get a New N95 Mask Increased resistance to breathing Excess moisture on mask Sensing a breakthrough (i.e. smell, taste) Visibly soiled Damaged or missing hardware Loss of elasticity Lack of a seal to the user’s face Use of the respirator for 1 full shift

Critical Thinking Activity Describe how to transport patients diagnosed with infectious TB to areas outside of their isolation rooms for essential procedures that cannot be performed in the isolation rooms. Patients placed in isolation should remain in their isolation rooms with the door closed. If possible, diagnostic and treatment procedures should be performed in the isolation rooms to avoid transporting patients through other areas of the facility. If patients who may have infectious TB must be transported outside their isolation rooms for medically essential procedures that cannot be performed in the isolation rooms, they should wear surgical masks that cover their mouths and noses during transport. Persons transporting the patients do not need to wear respiratory protection outside the TB isolation rooms. Procedures for these patients should be scheduled at times when they can be performed rapidly and when waiting areas are less crowded.

Review 1. Respirator fit-testing must be conducted every three years. True or False 2. Any respirator you use will protect you against harmful chemical fumes. False—annual requirement False—not any mask