Respirator Guidance Michael A. Yarnell Compliance Assistant HCFMSNJ – April 16, 2009

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

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

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

Other Controls  Hygiene Cleaning hands Decontaminating surfaces  Social distancing Reduce frequency, proximity and duration of contact with customers, employees and the general public

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

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

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

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

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

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

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

Cons  Requires cleaning between uses  Fan noise can make communication difficult  Significantly more expensive than other respirators ($400 to $1200)  Battery can be heavy

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)