1. Respiratory Protection from Airborne Infectious Agents:
Use of N-95 Disposable Particulate Respirators
This presentation covers the material an EMS or other health care worker needs to know to use a disposable N-95 respirator. Before it can be used, slides 12 and 19 must be tailored to the particular agency whose employees are undergoing this training. The respiratory program administrator must also review the slides to be sure they are accurate and comprehensive.
Vermont Department of Health, EMS Office
This program was adapted in 2009 from materials developed by the New Jersey Dept of Health & Senior Services

2. Objectives
Explain what N-95 disposable particulate respirators are and why they are necessary
Describe their capabilities and limitations.
Demonstrate proper use.
Describe the proper maintenance and storage of N-95 respirators.

3. Why is an N-95 disposable particulate respirator necessary?
Protection from airborne pathogens like influenza, tuberculosis, SARS, chickenpox, measles and smallpox.
It protects by filtering out infectious particles from
the air you breathe.

4. When is an N-95 disposable particulate respirator necessary?
Respiratory disease outbreak or
Intentional biological event
N-95 disposable particulate respirators are the minimum level of protection needed for airborne infectious agents.
Few infectious agents are truly airborne and require use of a respirator. Generally, when a new (novel) pathogen appears that is potentially airborne, the CDC will initially recommend respirator use for EMS and other health care workers. If the CDC determines the pathogen is droplet-borne and not airborne, it may recommend use of droplet precautions, including use of a surgical mask rather than a respirator. OSHA typically takes CDC’s recommendations and requires employers to follow them.

5. What is an N-95 disposable particulate respirator?

6. N-95s reduce exposure to particles that are small enough to be inhaled
Sizes of some
pathogens (microns)
Fungi
Mold spores
Bacteria
Viruses
One meter = inches
One millimeter = one-thousandth of a meter (0.04 inches)
One micron = one-thousandth of a millimeter ( inches)

7. N-95s reduce exposure to particles that are small enough to be inhaled
N-95 filters are tested on particles greater than 0.3 microns in size.
Particles < 100 microns
can be inhaled through
nose and mouth
1-5 micron particles can enter upper airways
Viruses = microns
This slide does not have overlapping text boxes, although it appears that way in edit mode. When the slideshow is used, the boxes will transition in and out appropriately to prevent overlapping.
0.1 – 1 micron particles can enter lower lungs and alveoli

8. What does “N-95” mean?
An N-series filter that is at least 95% efficient in removing particles greater than 0.3 microns in diameter.
N = Not oil resistant
R = Resistant to oil
P = oil-proof
95 = 95% efficient
99 = 99% efficient
100 = 99.97% efficient
Respirators are evaluated by the National Institutes for Occupational Safety and Health (NIOSH)

9. How can you tell if a respirator is NIOSH-approved?
NIOSH approval number
on respirator:
Approval label in box
NIOSH Certified Equipment List
Website

10. Is an N-95 disposable respirator the same as a surgical mask?NO
A surgical mask is not a respirator.
It is NOT NIOSH-approved.

11. Is an N-95 disposable respirator the same as a surgical mask?
A surgical mask may not provide adequate protection for EMS responders….
BUT . . .
A surgical mask on the patient may limit the spread of respiratory secretions.

12. What N-95 respirator is being issued?
This EMS agency uses these N-95
disposable particulate respirators:
Brand Model Sizes
#1 ______ _____________ _____
#2 ______ _____________ _____
BEFORE USING THIS PRESENTATION, ENTER THE BRAND, MODEL AND SIZES OF RESPIRATOR THE AGENCY PROVIDES.

13. Advantages of N-95 disposable particulate respirators
Lightweight
Fairly comfortable to wear
Mobility not restricted
Disposable
Low cost
Require no cleaning or maintenance

14. Limitations of N-95 disposable particulate respirators
They DON’T protect from:
______ deficiency
Harmful chemical gases and vapors
_____ or ______ contact with pathogens
High concentrations of _______

15. Limitations of N-95 disposable particulate respirators
They DON’T protect from:
Oxygen deficiency
Harmful chemical gases and vapors
Skin or eye contact with pathogens
High concentrations of pathogens

16. What do these limitations mean for EMS?
Don’t enter an oxygen deficient atmosphere.
Don’t use an N-95 disposable particulate respirator for protection from chemical hazards.
If the airborne infectious agent is also spread by skin or mucous membrane contact (such as SARS), use eye protection, gloves and gown.

17. What do these limitations mean for EMS?
If an intentional biological event has occurred, higher levels of respiratory protection may be required.
N-95 disposable particulate respirators must be worn the entire time you are close to potentially infectious persons.

18. If N-95 disposable particulate respirators are issued, EMS agencies must comply with OSHA’s Respiratory Protection Standard
Written respiratory protection program with an assigned program administrator
Proper selection of respirators
3. Training about the hazards and proper use
4. Medical clearance initially and every three years (more often if there are changes)
5. Fit testing (annually)
6. Evaluation of program effectiveness (annually)

19. Proper Use of Your Brand and Model of Respirator
OBTAIN AND REVIEW
THE MANUFACTURER’S INSTRUCTIONS FOR:
Proper donning
Seal check
Removal
Reuse
BEFORE USING THIS PRESENTATION, ENTER THE MANUFACTURER’S INSTRUCTIONS FOR THE RESPIRATOR PROVIDED BY THE AGENCY

20. General Seal Check Procedures for N-95 Disposable Respirators
Whenever the respirator is donned:
1. Place one or both hands completely over the
filtering facepiece.
2. Inhale and exhale sharply. If air leaks around your nose,
readjust the nosepiece. If air leaks between the face and
faceseal of the respirator, reposition it by adjusting the
panels and straps.
3. If you cannot achieve a proper seal, do not enter the
contaminated area. See your respiratory program
administrator.

21. Proper Use No facial hair that interferes with face to facepiece seal
If shape of the N-95 is compromised, it may not fit properly
If respirator becomes damaged, soiled or if breathing becomes difficult, leave the contaminated area and replace the respirator
If used in caring for patient with a disease spread through contact, dispose of N-95 after each use.

22. Medical Evaluation
N-95 use requires medical evaluation and clearance before use.
The medical evaluation is repeated in three years (or earlier if change occurs that might affect ability to use a respirator safely).
The medical evaluation includes a confidential respiratory questionnaire and/or in-person medical evaluation.

23. Medical Evaluation
Medical provider sends written clearance to the employer
Says only that the EMS responder can or cannot wear a specific respirator
No confidential information is included
Medical provider keeps questionnaire in confidential file.

24. This is the form VDH provides to document that a licensed health care provider has evaluated a responder/employee and determined that person may be fit tested. An agency may also create its own record for this purpose.

25. Fit-Testing If a respirator does not make a tight seal around
the face during inhalation, contaminated air may
leak around the edges of the face seal. The only
way to tell if a respirator fits and is capable of
protecting properly is to fit-test the respirator.
OSHA requires fit-testing prior to initial use
and annually thereafter.

26. Quantitative vs. Qualitative Fit-Testing
Quantitative: Computerized means
of detecting faceseal leakage
Qualitative:
Relies on wearer’s
subjective response to
taste, odor or irritation

27. This the form VDH provides to record a responder/employee’s respirator training and fit testing. An agency may also create its own record for this purpose.

28. After the plan is initiated
OSHA requires annual program evaluation
Responsibility of program administrator

29. Respiratory protection is effective only if:
The correct respirator is used
It’s available when you need it
You know when and how to put it on and take it off
You have stored it and kept it in working order in accordance with the manufacturer’s instructions

30. Vermont Department of Labor Occupational Safety & Health Administration
Project WORKSAFE
For more information, contact the
Vermont Department of Health
EMS responders:
Office of EMS
Other health care workers:
Personal Protective Equipment Manager