1. Respiratory Protection from Airborne Infectious Agents: Use of N-95 Disposable Particulate Respirators 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.

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 2-200 Mold spores 1-70 Bacteria 0.5-10 Viruses 0.02-0.3 One meter = 39.37 inches One millimeter = one- thousandth of a meter (0.04 inches) One micron = one- thousandth of a millimeter (0.00004 inches)

7. N-95s reduce exposure to particles that are small enough to be inhaled 1-5 micron particles can enter upper airways 0.1 – 1 micron particles can enter lower lungs and alveoli Viruses = 0.02-0.3 microns N-95 filters are tested on particles greater than 0.3 microns in size. Particles < 100 microns can be inhaled through nose and mouth

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

9. How can you tell if a respirator is NIOSH-approved? http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html NIOSH approval number on respirator: Approval label in box NIOSH Certified Equipment List Website 84A-####

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

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

12. What N-95 respirator is being issued? This EMS agency uses these N-95 disposable particulate respirators: BrandModelSizes #1 ________________________ #2 ________________________

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 ______ deficiency ______ deficiency Harmful chemical gases and vapors _____ or ______ contact with pathogens High concentrations of _______ They DONT protect from:

15. Limitations of N-95 disposable particulate respirators Oxygen deficiency Harmful chemical gases and vapors Skin or eye contact with pathogens High concentrations of pathogens They DONT protect from:

16. Wha t do these limitations mean for EMS? Dont enter an oxygen deficient atmosphere. Dont 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. Wha t 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 OSHAs Respiratory Protection Standard 1.Written respiratory protection program with an assigned program administrator 2.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 Proper donning Proper donning Seal check Seal check Removal Removal Reuse Reuse OBTAIN AND REVIEW THE MANUFACTURERS INSTRUCTIONS FOR:

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. filtering facepiece. 2. Inhale and exhale sharply. If air leaks around your nose, 2. Inhale and exhale sharply. If air leaks around your nose, readjust the nosepiece. If air leaks between the face and 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 contaminated area. See your respiratory program administrator. 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.

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

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

29. Respiratory protection is effective only if: The correct respirator is used Its 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 manufacturers instructions

30. Vermont Department of Labor Occupational Safety & Health Administration Project WORKSAFE 802-888-0620 www.labor.vermont.gov/?tabid=74 For more information, contact the Vermont Department of Health EMS responders: Office of EMS 800-244-0911 www.vermontems.org Other health care workers: Personal Protective Equipment Manager 802-951-0058