1. © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Respiratory Protection To Fit or Not To Fit November 7/05

2. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Infectious agents  Respiratory protection prevents the inhalation of infectious agents that are airborne or suspended as droplets in the air (aerosols).  Viruses  Mould/fungi  Some bacteria  Viruses and bacteria may be found in respiratory secretions of infected people, aerosolized during coughing or other activities.

3. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Significant diseases Other infectious diseases that can be airborne  Tuberculosis and SARS  Infection by moulds and fungi such as Aspergillus and Histoplasma  Viral diseases such as smallpox, hemorrhagic fevers, measles and chicken pox  Some bacterial infections causing respiratory illness, such as Legionnaires’ Disease

4. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Significant Diseases Other Infectious Diseases that can be spread by droplet.  Influenza  Febrile Respiratory Illness  Mumps- Pertussis  Common Cold  Adenovirus (respiratory strain)

5. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Importance of Protecting Workers  Most important resource!  A healthy and effective workforce is especially important during a crisis.  Legislative requirements...

6. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Importance of Protecting Workers “Despite anything in any general or special Act, the provisions of this Act and the regulations prevail” Occupational Health and Safety Act, Sec. 2(2)

7. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Legislation, standards and guidelines Occupational Health and Safety Act  Section 25 - Duties of Employer to provide PPE train about hazards and controls.  Section 27 -Duties of Supervisors to ensure workers use PPE  Section 25 and 27 -take every reasonable precaution in the circumstances for the protection of a worker,”  Section 28 - Duties of Workers to use PPE

8. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Legislation, standards and guidelines  Regulations for Health Care and Residential Facilities  Sections 8, 9 - Employer to develop written measures and procedures for such issues as:  Safe work practices  Safe working conditions  The control of infections  Hazards of biological, chemical or physical agents  The use wearing and care of personal protective equipment

9. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Legislation, standards and guidelines  Regulations for Health Care and Residential Facilities  Section 10 - Where a worker is required to wear personal protective equipment the employer must ensure proper training regarding limitations, use, maintenance etc., and must ensure proper fit of the equipment.

10. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Legislation, standards and guidelines Standards and Guidelines  Canadian Standards Association  CSA Standard Z94.4-02 - Selection, Use and Care of Respirators  Infection Control Guidelines  Health Canada  NIOSH  MOHLTC-PIDAC  Specific Directives

11. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Respirator selection  For many infectious agents, the identification of appropriate respirators has been done by experts such as Health Canada or the Centers for Disease Control and Prevention.  Infection control is a dynamic field and it is important for employers to keep current on what is being officially recommended.  The selection of respirators appropriate for infectious agents relies on the careful application of infection control and occupational hygiene knowledge.

12. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Air purifying respirators Classification of respirators Atmosphere supplying respirators

13. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Respirator selection N95 Respirators:  Currently the accepted standard  When an N95 is required, the MOL requires a NIOSH certified respirator (the PCM2000 is not NIOSH certified)

14. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Particulate air purifying respirators  NIOSH certification scheme means that the respirator is tested with a challenge agent meant to simulate a “worst case” scenario.  The particle size used is between approx. 0.1 and 0.3 microns in size  The flow rate is 85 l/minute. A respirator given the N95 classification is at least 95% efficient at these conditions (given a proper fit).

15. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Particulate air purifying respirators  Surgical masks are……. NOT respirators!!! But……….. they do provide some protection against contamination of the nose and mouth from contact with contaminated hands and from disease spread only by large droplets.

16. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Surgical masks  Where surgical masks are recommended for the protection of a health care worker, (such as when a febrile respiratory illness has been identified), they are part of the personal protective equipment that the worker requires.  Employers must ensure that staff have received training on the proper use, function and limitations of the mask in order to be in compliance with the OHS Act and the Health Care and Residential Facilities Regulations.

17. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Surgical masks  PIDAC’s Preventing Febrile Respiratory Illnesses document September 2005 states workers must wear a “good quality surgical/procedure mask covering the mouth and nose” when providing care to clients/patients requiring droplet precautions

18. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. PIDAC-FRI  Febrile Respiratory Illness (FRI): used to describe a wide range of droplet- spread respiratory infections, such as colds, influenza, influenza-like illness and pneumonia, which usually present with symptoms of a fever of greater than 38 AND new or worsening cough or shortness of breath.  Note: the elderly and immunocompromised may not have a fever

19. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. To Fit or Not To Fit  Legislation does not specify the % of workers that must be fit tested  Employer (in consultation with the JHSC) must assess the potential for their workers to be exposed to an infectious disease and determine which workers require respiratory protection

20. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. To Fit or Not To Fit The Risk Assessment should include  The potential for airborne precautions to be put into effect  The potential for an emergency or outbreak to occur (SARS- TB - Legionella)  The time it will take for proper training and fit testing in response to an outbreak

21. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. To Fit or Not To Fit  Some facilities are fit testing a core group of workers in the event of an outbreak  PLUS- training managers or workers as fit testers so that training and fit testing can be ramped up if necessary.

22. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Developing a respiratory protection program Program Elements: Roles and responsibilities Hazard assessment Respirator selection Health assessment Fit testing Training and education Use of respirators Program evaluation Record keeping

23. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Fit testing  Fit testing is required for all tight-fitting respirators including the N95 respirators that have been selected to protect workers from hazards associated with infectious agents.  Fit testing must be done AFTER the employer has completed the employee’s health assessment and BEFORE they are required to wear the respirator at work.

24. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Fit testing Fit testing should be carried out:  after employee has completed a health assessment and prior to initial use of respirator  at least every two years, although it is preferable annually (CSA Standard)  whenever there is a change in face-piece  whenever there is a significant change to the user’s physical condition (e.g. dental work, facial injury, >10% increase or decrease in weight)  with any other PPE required

25. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. Resources  CSA Standard Z94.4-02 - Selection, Use and Care of Respirators  Health Canada- Infection Control Guidelines – http://www.phac-aspc.gc.ca/publicat/ccdr- rmtc/02vol28/28s1/index.html http://www.phac-aspc.gc.ca/publicat/ccdr- rmtc/02vol28/28s1/index.html  PIDAC- preventing FRI- http://www.health.gov.on.ca/english/providers/ program/infectious/diseases/ic_fri.html http://www.health.gov.on.ca/english/providers/ program/infectious/diseases/ic_fri.html  HCHSA- www.hchsa.on.ca

26. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. HCHSA’s Respiratory Protection Training Program

27. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law. HCHSA Teleconference Ventilation Systems and Prevention of Respiratory Illness  Wednesday, November 9/05  2:00pm- 3:00pm  Dr Leon Genesove, Provincial Physician, Ontario Ministry of Labour  416-640-3407 (GTA)  1-866-322-8798 (rest of Ontario)

28. Health Care Health & Safety Association © Copyright 2005 HCHSA. All rights reserved/ tous droits réservés. Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.