Guidance for the Selection and Use of Facemasks and

Respirators

Materials referenced from CDC, FDA, NIOSH and OSHA

Current CDC & OSHA Recommendations

• Healthcare Settings– Workers:

• Standard and Contact Precautions + eye protection for direct patient care workers [NIOSH-approved N95 respirator]

• N95 respirators for other staff in close contact with patients

– Patients with ILI symptoms• Facemasks

• Community Settings – None (facemasks as needed)

• Part of overall Infection Control Practices

Masks vs. Respirators • Facemasks

– Designed to cover the mouth and nose loosely – Usually strapped behind the head – Made of soft materials and are comfortable to wear– Provide only minimal protection from respirable

particles

Masks vs. Respirators• Respirators

– Fits tightly to cover the nose and mouth– Provide protection against inhalation of small

and large airborne particles

N95- Filtering FacepieceElastomeric PAPR: Powered Air

Purifying Resp.

Rating of Protection Offered

• Facemasks• Can protect from large particles from

splashes• Not rated for protection from

small inhalable particles

• Respirators– Rated by oil-resistance and filter efficiency

• N95: Not oil resistant, and 95% efficient against small inhalable particles

• Elastomeric and PAPRs: typically HEPA (high-efficiency particulate air): 99.97% efficient

F I l t e r

Regulations & Recommendations for Respirators

• OSHA issues workplace health and safety regulations. When required, employers must:– Provide appropriate respirators

– Medical evaluation

– Fit testing

– Training

– Ensure workers do fit checking before each use

• CDC recommends when, what and how to use PPE

Current CDC Recommendations for Pandemic Influenza

• Healthcare – Direct Patient Care Workers– NIOSH-certified N95 or higher recommended for use

during high-risk activities including:• Aerosol-generating procedures

• Resuscitation of confirmed or suspected influenza case

• Providing direct care to confirmed or suspected influenza-associated

– Only slight revision from seasonal influenza guidance

• Part of overall Infection Control Practices

Current CDC Recommendationsfor Pandemic Influenza

• Healthcare Patients – Facemasks should be offered

• as part of a respiratory hygiene/cough etiquette strategy,

• to patients who present for care with coughing or have other ILI symptoms

• Close contacts and those with travel history• worn until the cause of symptoms is determined not an

infectious agent that requires isolation or patient has been appropriately isolated

Current CDC Recommendations• Community Settings

– Facemask use in proximity to a symptomatic person may not effectively limit transmission

– Emphasis should be on• cough etiquette and • staying home• facemask use if near confirmed cases• If symptomatic persons cannot stay home, consideration should

be given to having them wear a facemask in public

– No recommendation for use by asymptomatic persons, including those at high risk for complications

OSHA Occupational Risk Categories

• Very High: Healthcare workers performing aerosol-generating procedures or collecting respiratory tract specimens from known or suspected cases

• High: Healthcare workers and support staff exposed to known or suspected cases (including EMTs)

• Medium: high-frequency contact with the public

• Low: minimal occupational contact with the public

Recommendations for OSHA Occ. Risk Categories

• Very High:– Re-usable Elastomeric Respirator or PAPR or N95

• High:– Workers: N95, elastomeric respirator or PAPR– Patients: Facemasks

• Medium:– Facemasks

• Low:– None

OSHA Guidance on Respirator Stockpiling

OSHA Guidance on Facemask Stockpiling

Occupational setting Facemasks needed

Healthcare

Hospital (inpatient) 2 per patient per day

Essential visitors 3 per visitor per day

Emergency Rooms 1 per ill person

Outpatient office/clinic 2 per patient visit

Emergency medical services 1 per ill person

Respirator Re-Use• Elastomeric respirators and PAPRs

– Designed for re-use following proper cleaning– Filter cartridges can last long periods

• N95 Respirators– Designed for one time use; Not cleanable– Can be re-used in not grossly contaminated

• Protect with a facemask or face shield• Single-user

• Increased risk of contamination of hands and face

Community Use of N95 Respirators• FDA has cleared the following N95 respirators

for use by the general public• 3M™ Particulate Respirator 8670F• 3M™ Particulate Respirator 8612F• Pasture™ F550G Respirator• Pasture™ A520G Respirator

– N95 respirators are not designed for people with facial hair or children.

– People with chronic respiratory, cardiac, or other medical conditions that make it harder to breathe should check with their healthcare

References• http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm• http://www.cdc.gov/flu/professionals/infectioncontrol/

maskguidance.htm• http://www.osha.gov/dsg/guidance/stockpiling-facemasks-

respirators.html• http://www.osha.gov/Publications/

influenza_pandemic.html#classifying_exposure• http://www.osha.gov/Publications/3328-05-2007-

English.html#RespiratoryProtectionforPandemicInfluenza• http://www.fda.gov/cdrh/ppe/masksrespirators.html• http://www.cdc.gov/h1n1flu/guidance_ems.htm