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Prevention of Work-related SARS
Personal Protective Equipment
Hierarchy of methods of hazard control
Engineering control Administrative control Personal protective equipment
Control of infection
Administrative control Environmental control Personal protective equipment
Control of transmission of infectious disease
Airborne Droplet Contact
Personal protective equipment
Surgical mask Respirator Goggles Gown Gloves
Surgical mask
Three layers Standards and guidelines set in US by: American National Standards Institute The Association of Perioperative Registered
Nurses American Study Society of Testing and Mater
ials CDC
Surgical mask
Food and Drug Administration NIOSH
ASTM
Categorize the surgical mask into general use, sub-micron filtering, fluid resistant
Bacterial filtration efficiency Differential pressure Sub-micron particulate filtration Resistance to penetration by synthetic blood Flammability
Different types of surgical mask
Can be used with face shield or eyewear Flat –fold tie on Duck bill Cone shaped Flat-fold with shield High fluid resistant
Things to observe in using a surgical mask
Worn properly Comfortably cover the mouth and nose Fit- no tenting around the side of the mouth Use the pliable strip to promote a close fit Change frequently when wet Handle only the string and promptly dispose
into a waste receptacle On or off
Respirators
Purpose Function Respiratory protection program
Description and selection of respirators
NIOSH Facepiece Classification: tight fitting facepiec
e, loose –fitting facepiece Tight fitting facepiece is further classified into:
quarter masks, half masks and full facepiece Loose fitting facepieces include hoods, helme
ts, blouses or full suits which cover the head completely
Description and selection of respirators
Respirator classification : Air purifying respirators Atmosphere supplying respirators
Respirator selection
Hazard
Oxygen deficient Toxic Contaminant
IDLH: No
Particulate
Filter respirator
PAPR
Airline respirator
IDLH: Yes
Pressure-demand S.C.B.A.
Pressure –demand airline-respirator with escape provision
N95 respirator
42 CFR 84 Use the most penetrating 0.3 AM aerodynamic
mass median diameter. 9 classes of filters- three levels of filter
efficiency and each with three categories of resistance to filter efficiency degradation.
three levels of filter efficiency- 95%, 99% and 99.97%
three categories of resistance to filter efficiency degradation- N, R, P.
N95 respirator
N not resistant to oil R resistant to oil P oil proof The N series are tested by a mildly degrading ae
rosol of NaCl. The P- and R- series will be tested against a highly degrading aerosol of dicotylphthalate. The specific maximum loading dose was 200mg. The N- and R- series is uaually certified with a single work shift limitation
N95 respirator
Certification of filters was based on statistical evaluation of results from 30 filter tested. Pass/ Fail test based on result from 20 filters tested.
Fit test
Seal check Qualitative testing Quantitative testing Combined direct penetration through the filter a
nd leakage around the face seal TSI 8020 Portacourt plus TM measures the fit fac
tors Without surrogate fit testing, average exposure
was reduced to 33% of the ambient level, which is much less protection expected of this class of respirator, less than or equal to 10 %.
Fit test
When fit tested first, greater protection than normally expected (the average exposure was reduced to 4% of the ambient level)
Without fit testing, person unknowingly may have poor face seals, resulting in excessive leakage and exposure.
An requirement by OSHA
Effects of respirator use
Respiratory effects Increased airways resistance Increased dead space volume Cough Cardiovascular effects Discomfort Extraweight and Ergonomic concern Psychological and social effects Skin problems Senses
Pregnancy
No good data on respirator use in pregnancy Most common cause for denying medical
clearance Consider the risk of the work environment to
the mother and the developing child, the capacity of the mother to tolerate the PPE, as well as ergonomic consideration
Work condition
Job characteristics Work environment Psychological stresses Equipment –related stresses
Worker evaluation
Work description Medical history and physical examination Special testing Re-evaluation
Certification of use of respirator
Full use Restricted use
Advice
For infection control of patients with suspected SARS, CDC advises airborne precaution( including use of a N-95 filtering disposable respirator), wearing of eye protection and contact precaution was included in inpatient setting and outpatient setting. A qualitative fit test should be conduct for N95 respirator. If N95 respirator is not available, then surgical mask should be worn. The patient should wear a surgical mask.
Advice
For precaution for Aerosol generating procedures, CDC advises PPE should cover all exposed skin- single isolation gown, a disposable full-body isolation suit, a disposable surgical hood with an attached face shield in combination with a disposable respirator.
Disposable gloves Eye protection A face field Disposable particulate respirators minimum
level of respiratory protection
Advice
A fit test A higher level of respiratory protection should
be used if fit test fails Various types of PAPRs Full facepiece elastometric negative respirato
rs with N, R or P100 filter
Advice
WHO advises strict adherence with the barrier nursing of patients with SARS using precautions for airborne, droplet and contact transmission. N95 respirator should be worn all the time when attending patients with suspected and confirmed SARS. The patient should wear a surgical mask. All visitors, staff, students and volunteers should also wear N95 in entering the room of a patient with suspected or confirmed disease. Surgical masks are a less effective alternative to N95.
Advice
Hospital Authority advises:
Essential infection control advice All staff must receive infection control
precaution. All persons inside hospital setting must wear
a mask. For N95, ensure right size and check the leakage.
All person must practice hand hygiene.
Advice
Personal PracticeAll hospital settings All persons must wear a mask All must practice hand hygiene
All inpatient settings Standard precaution Droplet precautions: surgical mask for all patient
contact. Protective eyewear for close patient contact.
Conclusion
Last resort Level of evidence: expert panel Empirical measures based on the modes of
transmission when the full picture of the disease is not known
Brief introduction of surgical mask and respirator
Brief summary of how personal protective equipment was recommended in various organizations