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1、Respiratory protection Fabio Scano TB Infection Control Training 24-28 August 2010,2,Outline,To describe the differences between a surgical mask and a respirator To name the types of respirators that protect against TB transmission, and when to use them To list the elements of a respiratory programm
2、e,3,Outline,WHO recommendations Surgical mask vs. particulate respirator Respirator standards Respirator programme Proper use Fit testing,4,WHO recommendations,When used with administrative and environmental controls, particulate respirators may provide health care workers (HCW) additional protectio
3、n from TB Respirators Must meet or exceed standards Be properly used Be part of a training programme,5,WHO recommends particulate respirators for HCWs:,Caring for patients with confirmed or suspected infectious TB (in particular MDR-TB) Performing aerosol-generating procedures on infectious TB patie
4、nts Bronchoscopy, intubation, sputum induction Use of high speed devices for lung surgery or autopsy,6,Surgical masks,Reduce the spread of microorganisms from the wearer to others, by capturing large wet particles Do not protect the wearer from inhaling small infectious aerosols.,7,Particulate respi
5、rators,Protect the wearer from inhaling droplet nuclei Filter out infectious aerosols Fit closely to the face to prevent leakage around the edges,8,9,Surgical masks (yes for patients),10,Surgical masks do not protect staff from TB,11,Particulate respirators used for TB exposure,N95 (USA) Filter out
6、95% of particles,FFP2, FFP3 (Europe) Filter out 94-98% of particles,12,USA standards*,*National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC),13,European standards*,*Comit Europen de Normalisation (CEN) (European Committee for Standardization)
7、,14,CEN standards,Total inward leakage Initial filter penetration NaCL Paraffin oil 20%=P1 NA=P1 6%=P2 2%=P2 3%=P3 1%=P3 Maximum breathing resistance Loading test,15,Air-purifying respirators,Remove specific air contaminants by passing ambient air through the air-purifying filter, cartridge or canis
8、ter,16,Negative pressure respirators,air pressure inside the facepiece is negative during inhalation contaminated air can avoid the higher-resistance filter and leak in through gaps in the face seal,17,Types of air purifying respirators,Nonpowered (negative pressure) Powered air-purifying respirator
9、s (PAPR) A blower draws air through the filter and blows it into the face piece Pressure inside face piece reduces face-seal leakage (offers more protection) Loose fitting PAPRs can be used for people that cannot achieve an adequate seal,18,Respirator programme elements,Person assigned responsibilit
10、y Written procedures Medical evaluation Training Selection of respirators Fit testing Maintenance Programme evaluation,19,Why is fit testing necessary?,Ensure a proper seal between respirator and wearer Determine appropriate make/model Determine appropriate size,20,When should fit testing be done?,E
11、mployees should pass a fit test: Prior to initial use Whenever a different respirator facepiece (size, type, model or make) is used Periodically thereafter Whenever changes in the workers physical condition or job description that could affect respirator fit are noticed or reported,Find centre of no
12、se piece and bend,Open respirator,Place straps on back of hand,Place respirator on face,Pull top strap over head,Place top strap on crown of head,Pull lower strap over head,Place strap at base of head,Pinch metal clip around nose,Pull respirator over chin,Check for major leaks,33,Sources of facepiec
13、e leakage,Around facepiece/skin interface Through air-purifying element Through exhalation valve,Coal dust test,35,Factors contributing to poor fit,Weight loss or gain Facial scarring Changes in dental configuration (dentures) Facial hair Cosmetic surgery Excessive makeup Mood of workers (smiling/ f
14、rowning) Body movements,36,Qualitative fit tests:,Rely on the individuals response to the test agent to assess the adequacy of respirator fit Are scored as pass/fail,37,Maintenance and storage,Take care of your disposable respirator Decontamination NO! Cleaning NO! Storage Clean & dry place! Take ca
15、re when re-using respirator closely monitor service life Inspect prior to each use Dispose of the respirator if you question its performance,38,Is this respirator put on properly?,39,Post warning sign,40,Time to clear the air between patients,41,Bronchoschopy room,42,Summary,Surgical masks prevent i
16、nfectious particles from being expelled by the wearer Respirators protect the health care worker from inhaling infectious particles When used with administrative and environmental controls, N95, FFP2 or FFP3 respirators provide additional protection when HCWs care for infectious TB patients Whenever respirators are used, a respirator programme is necessary,
