N95 Respirator Fit-testers Training. UMDNJ Office of Environmental Health & Safety Services (EOHSS)

Transcription

1 N95 Respirator Fit-testers Training UMDNJ Office of Environmental Health & Safety Services (EOHSS) Updated 4 Nov 2009

2 Why are we here today? Prepare for larger H1N1 outbreak UMDNJ H1N1 Task Force Personnel within 6 feet of symptomatic persons will need to wear an N95 respirator, especially if there is no partition separating them Anyone who may wear a respirator must first be fit-tested.

3 Respirator Use and Fit OSHA Respirators shall not be worn when conditions prevent a good face seal. Such conditions may be the growth of a beard, sideburns, a skull cap that projects under the facepiece, or temple pieces of glasses. PEOSH Interpretation - Facial hair that lies along the sealing area of a respirator, such as beards, sideburns, moustaches, or even a few days growth of stubble, is not permitted on employees who are required to wear respirators that rely on a tight facepiece fit to achieve maximum protection

4 The Fit Test Procedure Qualitative vs. Quantitative Fit Testing You are being taught to perform qualitative fit-testing (yes it fits or no it does not fit)

5 Qualitative Fit Testing -To perform a qualitative test of the fit of the respirator, an aerosol of an agent you can taste is sprayed around the respirator to simulate droplet nuclei and airborne infectious agents. -If the face piece to face seal is not adequate (i.e., leaks), the test aerosol will by pass the filter and the user will taste it. -If the test agent is tasted, then fit is not adequate and the user should re-adjust the respirator or try another size.

6 Newark Forms Page Piscataway/NewBrunswick Forms Page

7 Respiratory use is one of many Control Measures Administrative measures -promptly identify, segregate, and treat suspect or active patients. Symptomatic patients must wear a face mask Vaccination (~2 weeks for immunity to develop) Work Practices Hand hygiene Engineering controls such as ventilation (negative pressure isolation rooms), booths with high efficiency filters, and HEPA filtration equipment, glass partitions for frontline personnel Respiratory protection and other personal protective equipment - Last line of defense

8 When should a respirator be worn for H1N1? Respirators should be worn: When in close contact (within 6 feet) of patients with symptoms of H1N1 or seasonal influenza (flu) Risk Assessment may not be necessary to change the respirator between patients if there is no direct patient contact (e.g. person behind a partition, housekeeping)

9 Commercial unavailability of N95s OSHA Prioritized Use Mode Since a shortage of disposable N95 respirators is possible, employers are advised to monitor their supply, prioritize their use of disposable N95 respirators and to consider the use of elastomeric respirators and facemasks if severe shortages occur. Employer must prioritize use of respirators to ensure that sufficient respirators are available for providing close-contact care for patients with tuberculosis. Healthcare workers performing high hazard aerosol-generating procedures (e.g., bronchoscopy, open suctioning of airways, etc.) on a suspected or confirmed TB or H1N1 patient must always use at least a fit-tested N95, even where a respirator shortage exists. For low risk exposures (not conducting procedures where aerosols produced, no direct patient contact) to H1N1, a surgical mask is better than nothing resistant to splashes, prevents wearer from touching nose and mouth

10 Examples of N95 Respirators These respirators are also known as N-95 disposable respirators. North 7130 (Latex Free) Sizes: One Size 3M 1870 Healthcare Particulate and Surgical Mask (Latex Free) Sizes: one size fits most Tecnol PFR-95 (Latex free) Sizes: Regular and Small

11 N95 Particulate Respirator The N designation means the respirator is designed to be used to filter aerosols free of oil. (N=not oil) 95 means a filter efficiency level of 95% for hardest to filter particles (.3 microns).

12 N95 Particulate Respirator Intended to reduce wearer exposure to certain airborne particles in a size range of 0.1 to >10.0 microns Fluid resistant to splash and splatter

13 N95 Respirator Limitations Proper fit is critical to respirator performance. Designed for filtering of particles only; Will not filter gases or vapors. May be uncomfortable if used for extended periods. Can not be worn by individuals with facial hair (beards, goatees, etc.). Need to replace if wet, damaged, heavily soiled or contaminated. Is less protective that a respiratory with a higher assigned protection factor

14 If Worn Properly. An air purifying respirator will reduce, but not eliminate the inhalation of aerosol contaminants. Does not supply oxygen. Does not totally eliminate exposure to or risk of contracting any disease or infection. PAPRs are more protective

15 Examples of Elastiomeric Respirators (for high risk situations where N95s are commercially unavailable) Half face Elastiomeric Full Face Elastiomeric These would need to be used with a HEPA cartridge

16 N95 and Elastiomeric are Negative Pressure Respirators This means they require the user to inhale (creating a negative pressure inside the respirator) in order to draw air inside the respirator. If there is any leakage, then contaminated air leaks into the mask.

17 Powered Air Purifying Respirators (PAPR) PAPRs are positive pressure- if there is any leakage, clean air leaks out of the mask

18 Why do we need to fit test N95s? Fit-testing is an OSHA Requirement We need to ensure that contaminated air does not enter the respirator around the facepiece. When you inhale, if the face piece does not fit correctly (i.e., there are openings or gaps), the air will enter through these openings instead of passing through the respirator filter. Everyone must be fit tested before being assigned a respirator to ensure that they have the size and respirator model that will provide the best fit.

19 Repeat fit-testing annually, and when: changes in facial structure such as from the following situations: weight loss or gain greater than +/- 5 pounds dental/denture changes, facial scarring, facial surgery, or other conditions which interfere with the seal of the face piece.

20 Summary of OSHA Requirements: 29 CFR : Respiratory Protection Standard Written Respiratory Protection Plan describing Program Annual Respiratory Protection Training in the proper use, limitations, leak-testing, and storage of the respirator and in the hazard being protected against Respirator Wearer Medical Surveillance to determine if the employee is cleared to wear a respirator Annual Respirator Wearer Fit-Test to ensure that the respirator fits and will not allow contaminated air to leak into the breathing area from around the face piece.

21 Written Plan Your department may have its own Respiratory Protection Plan or it may use the UMDNJ Clinical Respiratory Protection Plan posted at repiratory_protection_plan.pdf The UMDNJ Plan is designed to be customized for each unit/department by completion of fill-in-the-blanks.

22 Annual Training EOHSS has an online respiratory protection training module posted at Hands on training in donning and doffing the respirator and leak checking is part of the fit-testing procedure The EOHSS online training module has been updated to address H1N1

23 Medical Surveillance Your school/unit/department must have arrangements with a licensed healthcare provider (usually the campus Employee Health/Occupational Medicine Service) No specific requirement for how often medical clearance must be obtained Request for Medical Evaluation for Respirator Wearer (when completed by Provider, this serves as documentation of Medical Clearance) Respirator Wearer s confidential Questionnaire

24 Fit-testing Only people with documented training can perform fittesting

25 Procedure for Fit Testers

26 Summary-Procedure for fit testers Handouts, forms and the fit-test protocol are posted on the EOHSS website at: People being fit-tested must give you: a) documentation that they have completed respiratory protection training in the past year and b) documentation that they have received medical clearance (it does not have to be recent) to wear a respirator before you fit-test them. People being fit-tested must complete: a) Respirator Medical Reevaluation form before being fit-tested, even if their medical clearance is recent. People who answer yes on the form should not be fit-tested. They will need to complete the respirator wearers confidential questionnaire so that occupational medicine/employee Health Service can decide if they should be medically cleared or if they need an office visit. b) Should complete the appropriate section of the fit-test record form while waiting to be fit-tested Completed forms should be given to the person coordinating the Respiratory Protection program for your unit/department.

27 Step 1 A week before the session inform people to be fit-tested of the requirements for being fit-tested Inform them of the address of the respiratory protection module: and that training takes about minutes and that they must bring the documentation of training they received after completion to the fit-testing session. If they don t have documentation of medical clearance they need to get it- how to get it: download forms from the supervisor should fill out the Request for Medical Evaluation for Respirator Use form The person being fit-tested should complete the N95 Medical Evaluation Questionnaire, put it in a sealed envelope and give it to the supervisor to be sent along with the request form to the campus employee health or other provider. In many cases people get medical clearance without the need for a medical appointment.

28 Step 1 (continued) A week before the session inform people to be fit-tested of the requirements for being fit-tested: They must not eat, drink or chew gum for at least 15 minutes before the session Men must be clean shaven

29 Step 2 Get supplies ready Qualitative Fit test kit Variety of N95 respirators (sizes/models) Water/cups for people to drink between tests Handouts, Fit Test Protocol Respiratory Protection Medical Status Update form, and Fit Test Record forms (download from ) Disinfecting wipes and paper towel (for cleaning and then drying the fit-test hood between uses You may want to bring shaving supplies for people who arrive with facial hair

30 Step 3 Obtain two types of documentation before fit-testing each person Documentation That Must Be Provided 1-documentation of Medical Clearance 2-documentation of completion of respiratory protection training Respiratory Training can be completed online at OSHA does not specify frequency of Medical Evaluations so it does not need to be current The training must have been completed in the past year.

31 Step 4 Each person being fit-tested must first give the fit-tester a completed Medical Status Update Questionnaire The questionnaire is posted at: The questionnaire asks if there have been medical or psychological conditions since their last evaluation People who answer yes should not be fit-tested. They need new medical clearance before being fit tested.

32 Medical Reasons That Could Prohibit the Use of a Respirator A history of pulmonary or lung problems such as: Asbestosis, asthma, COPD, emphysema, TB, silicosis, shortness of breath, etc. Do not use a respirator if you have any health or respiratory problem until you obtain clearance from a Physician or other Licensed Health Care Professional.

33 Step 5 Before conducting the fit-test, check for facial hair - Persons who have Facial Hair must not be fit tested Beards, stubble, or sideburns will prevent a good facepiece seal. If practical, have shaving supplies available. No exception to this rule

34 Step 6 Before the fit-test, perform the Sensitivity Test This test is done to assure that the person being tested can detect the sweet or bitter taste of the test solution at very low levels. The Sensitivity Test Solution is a very dilute version of the Fit Test Solution. The test subject should not eat, drink, or chew gum for 15 minutes before the test.

35 Step 6 (cont) -Sensitivity Test The test hood is placed over the subject s head (without the respirator on) and the sensitivity solution is misted inside to make sure the subject can detect the test solution. If the subject can not detect the solution after 30 squirts a different test agent must be used or the fit-testing cannot be performed.

36 Step 7 Show the person being fit-tested how to inspect the respirator, don the respirator, and how to perform the positive and negative leak test Select the appropriate size depending upon the size of the person s face. Inspect the respirator for defects. Stretch the elastic straps slightly Follow donning instructions on the box

37 Donning an N95 Using both hands, starting at the top of the respirator, mold the nose clip around your nose to achieve a good face-torespirator seal Do not pinch the nose clip with one hand

38 Respirator Donning (continued) It is important to take the time to put on the respirator correctly each time it is worn!

39 A properly donned N95respirator The respirator must be correctly oriented on the face and held in position with both straps. The straps must be correctly placed, with the upper strap high on the head and the lower strap below the ears. For persons with long hair, the lower strap should be placed under (not over) the hair. The nose clip must be tightened using both hands to avoid gaps between the respirator and the skin.

40 Respirator Fit Check If the solution is detected at any time during the test: STOP! Instruct subject to remove the hood and mask; take a sip of water. Re-adjust the N95 and try again or try a different size/model Remind people being fit-tested that it is important to check the seal of the respirator by each time it is put on by performing the fit test.

41 RESPIRATOR FIT CHECKS Perform both a Positive Pressure Seal Check and a Negative Pressure Seal Check Positive Pressure Seal Check: With the respirator securely in place exhale greatly. The respirator will bulge slightly. If air leaks between the face and the face-seal of the respirator, reposition it and readjust the nose clip for a more secure seal.

42 RESPIRATOR FIT CHECKS Negative Pressure Seal Check: With the respirator securely in place inhale greatly. The respirator will collapse slightly. If air leaks between the face and the face-seal of the respirator, reposition it and readjust the nose clip for a more secure seal.

43 Respirator Shaped Like a Tecnol Fluidshield Open respirator and pull out and separate the straps inside. Hold respirator up to face pulling both straps over head, ensuring that the straps are not twisted. the lower strap should be below the ear the top strap should be as far up on the crown of head as possible..

44 Respirator Shaped Like a Tecnol Fluidshield (continued) Adjust nosepiece to conform around bridge of nose. Perform both positive and negative seal check tests.

45 Donning a North N95 demonstration

46 Donning Kimberly Clark N95

47 Step 8 Perform the qualitative fit test Follow the instructions on the N95 Respirator Fit-test Protocol Available at: publications/n95_qualitative_fit_t est_protocol.pdf

48 Step 8 (cont.) Overview of How to Perform the Qualitative Fit Test After the subject dons the respirator and performs a positive and negative fit, the hood is again placed over the head and the Fit Test Solution (a very concentrated saccharin or Bitrex solution) is misted into the hood.

49 Step 8 (cont)the instructor then prompts the wearer to perform a series of seven 1- minute tests that are designed to challenge the seal of the mask Normal breathing; Intermittent deep breathes; Turning head side-to-side; Nodding head up and down; Speaking out loud The Rainbow Passage; Running in place, bending (designed to raise your heart rate!); Normal breathing

50 Qualitative Fit Testing Once a person has been successfully fit tested with a particular respirator, inform the person the brand and model number of the respirator that passed the fit-test. This is the only size and model that should used. Do not switch to another model or size for any reason without obtaining another fit test.

51 Step 9 Complete and sign the Fit-test record. Give the completed and signed forms to the person who is coordinating the respiratory protection program for your department The person coordinating the program for your department should ensure that personnel are informed of which respirators they were successfully fittested on.

52 A few more things to know about N95s

53 How often should N95 respirators be replaced? as required by infection control procedures (generally speaking, between patients) if resp is contaminated with blood or body fluids if resp becomes wet or moist if resp is damaged if you have difficulty breathing After direct contact with a person with symptoms of infuenza (within 6 feet, not behind a partition

54 Removing an N95 If the respirator is grossly contaminated with sputum or other bodily fluids only handle the straps. To remove First pull lower strap over the head Second remove the upper strap Discard the respirator if it is contaminated or damaged

55 Care of an N95 Must be replaced if wet or damaged. Replace if contaminated (i.e. sputum or other bodily fluids) Do not crease or fold Do not write on the mask. It is ok to write on the strap

56 Storage Store unused N95s in a large resealable storage bag (i.e. zip lock bag). However, do not seal the bag when the respirator is wet.

57 Questions? Problems? contact: Your campus EOHSS office: Newark/Scotch Plains Piscataway/New Brunswick Stratford/Camden