Respiratory Protection from Airborne Infectious Agents:

1. Respiratory Protection from Airborne Infectious Agents: Use of N-95 Disposable Particulate Respirators Vermont Department of Health, EMS Office This program was adapted in 2009 from materials developed by the New Jersey Dept of Health & Senior Services

2. Objectives • Explain what N-95 disposable particulate respirators are and why they are necessary • Describe their capabilities and limitations. • Demonstrate proper use. • Describe the proper maintenance and storage of N-95 respirators.

3. Why is an N-95 disposable particulate respirator necessary? Protection from airborne pathogens like influenza, tuberculosis, SARS, chickenpox, measles and smallpox. It protects by filtering out infectious particles from the air you breathe.

4. When is an N-95 disposable particulate respirator necessary? • Respiratory disease outbreak or • Intentional biological event N-95 disposable particulate respirators are the minimum level of protection needed for airborne infectious agents.

5. What is an N-95 disposable particulate respirator?

6. N-95s reduce exposure to particles that are small enough to be inhaled Sizes of some pathogens (microns) Fungi 2-200 Mold spores 1-70 Bacteria 0.5-10 Viruses 0.02-0.3 One meter = 39.37 inches One millimeter = one-thousandth of a meter (0.04 inches) One micron = one-thousandth of a millimeter (0.00004 inches)

7. N-95s reduce exposure to particles that are small enough to be inhaled N-95 filters are tested on particles greater than 0.3 microns in size. Particles < 100 microns can be inhaled through nose and mouth 1-5 micron particles can enter upper airways Viruses = 0.02-0.3 microns 0.1 – 1 micron particles can enter lower lungs and alveoli

8. What does “N-95” mean? An N-series filter that is at least 95% efficient in removing particles greater than 0.3 microns in diameter. • N = Not oil resistant • R = Resistant to oil • P = oil-proof • 95 = 95% efficient • 99 = 99% efficient • 100 = 99.97% efficient Respirators are evaluated by the National Institutes for Occupational Safety and Health (NIOSH)

9. How can you tell if a respiratoris NIOSH-approved? 84A-#### NIOSH approval number on respirator: Approval label in box NIOSH Certified Equipment List Website http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html

10. Is an N-95 disposable respirator the same as a surgical mask? NO A surgical mask is not a respirator. It is NOT NIOSH-approved.

11. Is an N-95 disposable respirator the same as a surgical mask? A surgical mask may not provide adequate protection for EMS responders…. BUT . . . A surgical mask on the patient may limit the spread of respiratory secretions.

12. What N-95 respirator is being issued? This EMS agency uses these N-95 disposable particulate respirators: Brand Model Sizes #1 ______ _____________ _____ #2 ______ _____________ _____

13. Advantages of N-95 disposable particulate respirators • Lightweight • Fairly comfortable to wear • Mobility not restricted • Disposable • Low cost • Require no cleaning or maintenance

14. Limitations of N-95 disposableparticulate respirators • ______ deficiency • Harmful chemical gases and vapors • _____ or ______ contact with pathogens • High concentrations of _______ They DON’T protect from:

15. Limitations of N-95 disposableparticulate respirators • Oxygen deficiency • Harmful chemical gases and vapors • Skin or eye contact with pathogens • High concentrations of pathogens They DON’T protect from:

16. What do these limitations mean for EMS? • Don’t enter an oxygen deficient atmosphere. • Don’t use an N-95 disposable particulate respirator for protection from chemical hazards. • If the airborne infectious agent is also spread by skin or mucous membrane contact (such as SARS), use eye protection, gloves and gown.

17. What do these limitations mean for EMS? • If an intentional biological event has occurred, higher levels of respiratory protection may be required. • N-95 disposable particulate respirators must be worn the entire time you are close to potentially infectious persons.

18. If N-95 disposable particulate respirators are issued, EMS agencies must comply with OSHA’s Respiratory Protection Standard • Written respiratory protection program with an assigned program administrator • Proper selection of respirators • 3. Training about the hazards and proper use • 4. Medical clearance initially and every three years (more often if there are changes) • 5. Fit testing (annually) • 6. Evaluation of program effectiveness (annually)

19. Proper Use of Your Brand and Model of Respirator • Proper donning • Seal check • Removal • Reuse OBTAIN AND REVIEW THE MANUFACTURER’S INSTRUCTIONS FOR:

20. General Seal Check Procedures for N-95 Disposable Respirators Whenever the respirator is donned: 1. Place one or both hands completely over the filtering facepiece. 2. Inhale and exhale sharply. If air leaks around your nose, readjust the nosepiece. If air leaks between the face and faceseal of the respirator, reposition it by adjusting the panels and straps. 3. If you cannot achieve a proper seal, do not enter the contaminated area. See your respiratory program administrator.

21. Proper Use • No facial hair that interferes with face to facepiece seal • If shape of the N-95 is compromised, it may not fit properly • If respirator becomes damaged, soiled or if breathing becomes difficult, leave the contaminated area and replace the respirator • If used in caring for patient with a disease spread through contact, dispose of N-95 after each use.

22. Medical Evaluation • N-95 use requires medical evaluation and clearance before use. • The medical evaluation is repeated in three years (or earlier if change occurs that might affect ability to use a respirator safely). • The medical evaluation includes a confidential respiratory questionnaire and/or in-person medical evaluation.

23. Medical Evaluation • Medical provider sends written clearance to the employer • Says only that the EMS responder can or cannot wear a specific respirator • No confidential information is included • Medical provider keeps questionnaire in confidential file.

25. Fit-Testing If a respirator does not make a tight seal around the face during inhalation, contaminated air may leak around the edges of the face seal. The only way to tell if a respirator fits and is capable of protecting properly is to fit-test the respirator. OSHA requires fit-testing prior to initial use and annually thereafter.

26. Quantitative vs. Qualitative Fit-Testing Quantitative: Computerized means of detecting faceseal leakage Qualitative: Relies on wearer’s subjective response to taste, odor or irritation

28. After the plan is initiated • OSHA requires annual program evaluation • Responsibility of program administrator

29. Respiratory protection is effective only if: • The correct respirator is used • It’s available when you need it • You know when and how to put it on and take it off • You have stored it and kept it in working order in accordance with the manufacturer’s instructions

30. Vermont Department of LaborOccupational Safety & Health Administration Project WORKSAFE 802-888-0620 www.labor.vermont.gov/?tabid=74 For more information, contact the Vermont Department of Health EMS responders: Office of EMS 800-244-0911 www.vermontems.org Other health care workers: Personal Protective Equipment Manager 802-951-0058