An impressive number of new research and application related publications have been reviewed since the publication of the first edition. The references including relevant web sites and abstracts of these publications have been included to help the reader select appropriate resources for further reading.
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Choosing the appropriate equipment for hazardous situations
Good practice Is the RPE you're providing protecting worker health? Working with your RPE supplier. Free email updates Subscribe for free email newsletters and notifications - news and updates on Respiratory protective equipment. Email Address. Is this page useful? Few studies have tracked changes in carbon dioxide levels within the dead space of reusable elastomeric respirators and symptoms of hypercapnia among health care workers.
The dead space concentrations of oxygen However, it should be noted that these standards are not specifically applicable to respirator dead space. Despite increased carbon dioxide levels, no participants reported experiencing symptoms of hypercapnia Roberge et al. More research is needed to better understand whether the extended use of reusable elastomeric respirators over lengthier periods is associated with an increased exposure to carbon dioxide or to user discomfort Roberge et al.
Considerations about the psychological response of health care workers to the introduction and use of reusable elastomeric respirators in the workplace are critical for decision making, as compliance is essential. However, little is known about psychological responses to the use of reusable elastomeric respirators among health care workers experiencing the unique demands of a health care environment Roberge et al.
What is known is that many members of the general population live with general anxiety or panic disorders, which can be triggered by the perceived or actual physiological outcomes of respirator use Morgan, ; Wilson et al. Wu and colleagues found a statistically significant increase in state anxiety during the use of reusable elastomeric respirators by participants and no significant increase during the use of disposable filtering facepiece respirators. This small study involved 12 subjects in a simulated work environment performing set tasks that ranged from sedentary to requiring moderate levels of exertion.
Anxiety was measured at baseline and during respirator use with the State-Trait Anxiety Inventory, which measures the more constant anxiety characteristics of the individual trait anxiety and the specific level anxiety at the instance of measurement state anxiety. The participants experienced a 2. Although the evidence is limited, preexisting anxiety may make some users more likely to experience distress while wearing a respirator; however, this has not been sufficiently tested among users of reusable elastomeric respirators in a health care setting.
Additionally, Wu and colleagues comment that the physiological impacts of general respirator use shortness of breath or overheating may themselves play a more direct role in instigating an anxiety response among users, and these responses could be mirrored in the use of reusable elastomeric respirators in health care. Given the importance of user compliance and the significant role that psychological responses play in achieving high levels of compliance, respirator design and training should be developed with anxiety reduction in mind Wu et al.
The accessibility of reusable elastomeric respirators at the moment they are required by staff is a critical component of compliance with respiratory protection guidelines. However, the availability and accessibility of respiratory protection at the point of care has been cited by health care workers, specifically mobile staff, as a significant barrier to the use of these respirators. TCID and UMMC, both of which use reusable elastomeric respirators, have highlighted the difficulties associated with respirator availability. At UMMC, while the majority of respirator users 94 percent report that they usually or always have access to their respirator when they need it, as many as 40 percent of this group store their respirator in a location that is not readily accessible or is suboptimal Hines, This is especially true of mobile groups such as respiratory therapy staff and medical residents who may travel to multiple units during the day Hines et al.
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Furthermore, these mobile staff members were less likely than non-mobile staff to adhere to reusable elastomeric respirator use when so designated and more likely to prefer the use of the more accessible filtering facepiece respirators Hines et al. Of their experience in Vancouver, British Columbia, the investigators wrote,. Regarding availability, subjects identified challenges in obtaining an EHFR [reusable elastomeric respirator] when doing break relief, having to re-enter the patient room without time to complete the wipe of the EHFR and others noted that since there was an adequate supply of N95 FFRs they did not have to use an EHFR.
Ciconte et al. While there are a variety of logistical and storage options available, such as keeping the respirators in a central location such as a nurses station or locker or requiring staff to carry their assigned respirators with them Radonovich, , no option entirely eliminates issues with accessibility while balancing acceptability. TCID overcame this issue by having respirator users carry their reusable elastomeric respirators with them in a backpack Kizilbash et al.
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However, this requirement has been viewed in other organizations as a nuisance Hines et al. Among many users, reusable elastomeric respirators are perceived to be more protective due in part to a perception that it is easier to achieve a good and reliable fit with a reusable elastomeric respirator Hines et al.
This confidence in the protection provided by their respirator is likely related to the secure fit of the flexible elastomer seal, confidence in the ability to be fit tested, and continued confidence in the ability to achieve a good fit during regular use, as the fit can be easily checked at any time by performing a user seal check. Despite overall dissatisfaction with comfort and communication characteristics, elastomeric respirator users continued to prefer the use of this respirator in certain risk scenarios Chang, Reusable elastomeric respirator users did not have different inherent perceptions about specific threats than did users of filtering facepiece respirators Hines, There does not appear to be strong evidence of widespread patient anxiety triggered by the use of reusable elastomeric respirators by health care workers.
With the pandemic deployment of reusable elastomeric respirators at the University of Maryland, concerns were expressed that these respirators may cause anxiety, especially among children, as well as among intensive care unit patients with delirium. The committee could identify only one published article relevant to this topic. Forgie and colleagues surveyed 80 pediatric patients ages 4 to 10 years old and. Just over half 51 percent of parents preferred that their child be cared for by physicians wearing a face shield.
Sixty-two percent of parents stated that they thought the children would choose a provider wearing a face shield often noting that they thought it would preferable to see the face. The children did not have a strong preference with 49 percent choosing the physicians in the face shields and 39 percent choosing the medical mask. Fifty-nine percent of the children did not find either option frightening. This study provides important initial insights into how patients and their family members perceive the use of protective facial coverings by health care providers.
Reusable elastomeric respirators are not widely used in health care. In a survey of health care workers, only 26 percent reported that their institution had used reusable elastomeric respirators in the last year, as compared with 95 percent that had used disposable filtering facepiece respirators Wizner et al. Furthermore, of those institutions that had used reusable elastomeric respirators, none had used them exclusively. Based on this research, it is clear that these respirators are in use in health care facilities to a very limited extent; however, where, how, and by whom these respirators are used is largely unknown.
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The committee identified two health care facilities where reusable elastomeric respirators are widely used or had recently been used as part of an established respiratory protection program. TCID is the only known health care institution that uses reusable elastomeric respirators as the primary device in their respiratory protection program Joint Commission, UMMC is a bed academic medical center with approximately 8, staff and 1, faculty members located in downtown Baltimore, Maryland. In there were approximately 28, admissions, 61, emergency department visits, , outpatient visits, and 9, transfer admissions.
At UMMC, respiratory protection is used for protection against airborne infectious diseases, chemicals in laboratories and decontamination , and hazardous medications Chang, The need for reusable respirators was identified during pandemic planning for H5N1 avian influenza.
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Using a conservative model and assumptions, UMMC estimated that it would need almost , disposable filtering facepiece respirators to protect 1, front-line staff for the projected pandemic period of 42 days. Caching this many disposable filtering facepiece respirators was not considered reasonable, and it was thought that the supply chain would not be able to meet this spike in demand.
Instead, the organization decided to purchase 1, reusable elastomeric respirators with P cartridges for its stockpile cache. A number of respirator models were considered using such criteria as ease of fit, comfort, and cartridge selection. The model that was eventually selected was chosen due to its comfortable, fault-tolerant design and the enclosed, low-profile high-efficiency particulate air filter cartridge, versus the traditional open-face cartridge design of other models. The presenter noted to the committee that the use of one reusable elastomeric respirator per health care worker was considered cost effective, as a worker can use an excess of 20 disposable filtering facepiece respirators over the course of one shift Chang, By September supplies of disposable filtering facepiece respirators were extremely limited.
When it became apparent that the supply chain was not going to provide sufficient PPE for staff, UMMC began deploying its reusable elastomeric respirator cache preferentially to high-risk units and staff—the medical intensive care unit, the pediatric intensive care unit, emergency departments, respiratory therapists, and other specialties.
A cadre of unit-based volunteers, who were trained en masse, performed qualitative fit testing for the new respirators. Users were provided with instructions for use and with alcohol wipes for facepiece cleaning and were told to store their assigned respirator in a gallon plastic reclosable bag. Protocol required that users wash their assigned respirator weekly. Acceptance of the new respirator was high and undoubtedly influenced by the pandemic. The primary complaint heard from health care workers was the difficulty the patients had in hearing and understanding the provider when wearing the respirator.
There were also some concerns that the respirator would be frightening to pediatric patients and disoriented patients; however, these concerns proved largely unfounded Chang, As the pandemic situation ameliorated and the supply chain caught up with demand, UMMC elected to continue with the use of reusable elastomeric respirators as its first choice for respiratory protection. This choice was largely due to the perception of greater safety by users, fault-tolerant designs, ease of fit testing, and the ability to do a user seal check see Table Changes were made to the respiratory protection program in response to user requirements e.
However, concerns regarding the ability of the supply chain to provide adequate stocks of disposable filtering facepiece respirators and other products remain Chang, Currently, respirators in use at the medical center include N95 disposable filtering facepieces as well as reusable elastomeric respirators with P or chemical cartridges and PAPRs. However, the medical center is now beginning to shift away from reusable elastomeric respirators.
UMMC recently participated in a research study to assess user acceptance of the reusable elastomeric respirator Hines et al. Concurrently, direct feedback on the program from users indicated that mobile staff staff not assigned to one location such as respiratory therapists and residents did not travel with their reusable elastomeric respirator and instead were using the nearest available disposable filtering facepiece respirators. Furthermore, manufacturer instructions for cleaning were not consistently followed. As a result, many users were converted to disposable filtering facepiece respirators during their annual fit-testing cycle, and employees new to the UMMC respiratory protection program were provided with disposable filtering facepieces preferentially.
Currently, users may continue to opt for reusable elastomeric respirators on a request basis Chang, TCID specializes in the management of hard-to-treat tuberculosis TB cases by providing additional structure, access to specialized services, and a focused environment in which infectious disease specialists can practice. Hence, the specialized respiratory protection needs of health care workers in this institution may not be generalizable to other health care environments Kizilbash et al.
Prior to , the facility did not have an infection prevention and control program other than annual tuberculin skin testing TST.
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The testing showed that 40 to 50 percent of their staff had converted to TST positive after employment, and 1 to 2 percent of staff had TB disease. There were multiple reasons for this high seroconversion rate. Prior to , only medical masks were used for employee protection. In response to the need to better protect its employees, TCID implemented its respiratory protection program in Kizilbash et al.
Factors that influenced this selection included the perceived reliability, better protection, comfort, cost effectiveness, and ease of fit testing and user seal check experienced with the reusable elastomeric respirators see Table Following the TB test conversion of seven employees in , the facility has not had a TST conversion since Given the severity of TB and other diseases treated at TCID, adherence to the use of respiratory protection is highly prioritized, and fit testing is available to all employees at all times through the cardiopulmonary department, in addition to the yearly required fit test Joint Commission, All staff who enter patient rooms are required to undergo respirator qualitative fit testing and training.
TCID differs from many other health care centers in that it does not need to select specific clinical staff to undergo fit testing. Filter cartridges are changed annually or when dirty, saturated with fluids, damaged, or difficult to breathe through Joint Commission, Staff are required to leave their assigned respirators at the facility and to wipe the respirators after every use with an alcohol wipe. Cleaning is performed by removing the filter cartridges and submerging the facepiece in a soap and water solution Kizilbash et al.
Additionally, the correct usage and maintenance of reusable elastomeric respirators is routinely reinforced among the staff through equipment checks, written testing of infectious disease control knowledge, and documentation of respirator use. TCID reports high staff compliance with respiratory protection program policies, including the correct usage of reusable elastomeric respirators.
checkout.midtrans.com/arbo-lugares-para-conocer-gente.php The effectiveness of the respiratory protection program is evaluated through TB skin test conversions and incidence of active TB infection or other communicable diseases among staff Joint Commission, ; Kizilbash et al. A summary of the benefits and challenges of elastomeric respirators as identified by TCID staff is provided in Table Full facepiece respirator series: User instructions. Cleaning reusable respirators and powered air purifying respirator assemblies. Paul, MN: 3M. Baig, A.