Airborne Pathogens: Elusive and Dangerous Part 2

“Controlling the spread of a potential influenza pandemic is of critical importance to the more than 14 million healthcare workers in the United States (approximately 10 percent of the U.S. workforce) and their patients,” Fries wrote in a NIOSH blog. “Given that healthcare workers will be on the front lines during an influenza pandemic, protecting them with the best available prevention methods and PPE is imperative to reducing illness and death and preventing the progression of a pandemic.”

The basic steps that medical facilities should take to contain airborne pathogen exposure involve having the necessary equipment on site, and making certain that personnel are properly trained to deal with a wide range of possible threats well in advance, Birkner says.

He believes that for respiratory protection, every facility should have an adequate stockpile of NIOSH-certified N95 respirators or comparable equipment. Every employee should have one. Guidance on the size of the respirator stockpile and other useful pandemic preparation information can be found at: www.osha.gov/dsg/guidance/stockpiling-facemasks-respirators.html.

“Although this document has not been finalized, it has some good information that medical facilities can use to help them prepare,” Birkner adds.

Improper or lacking respiratory protection can be life threatening, says Michael Wang, marketing manager for Bio-Medical Devices Intl. “Purchasers seeking protection for their workers should not be satisfied by minimum protection, and should seek better than the least that is recommended by regulatory agencies,” Wang says. These devices are most useful when healthcare workers (HCWs) know how to use them. “...conduct yearly refresher respirator usage courses for your HCWs so in the event of a pandemic, HCWs are least likely to be in a ‘panic’ mode and remember how to use their respirators properly and effectively,” Wang says.

Proper fitting of respiratory devices can be accomplished through various equipment. For instance, the PORTACOUNT® PRO+ respirator fit tester by TSI can improve risk management programs, according to Tonya Foucault, a spokesperson for TSI.

Of course, if air is clean in the first place respiratory devices aren’t as necessary. Overall air quality can be improved in most settings by maintaining a high number of air exchanges per hour (proper air flow characteristics), proper maintenance of equipment and filters, adequate humidity and consistent air quality monitoring and testing, Cirillo says.

“Healthcare workers can be better prepared for the threat of airborne pathogens through continuing education in infectious diseases, maintaining vigilance regarding normal versus abnormal frequencies of such infections in their setting and ensuring that they are prepared with the proper equipment and training for respiratory crises should they occur in patients,” he adds.

Evaluation of whether patients should be isolated should be done as early as possible to prevent spread of infection from person to person, and sterile technique should be adhered to, including proper use of PPE, Cirillo says.

“It is one thing to treat patients, but how does one receive treatment if all of the healthcare workers are also becoming ill?” Cirillo asks. “It is extremely important that healthcare workers become aware of any outbreak early, communicate with all other healthcare facilities and personnel immediately and help to prevent spread within the healthcare facilities themselves where there are likely to be a high concentration of infected individuals.”

Furthermore, healthcare workers should be vaccinated against as many potential threats as possible, and after an outbreak, it is “most important” that the facilities are properly decontaminated before any uninfected person is admitted, he adds.

Tools

The right equipment is rendered almost useless if it is not cared for and inspected. Fortunately, there are several ways a facility can maintain the highest level of equipment preparedness regarding airborne pathogens, Pierson says.

He recommends “methodical and regimented” inspection of all pre-filters and high efficiency particulate air (HEPA) filters in permanent heating, ventilation and air conditioning (HVAC) systems. He also suggests that portable mobile containment units should be kept in strategic areas of the facility along with negative air machines to provide HEPA-filtered negative pressure. “Staff should be aware of these locations and should be trained to construct, move and set airflow (for the unit),” Pierson says.

He also believes that surface disinfectants that are registered by the Environmental Protection Agency should be used regularly on touch points. “Training materials, signs and other printed materials indicating procedures may be helpful as reminders between training exercises,” he adds.

It’s frightening any time an infectious agent makes its way around a healthcare facility, and when this occurs, all departments must work in tandem.

“The ability to quickly isolate patients without moving them from their patient or treatment room is a tremendous asset when dealing with a potentially deadly disease, and while having the appropriate tools ... in place is critical, a response plan should also be worked out and rehearsed,” Pierson says.

“Each part of the infection control response team should know their part and be able to perform it quickly in the event of an emergency,” he adds. “A facility may want to set up mock situations in which temporary isolation must be set up, or a sudden surge of patients flood the ER (emergency room). Staff should understand the importance of patient isolation and be able to set up equipment properly.”

Q & A: Respiratory Industry Insiders

Offer Airborne Pathogen Advice

Grant Rowe, respiratory protection product manager for Bullard, and Michael Wang, marketing manager for Bio- Medical Devices Intl., took part in an Infection Control Today Q&A about prevention and containment of airborne pathogens.

1. How should medical facilities prevent the spread of airborne pathogens? What steps should be taken?

Rowe: I am not a nurse, a doctor, healthcare worker, or even a facility designer but I can give you my perspective as a respiratory protection manufacturer and as someone who actively participates with APIC (Association for Professionals in Infection Control and Epidemiology) and AOHP (Asthma Health Outcomes Project). First, patients need to be quickly diagnosed and isolated. This doesn’t mean that the exact ailment must be determined immediately but a decision should be made very quickly if a patient should be moved to isolation. The isolation room is typically negative pressure which means that air from inside the room cannot escape due to pressure difference. It will also have ventilation with HEPA (high efficiency particulate air) filtration that completely removes and replaces the air many times per hour.

Next, anyone that comes in contact with patients suspected to have a potentially contagious infection that can be spread via airborne pathogens should take airborne precautions, and many times must also take contact precautions.

The specifics of these are spelled out by the CDC (Centers for Disease Control and Prevention) but they call for a NIOSH approved respirator such as an N-95 mask or higher protection. It is important to understand that a surgical mask is not a respirator and provides no protection against airborne pathogens. A surgical mask only prevents droplets from the healthcare worker reaching the patient. A respirator prevents airborne particles from reaching the healthcare worker. It is also important to understand that an N-95 mask is a tight fitting respirator that requires annual fit testing of the healthcare worker. In years past, OSHA did not enforce this but the Wicker Amendment has expired and enforcement is now in effect.

In addition, facial hair is not allowed when wearing a tight-fitting respirator such as an N-95 mask. Furthermore, it is important to be aware that there are respirators that do not require fit testing. PAPRs when worn with loose-fitting face pieces or hoods do not require fit testing. This is because air is constantly flowing into the respirator and effectively pushing out contaminants that may try to enter through the loose seal. This type of respirator actually provides higher protection than an N-95; PAPRs carry an assigned protection factor (APF) of 25 or 1000 (depending upon the head top) while an N-95 mask only carries an APF of 10. For more about assigned protection factors go to www.osha.gov.

Read more in part 3 Click Here

Air Purification Product with RCI Technology