Airborne Pathogens: Elusive and Dangerous Part 3

Finally, training must be done early and often. Too often I hear about a hospital receiving HRSA (Health Resources and Services Administration) grant money and buying respirators that get locked up in a remote storage location never to be heard from again. The danger here is that when the protective equipment is needed it will be too inaccessible and used improperly.

Wang: Respiratory protection, or the lack thereof, can obviously be life threatening. 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. The US Department of Labor says, “NIOSH-approved disposable particulate respirators (e.g., N95, N99, or N100) are the minimum level of respiratory protection that should be worn.” NIOSH (National Institute for Occupational Safety and Health) also says that, “Surgical masks are recommended only as a last resort for health care and medical transport workers exposed to SARS patients when no NIOSH-approved respirator equivalent to or greater than the N-95 is available.”

Key respirator qualities and characteristics that would provide proper respiratory and contact protection as well as be safely and conveniently compatible with a wide range of working environments to allow cost effective, full scale implementation, would include ≥ 99.97 percent filtration efficiency, approved by NIOSH (minimum HEPA level efficiency); universal fit — not necessary to fit test users so they are usable by any employee and may be shared with proper decontamination between uses; reusable to provide long term cost effectiveness; be free of bulky, weighty, or extending apparatus so as to not impede aggressive and agile movements as may be required in the work environment; be comfortable and convenient to the wearer to facilitate use compliance; be rugged and reliable for routine, daily use and for extended periods during emergencies; provide visual indication of filtering and operation effectiveness and safety.

Upon close examination, implementing a PAPR- (Powered Air Purifying Respirator) based infection control program for your HCWs (healthcare workers) can be both an increase in HCW safety as well as an advantage to the bottom line.

In addition, some facilities have considered assigning HCWs, who have a high risk of exposure to airborne pathogens, a PAPR to take home to minimize the likelihood of absenteeism in the event of a pandemic.

Lastly, 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.

2. In a physical disaster or a pandemic event, what airborne pathogens are most likely to cause problems, and how should they be treated?

Rowe: At present pandemic flu is the most likely danger. Experts are somewhat divided over whether the question is a matter of if or when the next pandemic will occur, but history has shown that there is a definite trend pointing to a pandemic in our near future. Other concerns are TB which appears to be patients that actually contracted it years ago and are having flare ups in the present day. Mold is a huge concern especially in areas where flooding or humidity can be heavy. The good news is that airborne precautions and contact precautions are very effective regardless of the specific pathogen. It is important to understand that some infections can enter in through the eyes (such as mold) and an N-95 mask will not be sufficient; tight-fitting goggles, a full face respirator, or a PAPR with a loose-fitting face piece or hood would be more appropriate in these situations.

Wang: In a physical disaster or a pandemic event airborne pathogens such as TB, SARS, Bird Flu (H5N1), Anthrax, mold/fungus, and other contagious elements expelled from buildings, underground, and other closed areas which can house such contaminants, may cause serious public health damage.

Please refer to your facility or CDC guidelines for proper treatment procedures.

An easy and obvious “preventive” measure is to properly wear a respirator during and after the incident. In addition, make sure your eyes are covered/protected with goggles. Thus, making MAXAIR an ideal choice of respiratory, head, face, and neck protection in the event of a physical disaster or a pandemic.

3. What materials should every healthcare facility have on hand to prevent airborne pathogen transmission?

Rowe: Signage, educating visitors, patients, contractors, vendors, and healthcare workers. Respirators, negative pressure isolation rooms, plans to handle surges including stockpiles of PPE (personal protective equipment), emergency surge capacity shelters and educational materials.

Wang: Respirator and surgical masks are most commonly used to prevent airborne pathogen transmission. However, more and more attention is being directed toward the use of PAPRs.

Why? The principle purpose of a surgical mask is to protect the surgical field and others (patients) from the spread of droplets from the users. Additionally, surgical masks may be used for user protection from splash during surgery.

A larger concern about surgical mask protection for a HCW is that they are typically not designed to make a seal against the face of the wearer. Without a good seal, their protection against viral and bacterial contaminants is poor.

Even N95 respirators are receiving greater scrutiny relative to their ability to provide cost effective bacterial and viral protection due to their low-filter efficiency and need for fit testing verification for each individual, for each brand and style of respirator, annually.

Fit testing is accomplished by qualitative as well as quantitative protocols. Qualitative fit testing is perhaps the easiest and fastest means of fit testing. The results are along the lines of “you get what you pay for” as results are variable.

Quantitative fit testing requires more technical skill and $10,000-$20,000 of test equipment.

The main concern about fit testing is that even when done properly and accurately, the HCW is only assured of a good fit for the masks that were used during the testing. Once they leave the test area, putting on another mask is another fitting episode. Is it done by the individual the same way each time, under the pressing conditions of the infected patient care regime? If not, disaster can happen as it did in Toronto during the SARS epidemic.

Also, masks, N95 and surgical, can not be fitted to HCWs with facial hair and other variables in facial shape, such as scars, large weight gain or loss, etc.

Even with a secure fit, the inherent filtering efficiency is less than PAPRs.

FDA (U.S. Food and Drug Administration) does not test surgical masks as they do respirators. Surgical masks are rated by the manufacture, and their reported particle filtration efficiencies, e.g., >95 percent, may be considerably higher values than what would be obtained using NIOSH N-95 test methods, e.g., as low as 70 percent.

Similarly, the maximum, ideal filtration efficiency of an N95 respirator is only guaranteed to be 95 percent. That means that with an excellent fit, 5 percent of the contaminant has to be expected to get through.

PAPRs (helmet-style respirators) use inherently higher efficiency filters than either surgical masks or N95 respirators. And, they are positive pressure respirator systems so they do not require fit testing. Also, they are reusable and are used interchangeably between HCWs, with appropriate decontamination between uses.

Masks and N95s are negative pressure devices. When the user inhales they create negative pressure within the mask that will suck in contaminated air anywhere there is an incomplete seal with their face. This is why a perfect seal, or fit, is so crucial.

PAPRs on the other hand, are positive pressure devices. For example, the MAXAIR System blower pulls the contaminated air through high efficiency filters, with from 99.97 percent to 99.997 percent filtering efficiency.

Now only .03 percent to .003 percent of the contaminant may get through. That is at least 150 to 1,500 times less than a mask.

The MAXAIR blower pulls in air, filters it, and passes it gently down in front of the face at a user selectable 6 CFM to 9 CFM. This provides sufficient air for all working conditions, and it provides an automatic cooling effect to the user.

More importantly, the high volume of air flow creates a positive pressure within the helmet so that the HCW can not pull in contaminated air from around the facial seal. This is the reason PAPRs do not require fit testing.

Another benefit of the PAPR air flow control is that is makes breathing as natural as if the HCW wasn’t wearing a respirator at all. This is not the case with masks as they present resistance to breathing.

Just as a leading healthcare institution published in 2005, you can achieve both better respiratory protection and a long term cost advantage with a non conventional PAPR solution such as MAXAIR.

Air Purification Product with RCI Technology