BEHAVIORAL OBJECTIVES • Understand traditional barriers of conversion to PAPRs • Understanding the need for increased focus to optimize protection • Understand proper protocols/fit test challenges • Features to consider when reviewing PPE for Bio-Hazards • Understanding the positive impact of PAPRs
PRESENTATION OUTLINE • Discuss Historical Standard of Care • PAPR Use in Infection Control & Prevention • Understand The Difference In The Levels of Protection Offered Between N95/PAPR • Identify & Understand The Critical Elements Involved In Evaluating Optimum Levels of Protection w/PAPRs
• Changing the Respirator Standard of Care
HISTORICAL STANDARD OF CARE (SOC) – N95 • PROS • Simple Device • Perceived Ease of Stocking/Distribution • Minimal up front/initial purchase price
HISTORICAL STANDARD OF CARE (SOC) – N95 • CONS • High level of user intolerance leads to high level of non compliance…poor overall protection • Reality of time consuming and complex ordering/stocking/distribution due to different brands, types and sizes required by HCW differences • On-going costs are extremely high • Fit testing and fit testing equipment • Managing those “no - fit” employees
HISTORICAL STANDARD OF CARE (SOC) - N95 • BOTTOM LINE ISSUES • N95s currently accepted by many w/o challenge • Reluctance by many to consider modern-design PAPR technology alternatives now available • Inherently higher protection factors • Demonstrated greater use-tolerance • Financial analysis demonstrated lower cost-over-time implementation • Most singular solution for all at-risk personnel
PAPR USE IN INFECTION CONTROL & PREVENTION • Traditional Barriers to Convert to PAPRs • Bulky/Heavy • Limited freedom of movement • Auditory issues – cannot use stethoscope • Must be able to hear patient vitals • Battery memory • No confidence in performance
PAPR USE IN INFECTION CONTROL & PREVENTION • Traditional Barriers to Convert to PAPRs • High cost of disinfection • Higher cost to replace disposables • Complicated instructions for use • If HCWs are expected to wear PAPRs…they must be simple to use • High cost of ownership • High cost of disposables • Increased cost due to premature disposal due to high cost of disinfection
PAPR USE IN INFECTION CONTROL & PREVENTION • Patient Safety a Major Concern • Too long to don traditional PAPRs • Bulk and weight limit freedom of movement • Noise can inhibit communication w/patient • Less patient friendly
PAPR USE IN INFECTION CONTROL & PREVENTION • Focus Needs To Increase On • Policy and Quality Education of PAPRs • Optimize implementation of PAPRs • Battery Maintenance • Simplify Cleaning & Storage Requirements • Comfort/Protection • Real time monitoring of air flow/battery charge • Patient safety • Utilizing new technology/designs in PAPRs
N95 DISPOSABLE RESPIRATOR • “N” – The respirator is NOT resistant to oil • “95” – 95% efficient • Estimated efficiency of N95s • 80% - 85% due to differing facial structures
PAPR LEVEL OF PROTECTION • 99.97% efficiency • “N” rated equivalent/comparable • Typically are not used in oily atmospheres • Bacterial & Viral contaminants • NO chemical protection
PROPER FIT TEST PROTOCOL • Administrative activities • Threshold Sensitivity Screening • Test subject’ s ability to detect test agent • Allow sense of smell to clear • 7 breathing exercises • Each exercise to last one minute • Stop test if subject detects odor • Fit with new respirator • Complete administrative paperwork
COMMON MAJOR MISTAKES DURING FIT-TESTING • Failure to conduct proper user seal check • No threshold sensitivity screening • Insufficient # of squeezes – fit test solution • Incorrect number/length of exercises • Failure to conduct proper type of exercises that may potentially identify leakage
FIT TEST CHALLENGES • Healthcare workers are on duty & must respond to patient care hindering Fit Testing • Fit Testing is time consuming and places a strain on the workload of any Occupational Health Department • Cost of Fit Testing is a high expenditure against budgets • Fit Testing is required annually placing further burden on human resources and budgets
GUIDELINES FOR THE EVALUATION OF PPE FOR INFECTION PREVENTION & CONTROL
PPE CONSIDERATIONS – WHAT TO LOOK FOR WHEN EVALUATING PPE • Mobility – ease of movement • Comfort – breathing resistance • Visibility – peripheral vision • Eye protection • Hearing • Status of system operation • Use of primary care equipment • Donning/Doffing • Disinfection
PPE CONSIDERATIONS – WHAT TO LOOK FOR WHEN EVALUATING PPE • Decontamination procedures • Time • Materials • Effectiveness • Storage • Define the role - affected departments • Training Provided
THE BENEFITS OF CONSIDERING THE USE OF PAPRS • Higher levels of protection • Higher levels of breathing comfort • Longer-term protection • Greater degree of safety • Job performance safety • Recent advances in design built around • Comfort • Safety • Designed to enhance safety…comfort…ability to perform work - related tasks
COSTS OF NOT CONSIDERING HIGHER LEVELS OF PROPER PPE • Increased risk of exposure • Reduced safety for the HCW • Reduced comfort • Higher cost of operation • Minimal protection • Abuse of protection • Hidden costs of employee exposure
REASONS GIVEN FOR NOT WEARING PAPRS • Bulky • Uncomfortable • Self-conscious • Won’t use it • Difficult to hear • Difficulty in performing duties • Patient reaction • Use of stethoscope limited • Too costly • Human Nature – resist change w/the unfamiliarity • Vanity
PAPR USE IN INFECTION CONTROL & PREVENTION • Need for commitment to worker safety • Protection of HCWs • Increased understanding of PPE • Appropriate PPE use needs strengthening • Convenience does not assure protection • Increased protection is not unmanageable
QUESTIONS TO CONSIDER • Is “ minimum ” or “ less than optimal protection ” really acceptable for your HCW’s? • Is Fit Testing • QLFT/QNFT time • Equipment cost • Time away from work – to get to “minimum” protection – really worth it? • Are you really prepared?
THE TAKE HOME MESSAGE IS… • Understand the “Sense of Urgency” in your facility • Take the time to understand your options • Carefully & objectively know the PPE pros & cons • Choose the Optimum solution • Keep in mind your primary goal…the protection of your healthcare workers
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