The Use and Effectiveness of Powered Air Purifying Respirators in Health Care Workshop Summary (2015) / Chapter Skim
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3 Why, Where, and How PAPRs Are Being Used in Health Care
3 Why, Where, and How PAPRs Are Being Used in Health Care
Pages 19-42
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From page 19... ...
Information was presented from two respirator research studies that quantified the differences in respirator use around the country. Representatives of two hospitals and one union shared what they have learned from health care workers about PAPR use and preferences.
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From page 20... ...
The REACH II Study evaluated hospitals' respiratory protection programs and respirator usage in six states/five regions across the United States: California, Michigan, Minnesota/Illinois, New York, and North Carolina. Data were collected from 1,500 hospital managers, unit managers, and health care workers from 98 hospitals and included 300 demonstrations of donning and doffing protective equipment.
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From page 21... ...
. Jennie Mayfield, Association for Professionals in Infection Control and Epidemiology, stated, "Based on experiences in the facilities of some of our members, we anticipate that, as PAPRs become cheaper and lighter, health care employers may consider expanding PAPR use to alleviate the burden of N95 fit testing, rather than from any appreciable benefit of employee protection." Similar comments were submitted by Dan Diekema, Society for Healthcare Epidemiology of America, and Barbara Murray, Infectious Disease Society of America, who noted, "Many facilities with low incidence of [tuberculosis]
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They have approximately 2,400 employees in the respiratory protection program. Health care workers have to complete a two-page questionnaire about their health histories.
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In addition, reminding people to complete N95 respirator fit testing, and keeping track of who has completed fit testing and who has not, is quite complex from a bookkeeping perspective. Health care workers need to have meaningful evidence to be persuaded to do something they do not want to do.
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From page 24... ...
Given the high cost per unit, PAPR availability will always be a problem in the event of a major outbreak or act of bioterrorism. Health care facilities need to have dual systems for N95 respirators and PAPRs, and they need to train health care workers to use both.
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has more than 2 million members, with more than half of them working in the health care field, including tens of thousands of physicians and nurses. A survey of about 150 SEIU members who are health care workers showed stronger support for using PAPRs than for using N95 respirators.
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From page 26... ...
Discussion on Health Care Worker Experiences Using PAPRs During the discussion session, the workshop participants considered how PAPR use in health care should be measured and how proper respiratory protection should be extended to non-hospital health care settings. James Johnson reminded workshop participants that N95 respirators and PAPRs are respiratory protective devices that are used for different hazards.
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From page 27... ...
Radonovich added that there is a need to address the confusion among health care workers about what they should be doing to properly protect themselves and to address the fact that there are some workers who do know what they should be doing but who do not always comply with the guidelines. Harber noted the importance of enhancing respiratory protection in ambulatory care settings where patients often go with symptoms that may signal presence of an infectious disease.
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Fit testing for the elastomeric air purifying respirators involved unit-based fit testers and educators as well as centralized fit testing services. Selective deployment of PAPRs in their facilities made respiratory protection available to all staff and helped minimize the need to potentially fit test and supply tight-fitting respirators to all staff.
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From page 29... ...
air purifying respirators that can be interchanged between different manufacturers' masks, although this may be in violation of certification. PAPR Use and Research at the Department of Veterans Affairs Lewis Radonovich, Department of Veterans Affairs PAPRs are used in most medical centers across the VA health care system, which includes outpatient clinics and hospitals.
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to make recommendations for future development of respirators for health care workers (Radonovich et al., 2009)
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Health care workers at Johns Hopkins are expected to know how to don and doff a respirator without contaminating themselves, so that they do not put themselves or their patients at risk. Furthermore, the workers need to know when the PAPR headpiece can be reused and when it has to be discarded due to exposure to certain infections.
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From page 32... ...
Perl stated that health care workers do see advantages in using PAPRs, as the equipment makes them feel safe; does not require them to breathe through a facepiece, which can be taxing for workers who are older or have underlying respiratory problems; and can be more convenient, because the PAPRs used in their facilities do not require fit testing and are reusable. She identified the top opportunities for overcoming barriers to the effective use of PAPRs in health care settings: decreasing noise, simplifying the cleaning and storage requirements, and improving battery life.
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From page 33... ...
The opportunities to improve NIOSH certification for PAPRs include clarifying the issues regarding the use of PAPRs in a sterile field, providing guidance on the appropriate use and decontamination of PAPRs for novel infectious diseases, and advancing the evidence that respiratory worker safety translates to safer and healthier workers and patients. Discussion on Health Care Employer Experiences with PAPRs The group discussion began with a focus on respiratory protection training.
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From page 34... ...
He stated that because the PAPRs used in the Mayo Clinic facilities do not need to be fit tested, the PAPR training is usually a show-and-tell format with little or no handson practice. An opportunity for hands-on training, noted Chang, is when an airborne isolation patient enters the University of Maryland's tracking system.
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. She added, "It would be up to the health care workers to tell the manufacturers that ‘this is the type of thing that we need.' And then we would be able to certify it.
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"Three factors have to be met in order to provide protection: proper equipment, properly worn, by a properly trained individual." Training is critical, and teaching health care professionals how to properly use PPE should be a core element of their education. A final necessity is a sustained market that builds respirators to meet the needs of health care workers.
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From page 37... ...
Challenges to using PAPRs that were identified in the laboratory work included a relatively short battery life, difficulties in hearing due to the noise of the blower, and to a lesser extent, difficulties in seeing due to the hood. The dedicated laboratory staff who were wearing PAPRs did weekly equipment checks, had a battery cycling schedule, and determined the cleaning procedures.
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has more than 15,000 members, most of whom collect, analyze, and interpret health care–associated infection data and work to reduce such infections. During the H1N1 influenza pandemic, APIC disseminated a position paper on extending the use of or reusing respiratory protection in health care settings during disasters.
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From page 39... ...
Ideally, PAPR design and NIOSH certification of PAPRs would consider the specific needs of health care workers. Preparedness and Response in the Chicago Department of Public Health Christopher Shields Chicago Department of Public Health The Chicago Department of Public Health oversees clinical and nonclinical emergency responders.
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Discussion on PAPR Use in Emergency Response The discussion began with participants voicing an overarching concern about performance requirements for PPE for health care workers. Bill Kojola raised the issue of the uncertainties about what is an infectious dose for each of various pathogens.
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From page 41... ...
An additional topic of discussion was the training and maintenance manuals for PAPRs. D'Alessandro noted that NPPTL reviews user instructions as part of the respirator certification process but does not require training or maintenance manuals and does not review those materials when they are available.
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