Reusable Elastomeric Respirators in Health Care Considerations for Routine and Surge Use (2019) / Chapter Skim
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4 Research and Development
4 Research and Development
Pages 153-174
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From page 153... ...
. This chapter focuses on the research and development efforts that are needed to improve reusable elastomeric respirators, beginning with a discussion of performance parameters and then examining the need for research on better understanding the airborne transmission of certain infectious diseases, cleaning and disinfection, designing for the next generation of elastomeric respirators, and informing market demand and the supply chain.
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From page 154... ...
From the health care facility management's perspective, durability, maintenance, and affordability are of importance, as shown in the figure. Adopting such a system and iterative approach would result in the development and deployment of effective reusable elastomeric respirators in the range of health care settings from patients' homes to hospitals to longterm-care facilities.
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From page 155... ...
The generation and buildup of CO2 in the dead space of the respirator has the potential to affect the work of breathing and hence the health care worker's comfort. As shown in the figure, the sensory factors include the impact on oral communication (i.e., speech intelligibility)
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From page 156... ...
As discussed in Chapter 2, most studies involving elastomeric respirators have been in controlled environments. Therefore, there is a critical need to assess the effects of these factors on the performance of reusable elastomeric respirators in real health care settings, both during normal times and during public health emergencies.
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From page 157... ...
For seasonal influenza, the recommendation is for droplet protection unless an aerosol-generating procedure is being carried out, in which case respiratory protection equivalent to a fitted N95 filtering facepiece respirator or equivalent N95 respirator must be used. For a potential influenza pandemic, the Healthcare Infection Control Practices Advisory Committee recommends that before entry to the patient room or care area a worker don a respirator that is "at least as protective as a fit-tested NIOSHcertified disposable N95 filtering facepiece respirator" (CDC, 2016)
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From page 158... ...
A fundamental understanding of airborne transmission of infectious diseases will make more likely the proper selection and use of respiratory protection and facilitate the design of the next generation of respiratory protection devices, including reusable elastomeric respirators. CLEANING AND DISINFECTION RESEARCH Safe and effective cleaning and disinfection is a prerequisite for the reuse of elastomeric respirators.
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From page 159... ...
Significant reductions in influenza viability for both soiling conditions were observed on the facepieces from 12 of 15 models of filtering facepiece respirators and the straps from seven of those models. This study showed that decontamination and reuse using ultraviolet germicidal irradiation could be effective for filtering facepiece respirators.
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From page 160... ...
. There are many methods that could be evaluated for the disinfection of reusable elastomeric respirators.
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From page 161... ...
. The design of the elastomeric respirator significantly influences the compliance of health care workers in using the device to protect themselves.
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From page 162... ...
30. 1Representatives on the Project BREATHE working group were from CDC (NIOSH National Personal Protective Technology Laboratory; Office for Infection Control, Division of Healthcare Quality Promotion; National Center for HIV, STD, and TB Prevention, Division of Healthcare Quality Promotion)
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used in the health care environment continued
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These efforts include work funded by the Biomedical Advanced Research and Development Authority (BARDA) to explore a variety of options to improve health care and community access to effective respiratory protection during a public health emergency (Wallace, 2018)
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Work is being done on developing a reusable N95-surgical elastomeric respirator for health care workers, which would be a hybrid of the N95 filtering facepiece respirator and a half-facepiece elastomeric respirator (HHS, 2017)
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From page 166... ...
Health care facilities would need to implement doffing protocols to ensure that the goal of having the extra layer of protection is achieved and that the contaminated pre-filter cover is properly collected, handled, and discarded. Research should be conducted to explore this option as it could potentially reduce the total cost of using elastomeric respirators while ensuring the health and safety of the health care workers who use them.
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From page 167... ...
. This formfitting, individually customized respirator with a replaceable filter has the potential to obviate extensive fit testing, thereby enhancing the health care worker's compliance in using the device as well as reducing the learning curve in using the device.
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From page 168... ...
Health care workers have traditionally used filtering facepiece respirators that are disposable and thereby simplify many of the operational logistics for health care facilities implementing a respiratory protection program. The absence of a "guaranteed volume" of elastomeric respirators for manufacturers in anticipation of a pandemic introduces another uncertainty in the supply chain, making it difficult for manufacturers to make a business case in support of the required investments in time, expertise, infrastructure, and funding to meet the potential for a demand surge.
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From page 169... ...
would provide a better overall demand estimate, which would provide the guidance that manufacturers are seeking to make investment decisions; The purchasing power that comes from buying large volumes of respirators could provide better negotiating power in reducing the cost of respirators for health care facilities; and The real-time "heat map" of available (and needed) respirator in ventories in health care facilities around the nation would facili tate the rapid transfer of supplies to areas with outbreaks, thereby augmenting the supply chain and helping ensure the safety of those health care workers.
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From page 170... ...
Partnerships will be needed to create the incentives for manufacturers to move beyond the focus on disposable filtering facepiece respirators to reusable respirators. In addition to innovations in respirator products, innovations will also be needed in the training and education of health care workers regarding respiratory protection and in ensuring that workers are knowledgeable about the risks of airborne diseases and act to mitigate those risks.
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2015. Disinfection of reusable elastomeric respirators by health care workers: A feasibility study and development of standard operating procedure.
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From page 172... ...
2008. Preparing for an influenza pandemic: Per sonal protective equipment for healthcare workers.
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2014. Effectiveness of common healthcare disinfectants against H1N1 influenza virus on reusable elastomeric respirators.
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