Medical Manuals - N95 masks PAPRs & P100 respirators

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Not Set Total posts: 117 Joined: 02/06/07 22:36:00

You are the best! Thank-you for your response! Laurel

Laurel Holmer, Infection Control Practitioner
Tahoe Forest Hospital District 10956 Donner Pass Road Suite 230
Truckee, Ca. 96161
(530) 582-8231 DIRECT LINE
fax: (530) 582-6326

Posted: 07/30/11 15:00:08
Not Set Total posts: 117 Joined: 02/06/07 22:36:00

Here are my thoughts from reading California ATD regulations:

1.
The regulations (g)(3)(B) clearly state that PAPRS must be used if the employee is performing high hazard procedures in isolation rooms. N95 respirators will be ok for housekeeping employees during their short duration visits to do maintenance and housekeeping in these rooms since (g)(3)(A) allows the use of N95 respirators when high hazard procedures are not involved.

According to (G)(4), The employer shall provide, and ensure that employees use, a respirator selected in accordance with subsection (g)(3) and Section 5144 when the employee: Enters an AII room or area in use for AII;

Therefore (G)(3)(A) allows the use of a N95 respirator for housekeeping or other non-high hazard procedure visits into an isolation room.

2.
In this case, PAPRS respirators are required when high hazard procedures are involved since influenza is on the ATD list. Routine cleaning tasks by housekeeping staff of AII rooms may just require N95 respirators.

3.
I fully agree with you. Using Source Control + P 100 maybe a safe bet to comply with ATD regulations. If the employer has determined P100 instead of N95 which may be ok, that is fine too.

The Exposure Control plan must clearly state the work practices and the PPE worn by ambulance drivers during their routine operations. Federal OSHA and even CAL/OSHA in their ATD regulations have exempted under (g)(4)9H)(1) the use of these respirators if they interfere with operating a vehicle or machinery provided they have other barriers or protective measures.

If you read the exceptions on (g)(4)(H)(2), there are many ways ambulance drivers could skip the use of respirators provided they implement those provisions

Thank you once again for writing to us.

Posted: 07/29/11 14:20:52
Not Set Total posts: 117 Joined: 02/06/07 22:36:00

Thank-you for your quick response!

I've read & reread the ATD std to try to take it all in. Still a few questions:

1. In the hospital setting, with negative pressure rooms used for airborne isolation for TB for instance, is use of N95 mask or PAPR allowed, or must it be a PAPR?

We currently allow either one, but now I'm beginning to question whether that complies with the ATD std, unless the whole negative pressure room is considered the "ventilated enclosure" of EXCEPTION 1 to subsection (g)(3)(B); however, the employee is in the room with the patient, not outside the enclosure.
Subsection (g) (4) (A) states that employee must use a respirator when entering an All room according to (g)(3)....so does that mean N95 is OK for routine interactions with patient, but PAPR or P100 must be used for aerosol-generating procedures?

We have & use PAPRS for airborne isolation rooms, but stock and use N95 masks for airborne precautions for short (<5 minutes) in patient rooms and as part of surge planning. I'm seeking a reality check as to whether this use is compliance with ATD std.

Please clarify.

2. Guidance from CDPH for influenza includes N95 masks for aerosol-generating procedures. Since influenza is on the ATD droplet precautions list, if source control is not possible or an aerosol-generating procedure is performed, do employees have a choice to wear either N95 or PAPR or must it be a PAPR or equivalent?

3. I met with 3 fire districts yesterday, and the conclusion of their chiefs to insure compliance with ATD std was that they want to direct their first responders to control respiratory secretions @ the source (e.g. place surgical mask on patient whenever possible) plus have the first responder wear a P100 since source control may not be reliable e.g. combative patient, child, need to perform a procedure that requires removing patient mask. They are concerned that staff will use the exception that wearing the mask interferes with operation of ambulance (no barriers between cab & back of ambulance to allow for ongoing communication) and the P100 masks purchased will not be used. I can see their point. My recommendation is to mask any patient not in control of their respiratory secretions or not reliable for respiratory hygiene, and use P100 when patient is not masked. It is the fire districts choice if they want to have their Exposure Control Plan state the more restrictive direction of using both source control + P100. What are your thoughts?

I very much appreciate being able to direct these questions to you.

Posted: 07/29/11 04:11:36
Not Set Total posts: 117 Joined: 02/06/07 22:36:00

Hi Laurel,

According to California Code of Regulations, Title 9, Section 5199 (g)(3) (B) Exceptions 1 and 2 state:

EXCEPTION 1 to subsection (g)(3)(B): Where a high hazard procedure is performed by placing the patient in a booth, hood or other ventilated enclosure that effectively contains and removes the aerosols resulting from the procedure, and the employee remains outside of the enclosure, the employee may use a respirator meeting the requirements of subsection (g)(3)(A)*

*use of a N 95 respirator is mentioned in (g)(3)(A).

EXCEPTION 2 to subsection (g)(3)(B): Paramedics and other emergency medical personnel in field operations may use a P100 respirator in lieu of a PAPR.

All others are expected to use powered air purifying respirator (PAPR) with a High Efficiency Particulate Air (HEPA) filter(s) from September 1, 2010.

Posted: 07/28/11 17:55:00
Not Set Total posts: 117 Joined: 02/06/07 22:36:00

s there any role for N95 masks in the hospital or prehospital setting (fire responders) for airborne precautions given the ATD std that calls for PAPRS or P100s?

Please clarify.

Thanks, Laurel
Laurel Holmer, Infection Control Practitioner
Tahoe Forest Hospital District 10956 Donner Pass Road Suite 230 Truckee, Ca. 96161
(530) 582-8231 DIRECT LINE
fax: (530) 582-6326

Posted: 07/28/11 13:34:01
 
 
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