Posted: 07/29/11 04:11:36
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.
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.