Respiratory Protection - AORN
Transcript of Respiratory Protection - AORN
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Respiratory Protection
Julie Cahn, DNP, RN, CNOR, RN-BC, ACNS-BC, CNS-BC
AORN Senior Perioperative Practice Specialist
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Polling Question #1
Polling Question #1
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Respiratory Protection Devices
1. Filtering Facepiece Respirators1. Includes N95s
2. Powered Air-Purifying Respirators (PAPRs)
3. Elastomeric 1. Full Facepiece Respirators
2. Half Facepiece Respirators
https://www.cdc.gov/niosh/npptl/pdfs/RespProtectionTypes-508.pdf
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NIOSH Respirator Ratings
N Series
Not Resistant to Oil
N95 – Filters at least 95% of
airborne particles
N99 – Filters at least 99% of
airborne particles
N100 – Filters 99.97% of airborne
particles
R Series
Somewhat Resistant to Oil
R95 – Filters at least 95% of
airborne particles
R99 – Filters at least 99% of
airborne particles
R100 – Filters 99.97% of airborne
particles
P Series
Strongly/Resistant to Oil
P95 – Filters at least 95% of
airborne particles
P99 – Filters at least 99% of
airborne particles
P100 – Filters 99.97% of airborne
particles
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Filtering
Facepiece Respirators
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Surgical N95 Respirator
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Key Points to Respirator Use
Capture Particles
Fit SnuglyWorn Correctly
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Annual Respirator Fit Testing
• Fit can change over time
• If it doesn’t fit it doesn’t work
• Prioritize testing if• Weight loss of >20 lbs
• Significant weight gain
• Extensive Dental Work
• Scarring
• Cosmetic Surgery
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Facial Hair
https://www.cdc.gov/niosh/npptl/pdfs/FacialHairWmask11282017-508.pdf
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https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/personal-protective-equipment-euas
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Comparing Surgical Mask & N95 Protection
SARS-CoV-2 Virus~0.05-0.2
Benson S, Novak D, and Ogg M. Proper Use of Surgical N95 Respirators and Surgical Masks in the OR. AORN J. 2013;97(4):458-470.Reprinted with permission from the AORN Journal. Copyright © [2013], AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved.
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SurgicalN95 Respirator
Benson S, Novak D, and Ogg M. Proper Use of Surgical N95 Respirators and Surgical Masks in the OR. AORN J. 2013;97(4):458-470.Reprinted with permission from the AORN Journal. Copyright © [2013], AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO 80231. All rights reserved.
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AORN Recommendations• NIOSH-approved
• Fit-tested
• Surgical N95 respirator or higher-level respirator
AORN Guideline for Transmission-Based Precautions
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Additional AORN Recommendations
• Surgical Smoke Safety• In procedures that generate smoke
and involve HPV• During higher-risk aerosol-generating
procedures
• Medication Safety• When handling medication that may
generate airborne powder or aerosols• When preparing for and
administering chemotherapeutic agents during hyperthermic intraperitoneal chemotherapy (HIPEC) procedures.
• A Safe Environment of Care• Respiratory plan may outline when
respirators are required for specific chemicals and when adequate ventilation cannot be provided
• When the level of formalin in an area is greater than 100 ppm
• Environmental Cleaning• When entering a room of a patient
with an airborne transmissible disease before a complete air exchange occurs.
• When cleaning procedures are expected to generate infectious aerosols
Recommendations from the Guideline for Transmission-based Precautions and the Guideline for Sterile Technique addressed separately.
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Powered Air-Purifying Respirators
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Polling
Question #2
Question #2
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PAPRs
https://www.osha.gov/Publications/3352-APF-respirators.pdf
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PAPR Placement
Only wear a PAPR under a sterile surgical
gown when the manufacturer specifies it can be worn this
way.
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Perioperative PAPR use Risks and Benefits
Respiratory Protection
Sterile Gown & Sterile Field Contamination
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AORN Guidance
• Interdisciplinary team evaluation of perioperative PAPR use when sterile fields are present
• If PAPR use is allowed, a standard plan for protecting the sterile field from contamination should be in place
• Portion of the sterile field to be covered
• Direction of blower exhaust
• Type of PAPR allowed (eg, loose-fitting, full-face piece, hood style)AORN Guideline for Sterile Technique
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Sterile Field Covering
Two “Cuffed” Drape Method
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Applying AORN Recommendations in Real Life
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Changing Evidence
• Reference:
• Howard R, Lathrop G, Powell N. Sterile field contamination from powered air-purifying respirators (PAPRs) versus contamination from surgical masks. Am J Infect Control. 2020; 42(2):153-156.
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Surgical Helmet Systems
• Hoods, Togas
• Does not provide respiratory protection
• Protective against splashes, splatters, and sprays
• Follow manufacturer’s instructions for use
• Donning• Determining if a mask is necessary
• Turn on fan once fully donned
• Head cover is unsterile once donned
Surgical Helmet System
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CAPRs vs PAPRs
CAPR PAPR
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Elastomeric Respirators
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Polling
Question #3
Question #3
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Elastomeric Respirators
https://www.cdc.gov/niosh/npptl/pdfs/FY17_N95infographicWhatAreAPR-508.pdf
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Resources & References
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Resources• NIOSH Infographics Page
• https://www.cdc.gov/niosh/npptl/RespiratorInfographics.html
• NIOSH• Health Hazard Evaluations (HHE)
• 42 Code of Federal Regulations Part 85
• https://www.cdc.gov/niosh/hhe/default.html
• Discovery and understanding of health hazards present in the workplace
• Recommendations for elimination or prevention related to the hazard
• Free
• Review of completed HHE reports• Surgical smoke
• Noise exposure
• Latex allergens and water incursions
• Waste anesthetic gases
• Nitrous oxide leakage
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Resources - AORN
• AORN Nursing Consult Line• For AORN Members• Tuesdays & Wednesdays• 0900-1300 Mountain Time• 800-755-2676
• AORN OR Nurse Link (ORNL)• For AORN Members• 24/7 access• ASK AORN• COVID-19
• AORN Guideline Essentials• For AORN Members• https://www.aorn.org/essentials
• AORN eGuidelines+• Paid Subscription• Get guideline updates in real time• https://aornguidelines.org/
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Resources - AORN
• The Science Behind N95 Decontamination
• https://www.aorn.org/events/hot-topics
• Reporting problems with devices under an EUA
• MedWatch
• https://www.accessdata.fda.gov/scripts/medwatch/
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Resources – AORN COVID-19
• COVID-19 FAQs• https://www.aorn.org/guidelines/
aorn-support/covid19-faqs
• COVID-19 Tool Kit• https://www.aorn.org/about-
aorn/aorn-newsroom/covid-19-coronavirus
• Perioperative Care of the COVID-19 Patient
• Located in eGuidelines+
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References
• Guideline for Transmission-Based Precautions. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.; 2020.
• Guideline for Sterile Technique. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.; 2020.
• Guideline for Surgical Smoke Safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.; 2020.
• Guideline for Medication Safety. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.; 2020.
• Guideline for a Safe Environment of Care. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.; 2020.
• Guideline for Environmental Cleaning. In: Guidelines for Perioperative Practice. Denver, CO: AORN, Inc.; 2020.
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References
• Benson S, Novak D, and Ogg M. Proper Use of Surgical N95 Respirators and Surgical Masks in the OR. AORN J.
2013;97(4):458-470.
• Howard R, Lathrop G, Powell N. Sterile field contamination from powered air-purifying respirators (PAPRs)
versus contamination from surgical masks. Am J Infect Control. 2020; 42(2):153-156.
• Rengasamy,S.,W.P.King, B.C.Eimer and R.E. Shaffer.(2008). Filtration performance of NIOSH-approved N95
and P100 filtering facepiece respirators against 4 to 30 nanometer-size nanoparticles. Journal of Occupational
and Environmental Hygiene. 5(9):556-564.
• Vourtzoumis P et al. Operating during COVID-19: Is there a risk of viral transmission from surgical smoke
during surgery? Can J Surg. 2020;63(3):E299-E301.
• Zakka K et al. Electrocautery, diathermy, and surgical energy devices: Are surgical teams at risk during the
COVID-19 pandemic? Annals of Surgery. 2020. Published Ahead of Print
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References
• https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html
• https://www.cdc.gov/coronavirus/2019-ncov/hcp/elastomeric-respirators-strategy/index.html
• https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/
• https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/urgicaln95.html
• https://www.cdc.gov/niosh/regulations.html
• https://www.cdc.gov/niosh/hhe/default.html
• https://www.cdc.gov/niosh/npptl/RespiratorInfographics.html
• https://www.cdc.gov/niosh/docs/2018-176/pdfs/2018-176.pdf
• https://www.cdc.gov/niosh/npptl/pdfs/Fit-test-10.508_FNL-508.pdf
• https://www.cdc.gov/niosh/npptl/usernotices/counterfeitResp.html
• https://www.cdc.gov/niosh/npptl/pdfs/RespProtectionTypes-508.pdf
• https://www.cdc.gov/niosh/npptl/pdfs/FacialHairWmask11282017-508.pdf
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References
• https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html
• https://www.cdc.gov/niosh/npptl/pdfs/N95RespirClassesInfographic-508.pdf
• https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource3s
• https://www.cdc.gov/niosh/npptl/pdfs/KeyFactorsRequiedResp01042018-508.pdf
• https://www.cdc.gov/niosh/npptl/pdfs/FY17_N95infographicWhatAreAPR-508.pdf
• https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
• https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource3healthcare.html#m
• https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource3healthcare.html#m
• see Are PAPRs approved for use in a sterile OR field?
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References
• https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/personal-protective-equipment-euas
• fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/adverse-event-reporting-medical-devices-under-emergency-use-authorization-eua-or-discussed-covid-19
• https://www.osha.gov/Publications/3352-APF-respirators.pdf
• https://www.osha.gov/Publications/3352-APF-respirators.pdf
• US Department of Labor, Occupational Safety and Health Administration, Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute of Occupational Safety and Health. Hospital Respiratory Protection Program Toolkit: Resources for Respirator Program Administrators. May 2015. Occupational Safety and Health Administration. https://www.osha.gov/Publications/OSHA3767.pdf. Accessed September 21, 2016.
• https://www.thomasnet.com/articles/plant-facility-equipment/papr-vs-capr-respirators/
• https://www.mopec.com/product/maxair-capr-series-the-no-hose-papr-powered-air-purifying-respirator/
• https://multimedia.3m.com/mws/media/1822363O/u-s-osha-position-on-fit-testing-during-covid-19-technical-bulletin.pdf
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Thank You!
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NEXT GENERATION RESPIRATORY PROTECTION
Jon Imms
Global Technical & Product Director
CleanSpace Technology Pty Ltd
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THE COMPLETE SOLUTION
Sustainability: An economical and environmentally friendly
sustainable solution
Reliability: Leading certified technology designed by
biomedical engineers and manufactured in Australia in ISO9001
facility specifically for the healthcare
Protection: Highest level of protection against airborne
contaminants; HEPA filtration
Deployable: Scalable training in use and care; ongoing
customer support anywhere in the world
Continuous Improvement: our customers become part of a
community of hospitals that share information.
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THE TECHNOLOGY
▪ NIOSH APPROVED
▪ Neck mounted compact design
▪ Lightweight and small
▪ Pressure sensors and algorithm continuously
pressurise the mask though the breath
▪ Rapid pressure control sampling, monitoring and
adapting 100Hz – high protection overcomes mask
leaks
▪ Quiet, long wear, efficient motor; 26,000 rpm.
Achieves high pressures and high airflows
▪ Lithium polymer smart battery technology: Light,
long run time and fast re-charge
PROPRIETARY AIRSENSIT™ TECHNOLOGY
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TRADITIONAL RESPIRATOR OFFERINGS
DISPOSABLES
✓ Light & simple
✓ Low protection
✓ Moisture/CO2/heat problems
✓ Breathing resistance
✓ Uncomfortable and low compliance
✓ High disposable costs
✓ Reliant on stockpile and supply chains
✓ Easy to counterfeit
✓ High Protection
✓ Reduces heat stress
✓ Reusable
✓ Heavy and bulky
✓ Many parts and complex
✓ Time to clean and disinfect
✓ Poor PPE compatibility
✓ High costs
TRADITIONAL PAPRS
✓ High protection
✓ Reduces heat stress
✓ Reusable
✓ No hoses or belts
✓ Light, small & easy to use
✓ Mobile & portable
✓ Fast disinfection time
✓ Lower cost
CLEANSPACE HALO
PAPR
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PROTECTING FRONTLINE HEALTHCARE WORKERS GLOBALLY
CleanSpace HALO - a powered air purifying respirator (PAPR) being successfully deployed to healthcare
workers in more than 40 countries.
Australia: Westmead (Syd) RPAH (Syd), Epworth (Vic),
Frankston (Vic), Nepean, St Vincent’s (Vic & Syd), Ramsay
Health, Royal Flying Doctors
USA: Houston Methodist (Tx), Maryland University (MD), Sutter
Health (CA), Kaiser Permanente, VA Hospitals.
Japan: Tohoku Univ Hosp, Fukushima Medical Univ, Tokyo
Medical Hosp, Ota General, St Marianna, Saiseikai Yokohama
Tobu, Kanagawa Prefecture, Nagoya Univ Hosp, Osaka Univ
Hosp, Kansai Medical Univ, JCHO Osaka
Singapore: Singapore General, Sengkang General, Teng
Tok Seng, National Centre for Infectious Disease, Novena
Private, SingHealth
Malaysia: Malaysia Health Authority (77 hospitals)
Indonesia: St Borromeus Hospital (West Java) Medistra
Hospital (Jakarta)
Philippines: Major COVID-19 hospitals including Philippines
General Hospital .
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PROTECTING FRONTLINE HCWs ACROSS THE USA
CleanSpace HALO has been deployed
in healthcare systems across the US
ensuring that American healthcare
workers treating COVID-19 patients
have the highest level of protection.
CleanSpace is proud to be protecting the
heroes on the frontline of the pandemic
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SAFE, COMFORTABLE, DEPLOYABLE
“YOU CAN
SEE THAT I’M
SMILING”
Dr nuri spog
HIGH PROTECTION AND ASSURED SAFETY
▪ Powered airflow and pressurised mask (no mask leak)
▪ Approved: NIOSH, CE Mark (TM3) )OSHA APF 50 & 1000)
▪ HEPA (99.97% filtration efficiency or above)
▪ Operating time up to 10hrs
▪ Rapidly cleaned. Compatible with standard disinfection/sterilisation
IMPROVED COMFORT, COMPLIANCE AND PRODUCTIVITY
▪ Light (370g/1lb), few parts and simple to use
▪ Mobility - No belts or hoses
▪ Fast to don (under ten seconds)
▪ Soft, clear silicon mask for clear communication
COST EFFECTIVE AND DEPLOYABLE AT VOLUME
▪ Reusable and modular.
▪ Eliminates reliance on supply chain and stockpiling
▪ Multi-language web-based Deployment and Training Programs
▪ Proven use in 600 hospitals globally
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EXPERIENCED HOSPITAL IMPLEMENTATION
▪ Global training team utilising comprehensive training
platform
▪ Technical and Cleaning IFUs (instructions for users)
▪ Actively educating and share experiences/best practice
from over one thousand hospitals globally
▪ Customer care and technical support
▪ Three year warranty
“minimal parts..no
cables, hoses or
helmets”
Rachel allsopp
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CleanSpace HALO is a reusable system that once deployed
can be relied upon by hundreds of healthcare workers for
many years.
Easy to clean, disinfect, recharge and reuse – CleanSpace
HALO offers healthcare providers assurance for their PPE
investment.
Like SARS, COVID19 has exposed life threatening
vulnerabilities in global supply chains for disposable masks.
Governments have been caught paying large sums for
counterfeit masks or receiving no products at all.
CleanSpace (Australian made) is a reusable program that
can be reliable upon for routine use and scalable during
pandemic preparedness.
RELIANCE ON DISPOSABLE MASKS LEAVES FRONTLINE HCW EXPOSED
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New Product - Steri-Plus
CleanSpace now has world’s first PAPR with an approval filtered exhalation value for operating theatres, patient
care settings or sterile/clean room requirements.
Steri-Plus was designed to meet the urgent needs of hospital infection control teams and surgeons.
Developed specifically for sterile environments (sterile field, operating theatre, clean rooms) or where filtering of
the wearer’s exhaled air is required to protect others.
Suitable for routine or high frequency use (such as a pandemic).
Features✓ For use with all existing CleanSpace half masks
✓ Filtration efficiency tested to 96% for particles 0.3 micron and above
✓ Easy to fit
✓ Reusable case. Easy to clean
✓ Approvals NIOSH, CE Mark, ASNZS1716 and TGA Class 1
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▪ Sydney based ASX listed company. Founded
(2009) by a team of biomedical engineers from
medical device industry
▪ Respiratory protection specialists with product
leading technology
▪ Design and manufacture patented
technology to significantly improve user
protection, comfort and cost
▪ International approvals – NIOSH/CDC, CE
Mark, TGA Class 1, Singapore Medical Device
Class 1, IP Rated 66
▪ Manufacturing ISO9001 facility in Sydney
Australia and exporting to 40 countries
▪ Used throughout USA
AUSTRALIAN TECHNOLOGY TRUSTED GLOBALLY
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Jon Imms| Global Technical & Product Director
Email: [email protected]
Website:
https://cleanspacetechnology.com/healthusa/