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Why Hospitals Need a Respiratory Protection Program(FFRs)

As published in HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT

Resources for Respirator Program Administrators

Respiratory Hazards in the Healthcare Setting

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The hospital environment contains hazards such as bacteria, viruses, and chemicals that may be inhaled by personnel and cause injury or illness. The approach for reducing exposure required by the Occupational Safety and Health Administration (OSHA) and accepted by health and safety professionals is to use a “hierarchy of controls.” This means we start with the most e ective controls—the elimination of hazards or substitution of less hazardous processes, chemicals, or products. Next in the hierarchy are engineering controls, which involve
isolating the hazard and/or using specialized ventilation (e.g., isolation rooms or laboratory hoods). Where these controls are not feasible or adequate, administrative controls (e.g., providing vaccinations or triaging chemical emergency patients) and work practices (e.g., following respiratory hygiene/cough etiquette strategies or keeping chemical containers capped) are used to reduce risk, most often by minimizing the extent or duration of the exposure, or reducing the number of employees exposed. Respirators and other personal protective equipment (PPE) are used as a last line of defense when exposures cannot be reduced to an acceptable level
using these other methods. Each facility should develop policies and procedures which address the control methods used at their institution.

The hazards associated with ATDs (e.g., infectious patients with a transmissible disease or, in rare situations, environmental sources of anthrax or

fungi) cannot be eliminated from or substituted out of the hospital setting. ATD pathogen exposures cannot routinely be measured in the air, and have no established occupational exposure limits. In addition, ATD pathogens vary in infectivity and severity of outcome. In order to protect employees from ATDs, healthcare facilities must implement comprehensive infection control plans utilizing a combination of engineering, administrative (including training and vaccination), and work practice controls, and provide for the use of respirators and other PPE.

Healthcare personnel who care for patients with ATDs must work in close proximity to the source of the hazard; even with controls in place, they are likely to have a higher risk of inhaling infectious aerosols (droplets and particles) than the general public. These personnel, and others with a higher risk of exposure related to the tasks they perform (e.g., lab or autopsy workers), must often be protected further through the proper use of respirators.

Respiratory Protection Reduces Inhalation of Aerosols

In order to understand how respirators can be used to protect healthcare personnel, it is important to understand what a respirator is and what it is not. One important distinction that must be made when discussing respirator use in healthcare settings is the difference between respirators and face masks. Face masks include surgical masks, which are fluid resistant, and procedure or isolation masks which are not fluid resistant. While some people may call both respirators and face masks “masks,” this is incorrect as they are very different in their design, performance and purpose.

The purpose of a facemask, when worn by healthcare personnel, is twofold. As part of “Droplet Precautions” (explained in more detail later in this document), the surgical mask is worn to protect the wearer from large droplets or sprays of infectious body fluids from patients that otherwise could be directly transmitted to the mucous membranes in the wearer’s nose or mouth. In other instances, a face mask is worn by healthcare personnel to protect patients by reducing the amount of large droplets with infectious agents the wearer could introduce into the room by talking, sneezing, or coughing; this protection is especially important where sterile fields must be maintained, such as operating rooms.

The purpose of a face mask, when worn by a patient suspected or confirmed with an illness such as in influenza or tuberculosis, is to reduce the amount of large infectious particles released as the patient talks, sneezes, or coughs; this limits their concentration in the room air and reduces the infection risk to others who are present.

However, face masks by design do not seal tightly to the wearer’s face. Therefore, they allow unfiltered air to easily flow around the sides of the face mask into the breathing zone and respiratory tract of the wearer. In addition, the materials used for face masks are not regulated for their ability to filter particles and are known to vary greatly between models. This makes it possible for small particles to pass through or around the face mask and be inhaled by the wearer. This is why they are not considered respiratory protection— face masks do NOT provide the wearer with a reliable level of protection from inhaling smaller particles, including those emitted into the room air by a patient who is exhaling or coughing, or generated during certain medical procedures.

The purpose of a respirator when worn by healthcare personnel, for example a N95 filtering facepiece respirator, is typically to protect the wearer by reducing the concentration of infectious particles in the air inhaled by the wearer. These particles may come from infectious patients who are exhaling, talking, sneezing, or coughing in the rooms in which healthcare personnel are working; from medical procedures performed on infectious patients (e.g., using bone saws or performing bronchoscopies); or from laboratory procedures (e.g., operating centrifuges, blenders, or aspiration equipment) that may aerosolize pathogens.

Respirators are designed and regulated to provide a known level of protection when
used within the context of a comprehensive and effective respiratory protection program
. For example, filtering facepiece respirators are designed to seal tightly to the face when the proper model and size is selected for the individual by using a t test procedure. The wearer can then be assured that inhaled air is forced through the filtering material, which allows contaminants to be captured and reduces exposure to both large droplets and small infectious particles.