ICT introduces a new, regular column in which members of industry suggest strategies for the evaluation and purchasing of infection prevention and control products. This month we take a look at respirators.
Participants:
— Grant Rowe, product manager for respiratory protection, Bullard
— Gregory Taylor, vice president of healthcare business development, Moldex-Metric, Inc.
— Michael Wang, marketing manager, Bio-Medical Devices Intl.
— Doug Durney, director of marketing and new business development, ILC Dover, LP
ICT: What is the biggest occupational safety and/or infection prevention and control-related advantage to using respirators/PAPRs over other protective gear?
Rowe: There are many advantages to using a PAPR in a hospital setting. First, I should mention that the two main other types of protective gear that are often used instead of a PAPR are surgical masks and N-95 respirator masks. Surgical masks offer the patient protection from liquid droplets coming from the healthcare worker but since they are not respirators they do not offer the healthcare worker (HCW) any respiratory protection against infectious airborne particles such as SARS, TB or various types of influenza.
The biggest safety advantage is the assigned protection factor (APF) offered by a PAPR. An APF is “the workplace level of respiratory protection that a respirator or class of respirators is expected to provide to employees when the employer implements a continuing, effective respiratory protection program [as stated in 29 CFR 1910.134]. A surgical mask does not have an APF since it is not a respirator, while an N-95 mask has an APF of 10. In contrast, a PAPR has an APF of 25 when configured with a loose-fitting facepiece, meaning that a PAPR provides 150 percent more protection than an N-95 mask.
Another occupational safety advantage of the PAPR is reduced heart, lung, and heat stress. A N-95 respirator requires the HCW to draw the air in through a resistive filter by virtue of his own heart and lung power. Very quickly the mask begins to become hot and moist causing heat stress; these increased stress factors can reduce focus on the critical tasks of patient care. In comparison, a PAPR employs a battery-operated fan to draw ambient air in through the purifying HEPA filter before it is delivered to the HCW’s breathing zone. Purified air continually flows into the facepiece, cooling the HCW so that he/she can work comfortably for several hours.
Still another advantage is that PAPRs with loose-fitting facepieces do not require fit testing. This is a financial, administrative and a safety advantage. Fit testing may cost between $75 to $125 per HCW per year and administrative responsibilities of scheduling, documenting, auditing and filing. Also, tight-fitting respirators not only require fit testing but require that the HCW be clean shaven, while a PAPR with a loose-fitting facepiece can be worn with facial hair. This keeps HCWs safer because there won’t be a scenario where an N-95 mask is incorrectly worn without a proper fit or in the presence of facial hair (which creates a leak path for airborne hazards to travel to the wearer’s respiratory system).
Finally, another advantage of the PAPR with a loose-fitting facepiece is improved communication. Non-verbal communication is sometimes as critical as the spoken word, and an N-95 hides the facial expressions while a PAPR with a loose-fitting facepiece allows patients to see warm smiles and other empathetic non-verbal cues. A calm patient can make the environment much safer for the HCW.
Wang: Key to insuring infection prevention is compliance. Without it, the risks of infection significantly increase — an incident will occur; it is only a matter of when. PAPRs’ inherently higher filtration efficiencies (versus N95 masks) provide the best protection. More importantly, they can lead to improved compliance versus N95s.
N95 compliance is confounded by high percentages of HCWs not passing fit testing. These personnel need alternate protection or must be “managed around.” Many who do use masks, re-use them, which is inappropriate. All this leads to cost and management burdens and poor compliance and safety. Many who are unfamiliar with PAPRs perceive they are too costly or too difficult. In practice, they find PAPRs can be more comfortable, better for patient communication, quite easy to use, and more cost effective to implement. More user and patient friendly PAPRs enhance compliance, which leads to better infection control.
Taylor: The main occupational safety/infection prevention or control advantage for using respirators, including PAPRs, is reduced risk of exposure to airborne hazards. A surgical mask may reduce risk of exposure to large droplets and or liquid-borne hazards but is not effective at filtering out small aerosolized hazards. A surgical N95 respirator will provide aerosol-, droplet-, and liquid-borne hazard protection when they are properly fitted to the individual user. Disposable or reusable respirator solutions generally offer a fiscally superior option to a PAPR for airborne particle/pathogen protection because more protection can be purchased for a given protection dollar investment.
Durney: The superior level of protection of PAPRs over other methods of respiratory protection affords the user the ability to perform any job function virtually without worry of becoming a victim of the function itself. PAPRs offer a dramatic increase in protection over N-95s while at the same time not requiring costly fit testing, inventorying multiple sizes of masks, or requiring facial hair restrictions. In addition, PAPRs reduce the physiological stress on the healthcare worker by virtually eliminating resistance and the heat build-up associated with exhaling into N-95s. Lastly, the use of reusable PAPRs will alleviate what we call “logistical strain,” which would reach its peak when trying to procure masks that are just not available in scenarios such as a pandemic, epidemic or biological/radiological terrorist attack.
