How Best to Protect Healthcare Workers from Airborne Pathogens

Respirators protect users from aerosolized and droplet contaminants. Extreme morbidity and death can result if not properly protected. N95s and surgical masks are common. Use of Powered Air Purifying Respirators (PAPRs) is increasing.

Aren’t N95 respirators and surgical masks good enough protection for healthcare workers (HCWs)?

Surgical masks protect the surgical field and others from the spread of droplets from the users. Masks can protect users from splash during surgery. Masks are typically not designed to seal against the user’s face; protection against viral and bacterial contaminants is poor. N95 respirators are receiving scrutiny relative to their cost effective bacterial and viral protection, their lower filter efficiency, and need for fit test verification for each HCW, each brand and style of respirator, annually. Qualitative testing is “you get what you pay for,” as results are variable. Quantitative fit testing requires more technical skill and $10,000 to $20,000 of test equipment. Even with proper and accurate fit testing, HCWs are only assured of good fit for masks used during the testing. Back in med-surg with pressing conditions of the infected patient-care regime, do they put it on the same ... with the same accuracy? If not, disaster can happen, as in the SARS epidemic in Toronto.

What if the N95 mask is positioned properly each time it is put on?

N95s and surgical masks can not be fitted to HCWs with facial hair and other variables, e.g., scars, weight gain or loss, etc. Their inherent filtering efficiency is less than PAPRs. The FDA (OSHA/NIOSH) does not test surgical masks as they do respirators. Manufacturers’ reported efficiencies may be higher than if using NIOSH N-95 test methods, as much as 95 percent versus 70 percent. Filtration efficiency of N95s is only guaranteed at 95 percent. With excellent fit, 5 percent contamination has to be expected to get through.

What is the better alternative?

PAPRs use inherently higher efficiency filters. PAPRs are positive-pressure systems; no fit testing is required. PAPRs are reusable and interchangeable between HCWs, with appropriate decontamination between uses. Masks and N95s are negative-pressure devices. On inhalation, the negative pressure within the mask pulls in contaminated air from an incomplete seal. PAPRs are positive-pressure devices. For example, the MAXAIR System pulls contaminated air through filters with 99.97 percent to 99.997 percent efficiency. Only .03 percent to .003 percent of the contaminant may get through -- between 150 to 1,500 times less than N95s and masks. MAXAIR pulls in outside air, filters it, and passes it gently in front of the face at a user selectable 6 CFM to 9 CFM. This provides sufficient air for all working conditions, and a cooling effect to the user. PAPRs’ high air-flow volume creates positive pressure within the helmet so HCWs cannot pull in contaminated air. No fit testing is required and all HCWs can safely use them. PAPRs’ air flow control insures normal breathing conditions. N95’s and masks add resistance, which the HCW must adjust to and overcome.

But what about costs, aren’t PAPRs prohibitively costly compared to masks?

As a leading healthcare institution published in 2005, you can achieve better respiratory protection and long term cost advantages with a non conventional PAPR solution, such as MAXAIR.

What qualities and characteristics should purchasers look for in surgical masks and/or respirators?

Lack of proper respiratory protection can be life threatening. Purchasers of protection should not accept minimum protection. OSHA says, “NIOSH-approved disposable particulate respirators (e.g., N95, N99, or N100) are the minimum level of respiratory protection that should be worn.” NIOSH says, “Surgical masks are recommended only as a last resort for health care and medical transport workers exposed to SARS patients when no NIOSH-approved respirator equivalent to or greater than the N-95 is available.”

Key qualities for proper respiratory and contact protection include:

• NIOSH approved ≥ 99.97 percent filtration efficiency (minimum HEPA level efficiency).

• Universal fit – no fit testing for any employee, sharable with proper decontamination between uses.

• Reusable for long-term cost-effectiveness.

• Free of weighty or extending apparatus so not to impede maneuverability in the work area.

• Comfortable and convenient to facilitate use compliance.

• Rugged and reliable for routine, daily use and extended periods during emergencies.

• Provide visual indication of filtering and operation effectiveness and safety.

Implementing a PAPR-based infection control program can increase HCW safety and the bottom line.