Mask and Respirator Use in the Health Care Setting Sept 30/05 Customer Answers to Problem Solving Questions Question #1: 1. What would you do in order of steps once you read his chart and see that he has suspected TB? Confine pt I.D. appropriate N95 for all staff in OR Go fetch the N95 Communicate to all staff Neg pressure room Anaesthetic machine Protective attire (mask eyes, gloves, gown) Recover in OR Communicate to post-op area Return pt to neg pressure room 2. How would you acquire the proper respiratory/facial protection? Fit test Seal check (we talked about where the N95s are kept in the hospital and that they need to locate where they are kept so that they can access them in a hurry, this could be in the OR, in Emerg, Stores etc) 3. What guidelines would you use to support the use of personal protective equipment (PPE)? Would consult the airborne precautions of: Ministry of Health /Labour NIOSH Health Canada
CDC CSA Health and Safety Question #2 1. What guidelines, documents, and nursing policies or other resources would you consult before your meeting? CSA, NIOSH, ORNAC, OCC Health, hospital policies, Ministry of Labour, Unions and all other peer hospitals- ORNAC Education group 2. What argument would you use to convince the hospital committee to assign the appropriate resources and funds for proper Personal Protective Equipment and fit testing to protect not only your staff, but also the staff of the rest of the hospital? Revisit SARS 2002 Residents fit testing should be the responsibility of University for their Med. Students and done at the school. Then forward this information to hospitals and Occ Health Retest is responsibility of chief of staff Just deal with it If PPEs are distributed they must be properly fitted If outbreak occurs person not tested, it impedes on other staff If fit tested at other hospital, info is brought with you to new hospital Mask testing should be part of nursing orientation Should be paid for by hospital, provincially Nurses can t strike are a necessary service and therefore, must be protected.
3. What argument would you use to convince not to assign resources and funds to fit testing and respirators? They didn t answer this, they said this would never happen, it is the law and you have to have an N95! Question #3 1. Do you think a surgical mask will reduce your exposure risk as efficiently as an N95 respirator? NO! surgical mask does not have a good seal, purpose is to protect pt. from staff (open wound) Surgical mask is not NIOSH approved, does not have min. filter efficiency (we discussed the correct filter efficiency of 0.3microns) N95 protects staff from pts, NIOSH approved and meets filtration standards 2. Difference between a user seal check and a fit test? User seal check each time you wear an N95 Fit to face, breath out, check for leaks Fit test fits specific make of respirator to employee Good for 1-2 years. 3. What do you look for in a properly fitted N95 respirator? NIOSH approved Good seal, tight fit Must pass fit test APF/OEL approved Satisfaction (comfort) of user
Question #4 1. If you have a surgical mask with a BFE of >99% and an N95 Respirator, which has more filter efficiency? N95 respirator has a better fit (if properly fitted and worn) More filter efficiency because of particle size. (We talked about a BFE is tested with a 1-5 micron large particles size and a N95 is tested with 0.3 micron smaller particle size. N95 require filter data as well as facial fit data for 9 different face shapes, and for a BFE no data fit test is required.) 2. How important is facial fit to the efficiency of a surgical mask and an N95 respirator? Surgical mask- not that important N95 very important 3. In what situations would you wear a surgical mask and in what situations would you wear an N95 Respirator? Surgical masks- floor nurses, regular surgical procedures, protection of patients, infection control (we added- for droplet and contact precautions and sterile field, anticipation of body fluids) N95 T.B., Bronchoscopy, high risk intubations, high risk or unknown respiratory problems, for protection of health care worker. (we added airborne precautions (chicken pox, SARS and Avian Flu) Three Key Learning s 1. Question #3. part 1. 2. Question #4. part 1, 2 and 3 3. They had great a suggestion of the nursing, medical schools to be responsible for fit testing and during orientation of new
staff. This shows that they are adding it into the culture of the everyday and year life of the hospital. Thanks Guys, Please send me your comments and feedback. Heather