BEHAVIORAL OBJECTIVES Understand traditional barriers of conversion - - PowerPoint PPT Presentation

BEHAVIORAL OBJECTIVES

• Understand traditional barriers of conversion to PAPRs
• Understanding the need for increased focus to optimize

protection

• Understand proper protocols/fit test challenges
• Features to consider when reviewing PPE for Bio-Hazards
• Understanding the positive impact of PAPRs

PRESENTATION OUTLINE

• Discuss Historical Standard of Care
• PAPR Use in Infection Control & Prevention
• Understand The Difference In The Levels of Protection

Offered Between N95/PAPR

• Identify & Understand The Critical Elements Involved

In Evaluating Optimum Levels of Protection w/PAPRs

• Changing the Respirator

Standard of Care

HISTORICAL STANDARD OF CARE (SOC) – N95

• PROS
• Simple Device
• Perceived Ease of Stocking/Distribution
• Minimal up front/initial purchase price

HISTORICAL STANDARD OF CARE (SOC) – N95

• CONS
• High level of user intolerance leads to high level of non

compliance…poor overall protection

• Reality of time consuming and complex
• rdering/stocking/distribution due to different brands, types

and sizes required by HCW differences

• On-going costs are extremely high
• Fit testing and fit testing equipment
• Managing those “no-fit” employees

HISTORICAL STANDARD OF CARE (SOC) - N95

• BOTTOM LINE ISSUES
• N95s currently accepted by many w/o challenge
• Reluctance by many to consider modern-design PAPR

technology alternatives now available

• Inherently higher protection factors
• Demonstrated greater use-tolerance
• Financial analysis demonstrated lower cost-over-time

implementation

• Most singular solution for all at-risk personnel

PAPR USE IN INFECTION CONTROL & PREVENTION

• Traditional Barriers to Convert to PAPRs
• Bulky/Heavy
• Limited freedom of movement
• Auditory issues – cannot use stethoscope
• Must be able to hear patient vitals
• Battery memory
• No confidence in performance

PAPR USE IN INFECTION CONTROL & PREVENTION

• Traditional Barriers to Convert to PAPRs
• High cost of disinfection
• Higher cost to replace disposables
• Complicated instructions for use
• If HCWs are expected to wear PAPRs…they must be simple

to use

• High cost of ownership
• High cost of disposables
• Increased cost due to premature disposal due to high cost of

disinfection

PAPR USE IN INFECTION CONTROL & PREVENTION

• Patient Safety a Major Concern
• Too long to don traditional PAPRs
• Bulk and weight limit freedom of movement
• Noise can inhibit communication w/patient
• Less patient friendly

PAPR USE IN INFECTION CONTROL & PREVENTION

• Focus Needs To Increase On
• Policy and Quality Education of PAPRs
• Optimize implementation of PAPRs
• Battery Maintenance
• Simplify Cleaning & Storage Requirements
• Comfort/Protection
• Real time monitoring of air flow/battery charge
• Patient safety
• Utilizing new technology/designs in PAPRs

N95 DISPOSABLE RESPIRATOR

• “N” – The respirator is NOT resistant to oil
• “95” – 95% efficient
• Estimated efficiency of N95s
• 80% - 85% due to differing facial structures

PAPR LEVEL OF PROTECTION

• 99.97% efficiency
• “N” rated equivalent/comparable
• Typically are not used in oily atmospheres
• Bacterial & Viral contaminants
• NO chemical protection

PROPER FIT TEST PROTOCOL

• Administrative activities
• Threshold Sensitivity Screening
• Test subject’

s ability to detect test agent

• Allow sense of smell to clear
• 7 breathing exercises
• Each exercise to last one minute
• Stop test if subject detects odor
• Fit with new respirator
• Complete administrative paperwork

COMMON MAJOR MISTAKES DURING FIT-TESTING

• Failure to conduct proper user seal check
• No threshold sensitivity screening
• Insufficient # of squeezes – fit test solution
• Incorrect number/length of exercises
• Failure to conduct proper type of exercises that may

potentially identify leakage

• Healthcare workers are on duty & must respond to patient care

hindering Fit Testing

• Fit Testing is time consuming and places a strain on the workload
• f any Occupational Health Department
• Cost of Fit Testing is a high expenditure against budgets
• Fit Testing is required annually placing further burden on human

resources and budgets

FIT TEST CHALLENGES

GUIDELINES FOR THE EVALUATION OF PPE FOR INFECTION PREVENTION & CONTROL

PPE CONSIDERATIONS – WHAT TO LOOK FOR WHEN EVALUATING PPE

• Mobility – ease of movement
• Comfort – breathing resistance
• Visibility – peripheral vision
• Eye protection
• Hearing
• Status of system operation
• Use of primary care equipment
• Donning/Doffing
• Disinfection

PPE CONSIDERATIONS – WHAT TO LOOK FOR WHEN EVALUATING PPE

• Decontamination procedures
• Time
• Materials
• Effectiveness
• Storage
• Define the role - affected departments
• Training Provided

THE BENEFITS OF CONSIDERING THE USE OF PAPRS

• Higher levels of protection
• Higher levels of breathing comfort
• Longer-term protection
• Greater degree of safety
• Job performance safety
• Recent advances in design built around
• Comfort
• Safety
• Designed to enhance safety…comfort…ability to perform work-

related tasks

COSTS OF NOT CONSIDERING HIGHER LEVELS OF PROPER PPE

• Increased risk of exposure
• Reduced safety for the HCW
• Reduced comfort
• Higher cost of operation
• Minimal protection
• Abuse of protection
• Hidden costs of employee exposure

REASONS GIVEN FOR NOT WEARING PAPRS

• Bulky
• Uncomfortable
• Self-conscious
• Won’t use it
• Difficult to hear
• Difficulty in performing duties
• Patient reaction
• Use of stethoscope limited
• Too costly
• Human Nature – resist change w/the unfamiliarity
• Vanity

PAPR USE IN INFECTION CONTROL & PREVENTION

• Need for commitment to worker safety
• Protection of HCWs
• Increased understanding of PPE
• Appropriate PPE use needs strengthening
• Convenience does not assure protection
• Increased protection is not unmanageable

QUESTIONS TO CONSIDER

• Is “minimum” or “less than optimal protection” really

acceptable for your HCW’s?

• Is Fit Testing
• QLFT/QNFT time
• Equipment cost
• Time away from work – to get to “minimum” protection –

really worth it?

• Are you really prepared?

THE TAKE HOME MESSAGE IS…

• Understand the “Sense of Urgency” in your facility
• Take the time to understand your options
• Carefully & objectively know the PPE pros & cons
• Choose the Optimum solution
• Keep in mind your primary goal…the protection of

your healthcare workers