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RESPIRATORY PROTECTION for TUBERCULOSIS a Health Care Worker GUIDE for RESPIRATORY PROTECTION

Tuberculosis is a contagious bacterial disease Tuberculosis is a contagious bacterial disease. Tuberculosis is spread by the respiratory route: TB bacteria contaminate droplets that get into the air when a patient with the disease speaks, coughs, or sneezes. A person breathes in these droplets from the air. If you inhale the Tuberculosis bacteria, you may get infected but not get sick with TB disease. A tuberculosis infection can be detected with a PPD (tuberculosis skin test). Tuberculosis disease is potentially severe and usually affects the lungs but may affect other organs. HCW = Healthcare Worker

SYMPTOMS OF TUBERCULOSIS chronic cough unexplained weight loss fever night sweats coughing up blood What is the difference between TUBERCULOSIS INFECTION and TUBERCULOSIS DISEASE? INFECTED No DISEASE INFECTED + DISEASE NOT INFECTED

NO RESPIRATOR REQUIRED NOT INFECTED PPD NEGATIVE PPD Chest X-RAY NEGATIVE NO RESPIRATOR REQUIRED X-RAY N95 NOT CONTAGIOUS HEALTHCARE WORKER PATIENT

NO RESPIRATOR REQUIRED INFECTEDNO DISEASE PPD POSITIVE PPD Chest X-RAY NEGATIVE NO RESPIRATOR REQUIRED X-RAY N95 NOT CONTAGIOUS HEALTHCARE WORKER PATIENT

INFECTED+ DISEASE PPD POSITIVE Chest X-RAY POSITIVE RESPIRATOR REQUIRED X-RAY N95 HEALTHCARE WORKER CONTAGIOUS

in preventing the spread of TB is to quickly identify isolate and The FIRST STEP in preventing the spread of TB is to quickly identify isolate and treat contagious patients PREVENTION MEASURES TB patients are put in rooms with special ventilation systems BUT When you are in close contact with a contagious TB patient RESPIRATORS ARE NECESSARY TO PROTECT YOU

RESPIRATOR DEFINITION Respirators are protective equipment that are designed to protect the wearer against harmful airborne agents. A seal is formed between face and the respirator. A surgical mask is not a respirator Because the surgical mask does not fit tightly to the face it does not provide good protection against airborne hazards. REQUIREMENTS Wearing a respirator reduces your chances of becoming infected with TB. The Hospital Infection Control committee determines when a healthcare worker must wear a respirator. The Occupational Safety and Health Administration (OSHA) regulates the use of respirators. NIOSH approves respirators for use.

RESPIRATORS MUST BE USED CORRECTLY Respirator Types -Air purifying respirators filter out harmful agents from the air -Air supplying respirators supply clean air to the person for breathing Healthcare workers wear AIR PURIFYING respirators to protect against TB. OSHA requires the use of certified respirators when respiratory protection is needed. The National Institute for Occupational Safety and Health (NIOSH) gives each certified respirator and certification number which is usually present on the respirator or attached on an instruction sheet. AS WITH ALL PERSONAL PROTECTION EQUIPMENT RESPIRATORS MUST BE USED CORRECTLY TO PROVIDE THE HEALTHCARE WORKER WITH THE BEST PROTECTION TRAINING AND EDUCATION ARE KEY FOR YOUR PROTECTION

Respirator Training Topics to cover Procedures for selecting respirators Medical Evaluations for respirator users Fit Testing Procedures for respirator users Procedures for Proper use of respirators Procedures for Cleaning Storing Inspecting Discarding Respirators Topics to cover ISOLATION SIGNS for AIRBORNE PRECAUTION RESOURCES

Procedures for selecting respirators Respirator Training N-95 The respirator to use when respiratory protection for Tuberculosis is needed. N95 HEALTHCARE WORKER

Employee Health will provide a medical evaluation Evaluations for respirator users Respirator Training Employee Health will provide a medical evaluation to determine the HCW ability to use a respirator. This is done before the employee is fit tested or is required to use the respirator. Using a respirator may place a physiological burden on the HCW that varies with the type of respirator worn, job conditions, and medical status of the HCW. A licensed health care professional will perform the evaluation using a medical questionnaire. The contents of the medical questionnaire are mandated by OSHA. This questionnaire is administered to the HCW in a confidential manner and the HCW can request to discuss the results of the medical evaluation with the licensed health care professional. EMPLOYEE HEALTH will provide the HCW with a WRITTEN STATEMENT regarding the outcome of the MEDICAL EVALUATION.

FOLLOW UP MEDICAL EVALUATIONS are performed: respirator users Respirator Training FOLLOW UP MEDICAL EVALUATIONS are performed: 1- if HCW reports medical signs or symptoms that are related to ability to use the respirator. 2- if the supervisor informs Employee Health of the need for re-evaluation 3- if information from the respirator program monitoring activities indicates a need for re-evaluation 4- if the workplace conditions significantly change

FIT TEST procedure is done: Testing Procedures for respirator users Respirator Training FIT TEST procedure is done: 1- before initial use of the respirator 2- whenever a different size, style, model or make of respirator is used 3- if HCW has a change in facial structure such as: facial trauma, facial surgery, loss of body weight, or dental changes. 4- if the HCW worker notifies the employer that the respirator fit is unacceptable. 5- at least annually

Fit Testing Procedures for respirator users Respirator Training FIT TESTING is done using an OSHA accepted qualitative fit test procedure. HEALTHCARE WORKER puts on the RESPIRATOR -- a HOOD is applied over the head of the HCW -- sweet tasting aerosol mist is introduced into the hood -- if the seal is tight the HCW should not experience any sweet taste. The test simulates activities such as turning the head, talking, and other possible activities that might occur during job tasks. N95

DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 1. Separate the mask to fully open 2. Gently bend the nose piece to conform the mask to face 3. Hold mask upside down to expose the two head bands 4. Separate the head bands with the index fingers 5. Cup the mask under chin - ORANGE side out 6. Bring the head bands over the head 7. Place first head band at neck - pull the second head band up and place at crown of head 8. Form nose piece across bridge of nose for tight fit

DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 1. Separate the mask to fully open

DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 2. Gently bend the nose piece to conform the mask to face

DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 3. Hold mask upside down to expose the two head bands

DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 4. Separate the head bands with the index fingers

DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 5. Cup the mask under chin - ORANGE side out

DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 6. Bring the head bands over the head

DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 7. Place first head band at neck - pull the second head band up and place at crown of head

8 Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR PUTTING ON THE RESPIRATOR N95 8. Form nose piece across bridge of nose for tight fit 8

DIRECTIONS FOR USING THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR USING THE RESPIRATOR Each time the HCW enters the contaminated area, face seal should be checked to make sure the fit is tight. Adjust the nosepiece if there is air leakage around the nose. Reposition head bands to secure facial seal around the edges of respirator. N95 IT IS THE HEALTHCARE WORKER’S RESPONSIBILITY TO OBTAIN A PROPER FIT EACH AND EVERY TIME. IF YOU DO NOT OBTAIN A PROPER FIT, DO NOT ENTER THE ISOLATION AREA.

DIRECTIONS FOR USING THE RESPIRATOR Procedures for Proper use of respirators Respirator Training DIRECTIONS FOR USING THE RESPIRATOR HEALTHCARE WORKER N95 Facial hair will make the seal loose and will not provide protection from harmful airborne hazards Even one or two days beard growth can effect the seal. Male HCWs should be clean shaven This to ensure that the respirator is fully protective.

Respirator Training Procedures for Cleaning Storing Inspecting Discarding Respirators Respirator Training

ISOLATION Respirator Training SIGN for AIRBORNE PRECAUTION Respirator Training An ISOLATION SIGN as this one will appear on the entrance to the patient room. Instructions for personal protective equipment are listed on the card. TAKE NOTE and FOLLOW THE INSTRUCTIONS STOP STOP ISOLATION PLEASE READ PRECAUTIONS BEFORE ENTERING PRECAUTIONS GLOVES GOWNS MASKS TRANSPORT ROOM AIRBORNE YES NO YES XXXX PRIVATE CONTACT YES YES NO XXXX PRIVATE DROPLET YES NO YES XXXX PRIVATE

PROGRAM ADMINISTRATOR -- Iva Jones, RN CIC RESOURCES PROGRAM ADMINISTRATOR -- Iva Jones, RN CIC INFECTION CONTROL www.osha-slc.gov/OshStd_data/1910)0134.html www.cdc.gov/nchstp/tb/pubs/corecurr.htm www.cdc.gov/niosh/tb.html American Lung Association -- 1-800-586-4872 St. Louis City Health Department -- 314-658-1128 St. Louis County Health Department -- 314-522-6410 -- 314-842-1300

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