2. HazMat for WV Hospitals: Personal Protective Equipment Module III

3. This course was developed by EnMagine, who we wish to gratefully acknowledge. The material has been modified by WV DHHR in cooperation with the West Virginia Hospital Association’s Disaster Preparedness Task Force in the teaching of Hospital Decontamination.

4. Objectives Explain the need for, types, selection criteria and limits of protective equipment commonly used in HazMat incidents. How to select, don, and doff the proper personal protective equipment. Understanding the hazards and limitations of personal protective equipment

5. Hazard Control Engineering Controls Administrative Controls Personal Protective Equipment

6. Protective Equipment Need for protective equipment Determine safety of decon personnel via protective equipment levels and needs.

7. Protective Equipment Protective Clothing –Proper level Respiratory Protection –Air Supplied Respirator –Air Purified Respirator Monitoring Devices

8. “Let’s talk PPE.” PPE is the last and least desirable Hazard Control option after: –Engineering Controls –Administrative Controls But, in “uncontrolled releases” or for managing contaminated patients it is often the only alternative.

9. What Level of PPE is needed? Level A – Most protective Level B Level C Level D – Least protective

10. Incomplete Data? Use highest level of PPE Level B lowest recommended (on scene) Level C usually recommended in healthcare…

11. OSHA Requirements Respiratory Protection: Self Contained Breathing Apparatus Supplied Air Respirator for inhalation hazards Air Purified Respirator

12. Bottom Line PPE helps to keep you safe (if the right PPE is used in the proper circumstances)

13. PPE Selection Criteria Physical form of hazardous material Degree of hazard Other –Oxygen level –Degree of unknowns

14. PPE The Four levels of PPE Each has advantages and disadvantages NO ONE ENSEMBLE IS APPROPRIATE IN ALL CIRCUMSTANCES! THESE ENSEMBLES DO NOT PROTECT AGAINST FIRE OR EXPLOSION! These were not developed with healthcare in mind (more on that later).

15. Level A SkinRespiratoryComments Vapor Protective (also known as gas tight or fully encapsulated) Atmosphere Supplying Respirator (Self contained breathing apparatus [SCBA] or Supplied Air Respirator) Highest level of skin and respiratory protection. Bulky, heavy, and greater potential of heat stress.

16. Level B SkinRespiratoryComments Liquid Splash Protection, (but suit not fully encapsulated) Atmosphere Supplying Respirator (Self contained breathing apparatus [SCBA] or Supplied Air Respirator) Lower level of skin protection with highest level of respiratory protection.

17. Level C SkinRespiratoryComments Liquid Splash Protection Air Purifying Respirator Lower level of skin and respiratory protection

18. Level D SkinRespiratoryComments No chemical protection No respiratory protection Examples include: work uniforms, street clothes, scrubs, and Standard/Universal Precautions (provides minor chemical protection)

19. “Let’s talk respiratory protection” (Two basic types) Atmosphere-supplying respirator means a respirator that supplies the respirator user with breathing air from a source independent of the ambient atmosphere, and includes supplied-air respirators (SAR) and self-contained breathing apparatus (SCBA) units. Air-purifying respirator (APR) means a respirator with an air-purifying filter, cartridge, or canister that removes specific air contaminants by passing ambient air through the air-purifying element.

20. SCBA Type/DescriptionAdvantagesDisadvantages Self Contained Breathing Apparatus A compressed air tank containing 30 or 60 minutes (usually effective for less than the rated time) of breathable air. It is mounted on a harness worn on the back with a tight fitting facepiece. Weight ~ 25-40 lbs An Atmosphere- supplying respirator. Greater mobility. Can be used for unknowns, in oxygen deficient atmospheres, and atmospheres above the Immediately Dangerous to Life and Health level. Heavy and bulky (increased overexertion injury hazard). Limited air supply. Users must be fit tested. No facial hair allowed that interferes with mask. High level of training required. High cost.

21. SAR Type/DescriptionAdvantagesDisadvantages Supplied Air Respirators (In line system) A hose attaches the user to a hip mounted regulator that is connected by another hose to either a compressed gas tank, compressor, or piped system. The mask can be either a tight fitting mask or loose fitting hood. Reduced potential of overexertion injuries. Can be configured for extended use. Loose fitting hoods do not require fit testing and can be used by persons with beards. Can place multiple responders on one system through use of a manifold system with a variety of air sources. Greater slip, trip and fall hazard from hoses. Limited range.

22. APR/PAPR Type/DescriptionAdvantagesDisadvantages Air purifying respirators (APR) A specialized filter attached to either a tight fitting or loose fitting facepiece. Can be of a demand valve or powered type (PAPR). A filtered air source. High mobility PAPRs are generally more comfortable than APR. Often less expensive than atmosphere supplying respirators. Cannot be used for unknown substances, atmospheres below 19.5% oxygen, materials with poor warning properties, or materials present above the Immediately Dangerous to Life and Health level. Same tight fitting facepiece issues as SCBA. Loose fitting hood can only be used with PAPR. Filters must be specific to type of contaminant present.

23. For Healthcare “If the agent class for a sudden release cannot be identified, level C PPE with an organic vapor/HEPA filter cartridge respirator is recommended.” JAMA / volume:283 (page: 242) Weapons of Mass Destruction Events With Contaminated Casualties: Effective Planning for Health Care Facilities, Anthony G. Macintyre, MD; et al, 2000

24. Control Zones & PPE Hot (red) zone & Warm (yellow) zone Level C or above is required Cold (green) Zone Level D

25. Respiratory Protection One of the major challenges of a hazardous material emergency response program.

26. No Respiratory Protection Air Purifying Respirators (APR) Atmosphere Supplying Respirators (ASR) –Supplied Air Respirators (SAR) –Self Contained Breathing Apparatus (SCBA) Respiratory Protection Key Points No Protection Filters (Many limitations.) Provides breathable air.

27. Components of APRs Face Piece Canister (filter) Blower pack (PAPR)

28. Respiratory Protection Respiratory –Appropriate Use and Limitations –If respiratory protection is being used, all participants must be enrolled in a Respiratory protections program that meets the OSHA Respiratory Standard. For example: Maintenance and care Fit testing (not required if using loose fitting facepiece.) Medical Clearance

29. PPE Risks and Limits Penetration Degradation Permeation

30. Type of Gloves for Decon? Nitrile PVC For hospital decon purposes, nitrile gloves are usually adequate. Butyl Neo- prene

31. Chemical Protective Clothing Body –PPE Compatibility Permeation, Penetration, Degradation

32. Head, Shoulders, Knees and Toes Head Shoulders Knees Toes And eyes, and ears, and mouth, and nose Head, Shoulders, Knees and Toes

33. Extremities Most likely to come in contact with contaminated patient –Hands Compatibility (Nitrile appropriate for most chemicals encountered in healthcare) Double gloving –Feet Boots, overboots, booties –To tape or not to tape?—Tape!

34. “The Law of Unintended Consequences” The primary hazards of wearing PPE: –Heat Stress –Slips / Trips / Falls –Overexertion (strains and sprains)

35. Medical Complications of PPE Heat Cramps occur in patients who exercise and sweat profusely, and subsequently consumes water without adequate salt. Heat cramps involve the most heavily exercised muscles. Heat Exhaustion presents with minor mental status changes, dizziness, nausea, headache, tachycardia and mild hypotension. Temperatures is less than 103º F.

36. Medical Complications of PPE Heat Stroke occurs when the patient's thermoregulatory mechanisms break down. Body temperature is elevated to extreme levels (>104 0 ) resulting in multi-system tissue damage, including altered mental status and physiological collapse. Patients with heat stroke have hot, dry skin; however, up to 50% of patient's with exertional heat stroke may exhibit persistent sweating. Therefore, the presence of sweating does not preclude the diagnosis. This is a True Medical Emergency! If you do not recognize and correct this immediately, the person will die.

37. When to discontinue work in PPE due to Heat Stress Symptoms of sudden, severe fatigue, nausea, dizziness, or lightheadedness are warning signs to doff your PPE immediately.

38. Personnel Monitoring and Medical Surveillance Baseline vital signs- pulse, temperature, (BP, weight) Exit Medical Surveillance (Employee Health Services) *Required for Levels A,B Recommended for Levels C,D

39. Hand Signals

40. Suit Log Times

41. Monitoring Devices Confined Space Meters –Oxygen –Combustible Gas –Carbon Monoxide –Hydrogen Sulfide Colorimetric Tubes pH Paper Rad Meters

42. Summary of Module III - PPE Four Levels of PPE: A, B, C, D Different Methods of Respiratory Protection Complications of PPE Suit Times Monitoring Devices

43. Questions?

44. PPE Demo

45. Donning Sequence Lower suit Boots Inner gloves PAPR Upper suit with hood Outer gloves Tape all seams, test air seal