1. Guidance for the Selection and Use of Facemasks and Respirators Materials referenced from CDC, FDA, NIOSH and OSHA

2. Current CDC & OSHA Recommendations Healthcare Settings –Workers: Standard and Contact Precautions + eye protection for direct patient care workers [NIOSH-approved N95 respirator] N95 respirators for other staff in close contact with patients –Patients with ILI symptoms Facemasks Community Settings – None (facemasks as needed) Part of overall Infection Control Practices

3. Masks vs. Respirators Facemasks –Designed to cover the mouth and nose loosely –Usually strapped behind the head –Made of soft materials and are comfortable to wear –Provide only minimal protection from respirable particles

4. Masks vs. Respirators Respirators –Fits tightly to cover the nose and mouth –Provide protection against inhalation of small and large airborne particles N95- Filtering Facepiece Elastomeric PAPR: Powered Air Purifying Resp.

5. Rating of Protection Offered Facemasks Can protect from large particles from splashes Not rated for protection from small inhalable particles Respirators –Rated by oil-resistance and filter efficiency N95: Not oil resistant, and 95% efficient against small inhalable particles Elastomeric and PAPRs: typically HEPA (high-efficiency particulate air): 99.97% efficient F I l t e r

6. Regulations & Recommendations for Respirators OSHA issues workplace health and safety regulations. When required, employers must: –Provide appropriate respirators –Medical evaluation –Fit testing –Training –Ensure workers do fit checking before each use CDC recommends when, what and how to use PPE

7. Current CDC Recommendations for Pandemic Influenza Healthcare – Direct Patient Care Workers –NIOSH-certified N95 or higher recommended for use during high-risk activities including: Aerosol-generating procedures Resuscitation of confirmed or suspected influenza case Providing direct care to confirmed or suspected influenza-associated –Only slight revision from seasonal influenza guidance Part of overall Infection Control Practices

8. Current CDC Recommendations for Pandemic Influenza Healthcare Patients –Facemasks should be offered as part of a respiratory hygiene/cough etiquette strategy, to patients who present for care with coughing or have other ILI symptoms Close contacts and those with travel history worn until the cause of symptoms is determined not an infectious agent that requires isolation or patient has been appropriately isolated

9. Current CDC Recommendations Community Settings –Facemask use in proximity to a symptomatic person may not effectively limit transmission –Emphasis should be on cough etiquette and staying home facemask use if near confirmed cases If symptomatic persons cannot stay home, consideration should be given to having them wear a facemask in public –No recommendation for use by asymptomatic persons, including those at high risk for complications

10. OSHA Occupational Risk Categories Very High: Healthcare workers performing aerosol-generating procedures or collecting respiratory tract specimens from known or suspected cases High: Healthcare workers and support staff exposed to known or suspected cases (including EMTs) Medium: high-frequency contact with the public Low: minimal occupational contact with the public

11. Recommendations for OSHA Occ. Risk Categories Very High: –Re-usable Elastomeric Respirator or PAPR or N95 High: –Workers: N95, elastomeric respirator or PAPR –Patients: Facemasks Medium: –Facemasks Low: –None

12. OSHA Guidance on Respirator Stockpiling

13. OSHA Guidance on Facemask Stockpiling Occupational settingFacemasks needed Healthcare Hospital (inpatient)2 per patient per day Essential visitors3 per visitor per day Emergency Rooms1 per ill person Outpatient office/clinic2 per patient visit Emergency medical services1 per ill person

14. Respirator Re-Use Elastomeric respirators and PAPRs –Designed for re-use following proper cleaning –Filter cartridges can last long periods N95 Respirators –Designed for one time use; Not cleanable –Can be re-used in not grossly contaminated Protect with a facemask or face shield Single-user Increased risk of contamination of hands and face

15. Community Use of N95 Respirators FDA has cleared the following N95 respirators for use by the general public 3M™ Particulate Respirator 8670F 3M™ Particulate Respirator 8612F Pasture™ F550G Respirator Pasture™ A520G Respirator –N95 respirators are not designed for people with facial hair or children. –People with chronic respiratory, cardiac, or other medical conditions that make it harder to breathe should check with their healthcare

16. References http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm http://www.cdc.gov/flu/professionals/infectioncontrol/maskguidan ce.htm http://www.osha.gov/dsg/guidance/stockpiling-facemasks- respirators.html http://www.osha.gov/Publications/influenza_pandemic.html#clas sifying_exposure http://www.osha.gov/Publications/3328-05-2007- English.html#RespiratoryProtectionforPandemicInfluenza http://www.fda.gov/cdrh/ppe/masksrespirators.html http://www.cdc.gov/h1n1flu/guidance_ems.htm

17. Hand Hygiene Perform hand hygiene immediately after removing PPE. –If hands become visibly contaminated during PPE removal, wash hands before continuing to remove PPE Wash hands with soap and water or use an alcohol-based hand rub *Ensure that hand hygiene facilities are available at the point needed, e.g., sink or alcohol-based hand rub

18. Use of PPE for Expanded Precautions Contact Precautions – Gown and gloves for contact with patient or environment of care (e.g., medical equipment, environmental surfaces) In some instances these are required for entering patient’s environment Droplet Precautions – Surgical masks within 3 feet of patient Airborne Infection Isolation – Particulate respirator* *Negative pressure isolation room also required

19. Key Points About PPE Don before contact with the patient, generally before entering the room Use carefully – don’t spread contamination Remove and discard carefully, either at the doorway or immediately outside patient room; remove respirator outside room Immediately perform hand hygiene

20. How to Don a Mask Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with ties or elastic Adjust to fit

21. How to Don Eye and Face Protection Position goggles over eyes and secure to the head using the ear pieces or headband Position face shield over face and secure on brow with headband Adjust to fit comfortably PPE Use in Healthcare Settings

22. How to Don a Particulate Respirator Select a fit tested respirator Place over nose, mouth and chin Fit flexible nose piece over nose bridge Secure on head with elastic Adjust to fit Perform a fit check – –Inhale – respirator should collapse –Exhale – check for leakage around face

23. Removing a Mask Untie the bottom, then top, tie Remove from face Discard

24. Removing a Particulate Respirator Lift the bottom elastic over your head first Then lift off the top elastic Discard