airborne pathogens and respirator use l.
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Airborne Pathogens and Respirator Use Objectives – The Illnesses Discuss Airborne Diseases and the healthcare provider How they spread Who is at risk Possible causes Symptoms Objectives – EMS Transport What you should do to protect yourself General considerations Infection control

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objectives the illnesses
Objectives – The Illnesses
  • Discuss Airborne Diseases and the healthcare provider
    • How they spread
    • Who is at risk
    • Possible causes
    • Symptoms

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objectives ems transport
Objectives – EMS Transport
  • What you should do to protect yourself
    • General considerations
    • Infection control
    • Waste disposal
    • Cleaning and Disinfection
    • Follow-up of EMS personnel

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objectives the n95 respirator
Objectives - The N95 Respirator
  • What is it? Why do I need it?
  • How do I use it?
  • Fit testing
  • What are the limitations?

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airborne pathogens
Airborne Pathogens
  • Tuberculosis
  • Influenza
  • Avian Influenza
  • Smallpox
  • SARS

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tuberculosis

Tuberculosis

Famous people who have had TB

Fredric Chopin*

Eleanor Roosevelt*

Nelson Mandela

Ringo Starr

Tom Jones

Tina Turner

*Died of TB

what is tuberculosis tb
What is tuberculosis (TB)?
  • Disease caused by bacteria called Mycobacterium tuberculosis
  • Chronic bacterial infection
  • Was once the leading cause of death in US
  • The number of cases declined in the 1940’s when drugs were developed to treat TB
  • TB is still a problem worldwide (NIAID)
    • 8 million people develop TB yearly
    • 3 million die

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how is tb spread
How is TB spread?
  • Through the air from person to

person by coughing

  • Usually attacks lungs
  • Two stages
    • Latent TB
      • asymptomatic and not contagious
      • can take medication to prevent development of disease
    • Active TB Disease
      • May spread to others
      • May have abnormal chest x-ray
      • Usually have positive skin test

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symptoms of tb
Symptoms of TB
  • Chills
  • Fever
  • Weakness or fatigue
  • Sweating while sleeping, Night sweats
  • Cough that lasts longer than 2 weeks
  • Pain in chest
  • Coughing up blood or sputum

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risk factors
Risk Factors
  • Close contact with someone who is infected with TB
  • Traveling to a country where TB is common
  • Immune compromised
  • Foreign-born individuals and minorities have a higher incidence of developing TB
    • 2002: 50% of US cases were in foreign-born individuals (CDC)
    • 2002: 80% of all US TB cases were in ethnic and racial minorities (CDC)

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multi drug resistant tb mdr tb
Multi-drug resistant TB (MDR TB)
  • Bacteria become resistant

to antibiotics

  • Arose from improper use of

antibiotics in the treatment of TB

  • Treatment of one case can cost up to $1.3 million (CDC)
  • 45 states and Washington, DC have confirmed cases of MDR TB (CDC)

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mdr tb continued
MDR TB continued
  • Treatment is difficult and costly
  • Can develop from not taking proper course of antibiotics for TB
  • MDR TB can be spread by an infected person

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how to protect yourself
How to protect yourself
  • BCG vaccine for TB is given in many countries, but not the US
  • Not recommended for healthcare workers unless a high percentage of patients are infected with MDR TB (CDC)
  • PPD test if exposure is suspected
  • USE proper PPE when in contact with patients who may have TB

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tuberculosis summary
Tuberculosis Summary
  • Chronic bacterial infection

spread through the air

  • Fever, chills, sweating while sleeping, persistent cough, coughing up blood or sputum
  • MDR TB
  • Use proper PPE and get PPD test if exposed

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influenza

Influenza

“I had a little bird,

His name was Enza,

I opened the window and in flew Enza.”

-Children’s nursery rhyme about the flu epidemic of 1918

what is influenza the flu
What is influenza (“the flu”)?
  • Disease caused by a virus
  • Respiratory
  • More severe than a cold
  • 10%-20% of US residents will

get the flu each year (CDC)

  • Can lead to complications for some people
  • 36,000 people die each year from complications (CDC)

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types of influenza virus
Types of influenza virus
  • Influenza A
    • Most common and most serious
    • Can lead to epidemics
  • Influenza B
    • Can also cause epidemics
    • Symptoms are milder
  • Influenza C
    • Never connected with large epidemics

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how is influenza spread
How is influenza spread?
  • Flu season is from November to March
  • Respiratory droplets
    • Coughing
    • Sneezing
    • Droplets on objects
  • Contagious from 1 day before symptoms start to 7 days after symptoms start (CDC)

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symptoms
Symptoms
  • Cough and congestion
  • Fever
  • Headache
  • Body Aches
  • General malaise
  • Sore throat

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vaccine the flu shot
Vaccine- The Flu Shot
  • Administered yearly
  • Injection or nasal spray (FluMist)
  • New vaccine made every year
  • Can prevent types A and B

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who should get a flu shot cdc
Who should get a flu shot? (CDC)
  • >50 years old
  • Diabetic
  • Live or work in a nursing home
  • Compromised immune system
  • Chronic heart, lung, or kidney disease
  • Will be more than 3 months pregnant during flu season

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protecting yourself
Protecting yourself
  • Get flu shot
  • Use proper PPE around patients suspected of having the flu
  • Disinfect surfaces regularly
  • Keep yourself healthy during the flu season!
    • Get enough rest
    • Eat well

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influenza summary
Influenza Summary
  • Flu season is from November to March
  • Use PPE
  • Disinfect
  • Get a flu shot

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avian influenza

Avian Influenza

February 2004: 72,000 chickens were slaughtered in Delaware after two cases of Avian Influenza were found at a poultry farm under contract for Perdue Farms, Inc.

what is avian influenza
What is Avian Influenza?
  • Influenza virus that can infect birds and humans
  • Type A influenza
  • 3 Type A viruses and each have 9 subtypes
    • H5: can be high or low pathogenic; can cause severe illness or death
    • H7: can be high or low pathogenic; infections are rare and symptoms are mild
    • H9: low pathogenic; very rare in humans

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transmission
Transmission
  • Contact with infected poultry or contaminated surfaces
  • No documented cases of sustained human to human transmission
    • Have been isolated incidents of human to human transmission
  • Monitoring is important
    • Influenza viruses have the ability to change
    • May gain the ability to spread from person to person

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symptoms29
Symptoms
  • Same as typical flu-like symptoms
  • Conjunctivitis
  • Pneumonia
  • Severe respiratory

distress

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incidents of h5 avian influenza
Incidents of H5 Avian Influenza
  • 1997: Hong Kong- First documented transmission of birds to humans
    • 18 people hospitalized
    • 6 died
    • 1.5 million chickens slaughtered to prevent further spread of disease
    • Person to person transmission was also documented

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incidents of h5 avian influenza31
Incidents of H5 Avian Influenza
  • 2003: China and Hong Kong
    • 2 people infected after traveling to China
    • 1 died
    • Source of infection not identified
  • 2004: Thailand and Vietnam
    • WHO reported cases of H5 influenza among bird populations
    • Ongoing since January 2003
    • Human cases found in Thailand and Vietnam (WHO)
      • 37 reported cases
      • 26 died
      • Most recent cases were reported August 12, 2004

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avian influenza summary
Avian Influenza Summary
  • Can be transmitted from birds to humans
  • Typical flu-like symptoms plus
    • Conjunctivitis
    • Respiratory distress
    • Pneumonia
  • Use PPE

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questions
Questions?

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smallpox

Smallpox

In 1972, a single case of small pox in Yugoslavia led to the

infection of 150 people, 34 deaths, 10,000 people quarantined

and 20 million vaccinated.

-World Health Organization

what is smallpox
What is Smallpox?
  • Variola Virus
  • Contagious infectious disease
  • Eliminated in human populations
  • Laboratory stockpiles exist
  • Concern that it may be used as an agent of bioterrorism
  • No treatment
  • Only prevention is vaccine
  • Two types
    • Variola major
    • Variola minor

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variola major
Variola Major
  • Most common
  • Severe
  • Very high fever
  • Large rash
  • 4 types
    • Ordinary: most frequent
    • Modified: occurs in people who have been vaccinated; mild
    • Flat: rare and severe
    • Hemmorhagic:rare and severe
  • Fatality rate of 30% (CDC)

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variola minor
Variola Minor
  • Less common
  • Less severe symptoms
  • Fatality rate of <1%

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slide39

From World Health Organization

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transmission42
Transmission
  • Person to person
  • Prolonged contact with infected person
  • Contact with infected body fluids or contaminated objects
  • Can be spread through the air in enclosed settings, but this is rare

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vaccine
Vaccine
  • Complete protection if given before exposure
  • If given within 3 days after exposure, will prevent or greatly lessen severity
  • 4-7 days after exposure: lessens severity of disease
  • No protection if given after rash appears
  • Not widely available to the public at this time
  • Stockpiles are in place in case of an outbreak

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vaccine contraindications cdc
Vaccine contraindications (CDC)
  • Vaccinia virus can be spread to others from the injection site of an immunized person
  • Eczema and other exfoliative skin conditions
    • May develop eczema vaccinatum
    • Inadvertent autoinnoculation of affected area
      • Could develop vaccinia
  • Immune compromised individuals
  • Pregnancy
  • Infants and children
    • Not given to infants <12 months of age
    • Only in emergency situations to children <18 years of age
  • Breastfeeding mothers should not get the vaccine
  • Heart disease

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protecting yourself45
Protecting yourself
  • Vaccine
  • Use PPE when in contact with infected patient or contaminated fluids
  • Watch for signs/symptoms of smallpox if you believe you were exposed
    • Early vaccination after exposure can prevent or lessen the disease

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smallpox summary
Smallpox Summary
  • Contagious infectious disease
  • Transmitted through close contact with infected person
  • Vaccine

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sars severe acute respiratory syndrome

SARSSevere Acute Respiratory Syndrome

The 2003 global SARS outbreak led to over 8,000 people becoming ill, and 774 deaths. It is estimated the panic caused by the disease cost Canada $1 billion in lost tourism and all of Asia over $28 billion.

(BBC News)

what is sars center for disease control definition
What is SARS?Center for Disease Control Definition
  • SARS is a respiratory illness of unknown etiology. It was first identified in February 2003.
  • SARS was first noticed in Southeast Asia. To date more than 100 cases have been reported in the United States
  • Public health experts think that SARS is spread by close contact between people

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how sars spreads
How SARS Spreads
  • SARS is most likely spread when someone sick from the disease coughs droplets into the air and someone else breathes the virus in
  • It is possible that SARS may spread more broadly through the air or from touching an object that is contaminated

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who is at risk for sars
Who Is at Risk for SARS?
  • Individuals having close contact with someone sick from the disease
  • Those sharing a household with someone sick from the disease
  • Healthcare providers who do not use the proper infection control techniques when providing care for patients sick from the disease

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possible causes of sars
Possible Causes of SARS
  • Scientists at the CDC and other laboratories have detected a previously unrecognized coronavirus in patients with SARS.
  • While the new coronavirus is still the leading hypothesis for the cause of SARS, other viruses are still under investigation as potential causes.

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what are coronaviruses
What are Coronaviruses
  • These viruses are a common cause of mild to moderate upper-respiratory illness in humans and are associated with respiratory, gastrointestinal, liver and neurologic disease in animals.
  • Coronaviruses can survive in the environment for as long as three hours.

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symptoms of sars
Symptoms of SARS
  • Fever or hot to touch

AND

  • Cough

AND

  • Clinical findings of respiratory distress

AND

  • Travel within 10 days to an area with suspected community transmission OR
  • Close contact within 10 days with a person with a respiratory illness or someone sick from SARS

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how to protect yourself56
How to protect yourself
  • Wear proper respiratory protection
  • Recognize signs and symptoms of SARS

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sars summary
SARS Summary
  • Very little known about SARS
  • Possibly spread through droplets in air
  • Fever, chills, severe respiratory distress
  • Wear respiratory protection

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questions58
Questions?

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general considerations
General Considerations
  • Patients should be transported using the minimum number of EMT personnel and without non-infectious patients or passengers in the vehicle.
  • Sufficient infection control supplies should be on board.
  • Receiving facilities must be notified prior to transport of infectious patients.

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infection control general
Infection Control - General
  • PPE may not be removed during transport.
  • Personal activities (including: eating, drinking, application of cosmetics, and handling of contact lenses) should not be performed during patient transport.
  • These diseases may be transmitted if residual infectious particles on environmental surfaces are brought into direct contact with the eyes, nose or mouth.

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infection control ppe
Infection Control – PPE
  • Disposable, non-sterile gloves must be worn for all patient contact.
  • Disposable fluid-resistant gowns should be worn for all patient care activity.
  • Goggles or face-shields must be worn in the patient-care compartment and when working within 6 feet of the patient. Corrective eyeglasses alone are not appropriate protection.
  • N-95 respirators should be worn by personnel in the patient-care compartment at all times.

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infection control ppe63
Infection Control - PPE
  • Gloves are removed in the correct manner and discarded in biohazard bags after patient care is completed (e.g., between patients) or when soiled or damaged.
  • Hands must be washed or disinfected with a waterless hand sanitizer immediately after removal of gloves.

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infection control driver vehicle
Infection Control – Driver & Vehicle
  • N-95 respirators should be worn by the driver if the driver's compartment is open to the patient-care compartment.
  • Drivers that provide direct patient care must wear a disposable gown, face shield, and gloves during patient-care activities.
  • Use vehicles with separate ventilation for driver and patient compartments if possible.
  • Maximize air exchange
    • Open dashboard vents
    • Open rear vents to maximum level

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infection control
Infection Control
  • The patient may wear a paper surgical mask to reduce droplet production, if tolerated.
  • Oxygen delivery with NRB masks may be used for patient oxygen support during transport.
  • CPR should never be performed using mouth-to-mouth or mouth-to-mask.

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infection control patient care
Infection Control – Patient Care
  • The BVM should be equipped with a HEPA filter for expired air.
  • When using CPAP ensure that a HEPA filter is attached to the exhalation port.
  • There is no documented additional risk when using aerosol nebulizers if all of the precautions just discussed are used by the health care provider.

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follow up of ems personnel
Follow-up of EMS Personnel
  • Record the following information
    • Date and route of transport
    • Duration of patient transport
    • Names of personnel in contact with the patient
  • EMT services should closely monitor personnel who have transported potentially infectious patients for evidence of fever, rash or respiratory illness.
    • EMT personnel who transport SARS patients should be assessed at least daily for 10 days after transporting a SARS patient (directly or by telephone).
    • If the EMT was exposed to Smallpox, it is important to be vaccinated as soon as possible. May be symptom-free for up to 17 days after contracting the disease.

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follow up of ems personnel68
Follow-up of EMS Personnel
  • Personnel may continue working during the follow-up period if they have no symptoms of the disease.
  • Personnel who have transported a SARS patient and become symptomatic within the 10 day follow-up period should be directed to seek medical evaluation and should be reported to the state health department and to the CDC.

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questions69
Questions?

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the n95 respirator71
The N95 Respirator
  • The most common respirator used is the disposable particulate type N95.
  • The “N” stands for respirator filters that can be used when no oil is present in the contaminants.
  • The“95” means that the product has been tested and certified by NIOSH to have a filter efficiency level of 95% or greater against particulate aerosols.

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why a respirator is necessary
Why a Respirator Is Necessary
  • Healthcare providers work in an environment where there is a risk of disease transmission through airborne infectious particulates.
  • Respirators, such as the N-95, provide protection from airborne infectious particulates when properly fitted and worn.

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osha 1910 134 standards for respiratory protection
OSHA 1910.134 Standards for Respiratory Protection
  • Medical screening to determine if the employee is physically able to wear a respirator.
  • Fit-test to determine if the respirator fits properly on the employee’s face.
  • Training on the selection, use, storage, and limitations of the respirator used.

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the medical screening
The Medical Screening
  • A licensed health care professional will perform the evaluation using a medical questionnaire.
  • The contents of the medical questionnaire are mandated by OSHA.
  • 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.

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follow up medical examination is performed if
Follow-up Medical Examination Is Performed If:

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 should indicate any need for re-evaluation.

4- If the workplace conditions significantly change.

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fit test procedure is done
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

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types of fit testing
Types of Fit Testing
  • Qualitative Fit Test: Worker is assessed on a pass/fail basis to determine the adequacy of respirator fit. It relies on the individual’s response to the test agent.
  • Quantitative Fit Test: Assessment of respirator adequacy by numerically measuring the amount of leakage into the respirator.

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fit testing the respirator qualitative testing
Fit Testing the Respirator Qualitative Testing
  • HCW puts on the respirator.
  • Hood is applied over the head.
  • 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.

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fit testing the respirator quantitative testing
Fit Testing the Respirator Quantitative Testing
  • HCW puts on respirator attached to PortaCount machine.
  • HCW performs series of movements to test respirator fit.
  • PortaCount machine measures amount of particles leaking into mask.

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donning of the n95 respirator step 1
Donning of the N95 Respirator* Step #1
  • Cup the respirator in your hand with the nosepiece at your finger tips allowing the headbands to hang freely below hands.

*Always refer to the instructions provided by manufacturer

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donning of the n95 respirator step 2
Donning of the N95 Respirator Step #2
  • Position the respirator under your chin with the nosepiece up.

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donning of the n95 respirator step 3
Donning of the N95 Respirator Step #3
  • Pull the top strap over your head so it rests high on the back of head.

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donning of the n95 respirator step 4
Donning of the N95 Respirator Step #4
  • Pull the bottom strap over your head and position it around your neck below ears.

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donning of the n95 respirator step 5
Donning of the N95 RespiratorStep #5
  • Using two hands, mold the nosepiece to the shape of your nose by pushing inward while moving your fingertips down both sides of the nosepiece.
  • Pinching the nosepiece using one hand may result in less effective respirator performance.

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fit check of the n95 respirator
Fit Check of the N95 Respirator
  • Face fit check - the respirator seal should be checked before each use.
  • To check fit, place both hands completely over the respirator and exhale.
  • If air leaks around your nose, adjust the nosepiece as described in step 5.
  • If air leaks at respirator edges, adjust the straps back along the sides of your head.
  • Recheck.

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facial hair
Facial Hair

Facial hair will make the seal loose and will not provide protection from harmful airborne hazards.

Even just one or two days beard growth can effect the seal.

Males should be clean shaven.

This is to ensure that the respirator is fully protective.

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removal of the n95 respirator step 1
Removal of the N95 Respirator Step #1
  • Cup the respirator in your hand to maintain position on face.
  • Pull bottom strap over head.

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removal of the n95 respirator step 2
Removal of the N95 Respirator Step #2
  • Still holding respirator in position, pull top strap over head.

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removal of the n95 respirator step 3
Removal of the N95 Respirator Step #3
  • Remove the respirator from your face
  • Discard as a Biohazard (Red Bag)

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limitations of the n95 respirator
Limitations of the N95 Respirator
  • If this respirator becomes wet, it is no longer effective and must be replaced.
  • The N-95 respirator has the ability to filter particles 1 micrometer with a filter efficiency of > 95%.
  • The N-95 is not intended for protection from organic vapors, toxic gases, or toxic particulates.

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waste disposal
Waste Disposal
  • All solid waste, e.g., Used gloves, dressings, etc., Should be collected in a red biohazard bags for regulated medical waste disposal.
  • Any suctioned fluids and secretions must be sealed to prevent any splashes.

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cleaning and disinfection
Cleaning and Disinfection
  • Non-patient-care areas of the vehicle should be cleaned and maintained according to vehicle manufacturer’s recommendations.
  • Cleaning personnel should wear non-sterile gloves, disposable gowns and face shields while cleaning the patient-care compartment.
  • Patient-care compartments (including stretchers, railings, medical equipment control panels, and adjacent flooring, walls and work surfaces likely to be directly contaminated during care) should be cleaned using the department approved disinfectant.

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cleaning and disinfection93
Cleaning and Disinfection
  • Spills of body fluids during transport should be cleaned by placing absorbent material over the spill and collecting the used cleaning material in a biohazard bag.
  • The area of the spill should be cleaned using an EPA-registered hospital disinfectant.
  • Contaminated reusable patient care equipment should be placed in biohazard bags and labeled for cleaning and disinfection.
  • Wear proper PPE when cleaning equipment.

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questions94
Questions?

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for additional information
For Additional Information
  • CDC

Center for Disease Control

www.cdc.gov

  • WHO

World Health Organization

www.who.int

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