In pandemic, PAPRs can't replace all N95s
Hospital relies on just-in-time fit-tests
Some hospitals have virtually eliminated annual fit-testing by relying on powered air-purifying respirators (PAPRs). But the advent of novel H1N1 brings into focus a reality of pandemic preparedness: You're going to need to conduct just-in-time fit-testing despite the PAPR use.
The Johns Hopkins University and Health Systems in Baltimore is noted for its significant investment in PAPRs. The health system has about 1,000 PAPR units - including the pricey battery packs. But with more than 10,000 employees, Hopkins recognizes that pandemic response will still require the use of N95 respirators, says John Schaefer, CIH, HEM, associate director of health, safety and environment.
"In a facility this size, the thousand PAPRs would not handle everything we needed. That's just being realistic," he says.
The respirators are assigned on a tiered basis in an airborne infectious disease outbreak, Schaefer says. "Even though we have a lot of PAPRs, they would be relegated to those people doing the high-risk procedures [such as intubations]," he says. "They would go on the crash carts and in the isolation areas."
For people who have no patient contact or risk that is the same as anyone in the community, such as employees in the business office or medical records, no respiratory protection would be required. Those employees who may be involved in screening or other contact with visitors and patients would be assigned an N95, he says.
So Hopkins developed a pandemic plan that included N95s. First, the health system selected and stockpiled a model that would be relatively easy to use. In other words, it was obvious which side was up or down, the straps were easy to secure, the respirator could be donned quickly.
Then Hopkins designated and trained almost 200 fit-testers. When novel H1N1 emerged, Schaefer and his colleagues gave those fit-testers refresher training.
The process went smoothly, and the fit-testers tested employees on their units using quantitative tests, Schaefer says. "Everybody knew what their role was [in the H1N1 response]," he says.
Even before H1N1 outbreak, the ED had opted to use elastomeric respirators, which are reusable and are more protective than N95s. Each employee in the ED is assigned a respirator, which they clean and maintain and keep in a locker, he says. They also have been fit-tested.
Although the CDC recommendations on H1N1 didn't specifically address the use of PAPRs or elastomerics, it is always acceptable to choose respirators that provide greater protection, says Roland BerryAnn, deputy director of National Personal Protective Technology Laboratory of the National Institute for Occupational Safety and Health, which is part of CDC.
"The recommendations try to specify that that is the minimum level of protection. Certainly, we would not discourage the use of more protective equipment," he says.
N95 supply could be an issue for hospitals that haven't planned ahead. BerryAnn says he heard reports that demand exceeded supply for N95s in the first weeks of the novel H1N1 outbreak. Manufacturers reported that they maintained the orders of regular customers but cut back on orders that requested a sudden, large increase, he says.
Some hospitals have virtually eliminated annual fit-testing by relying on powered air-purifying respirators (PAPRs). But the advent of novel H1N1 brings into focus a reality of pandemic preparedness: You're going to need to conduct just-in-time fit-testing despite the PAPR use.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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