Personal Protective Equipment for the Healthcare Professional

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Personal Protective Equipment for the Healthcare
Professional
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Acknowledgements

• South Carolina Area Health Education Consortium
  (AHEC)
• Funded by the Health Resources and Services
  Administration.
• Grant number 1T01HP01418-01-00
• P.I. David Garr, MD, Executive Director AHEC
• BT Project Director Beth Kennedy, Associate
  Program Director AHEC
• Core Team
• BT Co-director Ralph Shealy, MD
• BT Project Manager Deborah Stier Carson, PharmD
• BT CME Director William Simpson, MD
• IT Coordinator Liz Riccardone, MHS
• Web Master Mary Mauldin, PhD
• P.R Coordinator Nicole Brundage, MHA
• Evaluation Specialist Yvonne Michel, PhD
• Financial Director Donald Tyner, MBA

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Acknowledgment

• This material has been prepared for SC AHEC
  Bioterrorism Training Networkby
• Ralph M. Shealy, M.D., FACEPCo-Director of SC
  AHEC Bioterrorism Training Network
• Medical Director for Operations, Charleston
  County EMS
• Medical Director, Charleston County Rescue Squad

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Objectives

• Explain the effectiveness of normal precautions
  for protection in a biological attack.
• List the additions necessary to convert normal
  operating room garb into an effective biohazard
  ensemble.
• Describe five types of respiratory protection

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Objectives

• Describe five characteristics of an effective
  respirator
• Describe the four levels of hazardous material
  ensembles and when they are uses.

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Throughout the ages, whenever a new danger has
been discovered, humans have devised a defense
against it.
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This presentation is for HEALTH professionals.
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Health professionals have vast experience with
exposure to pathogens.
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In fact, diligent application of normal infection
control practices will protect us from patients
who are victims of a bioterrorism attack.
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Health professionals have vast experience with
exposure to pathogens.NOT ALL OF IT IS GOOD!
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Operating Room Procedure

• Restricted access
• Meticulous disinfectant cleaning
  (decontamination) of the room itself.
• Controlled ventilation
• Air filtration
• Ultraviolet germicidal devices
• Special garb
• Scrub procedures

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OR Garb

• Scrub suits
• Head covering
• Masks
• Gown
• Gloves
• Shoe covers

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Added Protection for OR Staff Against Splashed
Liquids

• Eye protection
• Outer garments impervious to fluids
• High top rubber overboots

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Chinks in the Armor

• Small particles entrain with airflow around the
  mask and are inhaled.

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Inhalation

• Small particles and gases are absorbed deep
  within the alveoli
• Chemicals are rapidly absorbed into the
  bloodstream.

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Respiratory Protection

• Particulate respirator
• Chemical Cartridge/Gas Mask respirator
• Powered Air-Purifying Respirator (PAPR)
• Self-Contained Breathing Apparatus (SCBA)
• Supplied air

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Effective Only IF

• The correct respirator is used
• It's available when you need it
• You know when and how to put it on and take it
  off
• It achieves a secure seal with normal activity
• Its properly stored and maintained

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Particulate Respirator

• Simplest and least expensive
• Only protect against particles, not chemicals,
  gases, or vapors.

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Particulate Respirator

• Rated by NIOSH
• Assumes tight seal
• N95 95 at 3-5 microns
• N99 99 at 3-5 microns
• N100 99.97 at 0.3 microns

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Take-home Point

• N100 effective against microbes if seal is tight.
• If seal is not tight, a positive pressure
  respirator is required
• No protection against chemical liquids, vapors,
  and gases

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Chemical Cartridge/Gas Mask Respirator

• Clean air of particles by passing it through
  filter.
• A charcoal layer absorbs chemicals
• Other absorbents have actions against specific
  chemicals and certain combinations.
• There is no all purpose filter
• Not safeagainst an unknown

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Chemical Cartridge/Gas Mask Respirator

• Filters become saturated in high concentrations
  of agent
• Filters outdate
• A gas mask protects the respiratory tree but does
  nothing to prevent skin absorption

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Powered Air-Purifying Respirator (PAPR)

• Uses a battery powered fan to blow air through
  filter
• Positive pressure inside mask overcomes any leak
• Requires less work of breathing
• Requires agent-specific filter

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Self-Contained Breathing Apparatus (SCBA)

• Air is supplied from tanks under positive
  pressure into mask.
• Positive pressure gradient overcomes leaks
• No filters or batteries are required.

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Self-Contained Breathing Apparatus (SCBA)

• Safe without regard to concentration of agent
• Heavy
• Requires training and practice
• Tanks run out of air.

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Supplied Air

• Air under pressure from outside source through a
  hose
• Unlimited air supply
• Mobility impaired by tether

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Some Cant Use Some Respirators

• Respirators increase work of breathing.
• Claustrophobia an issue
• Do not accommodate eyeglasses well

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Respiratory Standards

• OSHA respiratory-protection standard (29 CFR
  1910.134)

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Absorption

• The passage of chemicals through intact skin
• Requires barrier protection that resists
  degradation, penetration, and permeation by the
  chemical
• Need not be air-tight for splash protection
• Must be airtight for gases and vapors

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Chemical Protective Barriers Are Agent Specific!

• Degradation
• Penetration
• Permeation

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Puncture

• Awareness, procedures, and engineering controls
  have limited incidence of skin penetration with
  contaminated sharps.
• PPE adds little additional protection

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Incorporation

• Introduction of contaminant into a wound or
  through a skin defect.
• Appropriate barrier protection prevents both
  incorporation as well as absorption.

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EPA Levels of Chemical Protection

• Level D
• Level C
• Level B
• Level A

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Level D

• Ordinary work clothes.
• Should not be used in an environment where
  respiratory or skin hazards exist.

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Level C

• Full face air purifying respirator
• Cloth coveralls
• Chemical resistant overgarment with hood
• Chemical resistant inner and outer gloves.
• Chemical resistant boots
• Hard hat
• Two way radio
• Escape mask

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Level B

• Positive pressure self-contained breathing
  apparatus (air from tank or hose)
• Chemical resistant overgarment
• Inner and outer chemical resistant gloves.
• Chemical resistant boots
• Two way radio
• Hard hat

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Level A

• Positive pressure self-contained breathing
  apparatus with air supplied by tank or hose.
• Fully encapsulating chemically resistant suit
  over cloth coveralls
• Inner and outer chemically resistant gloves
• Chemically resistant boots
• Two way radio
• Hard hat

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• Medical care to chemical victims is best
  performed after decontamination.
• Airway control and control of hemorrhage
  performed in PPE may be lifesaving.

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Unknown Biological Hazard Demands Level C

• The use of liquid splash protection and a powered
  air purifying respirator (PAPR) are adequate for
  protection against victims of a biological
  attack.
• Virtually all medical procedures can be performed
  in this attire
• This is NOT sufficient protection against an
  unknown chemical

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Personal Protective Equipment

• Scrub suits
• Head covering
• Masks
• Gown
• Outer garments impervious to fluids
• Gloves
• Shoe covers
• High top rubber overboots
• Eye protection

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Crime Scene

• A site associated with terrorist activity is a
  crime scene.
• Recognition and preservation of evidence is
  critical.

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Case 1

• A paramedic is a recreational cave explorer who
  is certified in cave rescue. A caving novice has
  been injured deep within a cave inhabited by a
  large colony of bats, some of which have tested
  positive for rabies in the past.
• What is his best bet for PPE?

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Case 1 (continued)

• The paramedic wears a moustache and beard. He is
  unsure that a particulate mask will achieve a
  tight seal.
• What should he do?

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Case 2

• Several people in the Federal Building next door
  to your office have experience a white powder
  incident in which exposure to anthrax has been
  alleged. They come to your office to be checked.
• What personal protective equipment do your
  require?

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Summary of Key Points

• Appropriate personal protective equipment for
  workers potentially exposed to an unknown
  organism includes a powered air purifying
  respirator with full facepiece and HEPA filter,
  disposable clothing, and gloves.

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