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COVID-19 Guidance on the Reuse of Elastomeric (Half )

This guidance is adapted for use in Manitoba from materials developed by McGill University Health Centre.

CONTEXT

Reusable respirators (specifically, reusable half-facepiece elastomeric respirators) are the standard respiratory protection device used in many industries and in certain healthcare settings and facilities.

The durability and reusability of elastomeric respirators make them desirable for stockpiling for emergencies, where the need for large volumes of respirators can be anticipated.

MATERIAL

Elastomeric Half-Facepiece Respirators (EHFR) (see annex 1 to compare with other /respirators) are half-face, tight-fitting respirators made of synthetic or rubber material. These materials permit them to be repeatedly disinfected, cleaned, and reused.

PROCEDURES

Prior to first use all healthcare workers must be fit tested by Occupational Health and/or designate.

FILTER ASSEMBLY INSTRUCTIONS 1. Align opening of cartridge/filter with filter attachment on facepiece. The alignment mark on the cartridge/filter should face the front of the facepiece. 2. Turn cartridge/filter clockwise one quarter until it is firmly seated and cannot be further turned. 3. Repeat for second filter.

DONNING THE HALF-MASK (STANDARD SUSPENSION) 1. Perform hand hygiene. 2. Inspect the to ensure it is in proper operating condition (not cracked, damaged, flaps are not torn or missing, straps not damaged, etc.).

Jan. 4, 2021 COVID-19 Reusing and Disinfection of Elastomeric Respirators (half face respirator) 1 Adapted from McGill University Health Centre

3. Replace any damaged or defectives parts before use. 4. Adjust head cradle size as needed to fit comfortably on head. 5. Place the respirator over the mouth and nose, then pull the head harness over the crown of the head. Grasp the bottom straps, place them at the back of the neck and hook them together. 6. Pull the ends of the straps to adjust the tightness. Do not over-tighten.

7. Perform a positive and negative user seal check each time respirator is donned. If you cannot achieve a proper seal, DO NOT enter contaminated area. See your supervisor. a. Positive Pressure Seal Check i. Cover the opening in exhalation valve cover with hand and exhale gently. If facepiece bulges slightly and no air leaks are detected between your face and facepiece, a proper seal has been obtained. ii. If faceseal air leakage is detected, reposition respirator on your face and/or readjust tension of the elastic straps to eliminate leakage. b. Negative Pressure Seal Check i. Using hands, press or squeeze cartridge/filter covers toward facepiece to restrict airflow and inhale gently. Be careful not to disturb the position of the respirator. If you feel the facepiece collapse slightly and pull closer to your face with no leaks between your face and the facepiece, a proper seal has been obtained. ii. If faceseal air leakage is detected, reposition respirator on face and/or readjust tension of straps to eliminate the leakage. 8. Place a overtop of the respirator (in a vertical position between the cartridges) to cover the exhalation valve.

Jan. 4, 2021 COVID-19 Reusing and Disinfection of Elastomeric Respirators (half face respirator) 2 Adapted from McGill University Health Centre

9. If you experience any discomfort at any time, doff the mask after exiting the potential aerosolization room. 10. If filters become damaged, soiled or breathing becomes difficult, leave the contaminated area immediately and replace the filters. 11. Continue donning PPE as required for surgical procedure

DOFFING AND CLEANING PROCESS OF THE HALF-MASK *****Doff respirator in the designated clean station****

1. Perform hand hygiene and don clean gloves.

2. When doffing, first remove procedure or surgical mask. Carefully remove the respirator by grabbing the bottom straps and undo the attachment; avoid touching the inside of the respirator. Hold onto the bottom elastic straps with one hand keeping a tension. Grab the top strap from the back of the head and pull it away from your face.

3. Leave the filters attached to the respirator.

4. Place the face piece in the designated container to be taken to MDR.

5. Discard gloves and perform hand hygiene.

Transport of Elastomeric Half Masks to Medical Device Reprocessing (MDR)

Cleaning and disinfection of the elastomeric half respirators and cartridges will be centralized in Medical Device Reprocessing (MDR), following the written Standard Operating Procedures (SOP) for cleaning and disinfecting these devices. Refer to the appropriate SOP in MDR.

REFERENCES

IRRST documents for cleaning : https://www.irsst.qc.ca/covid-19/avis-irsst/id/2632/desinfection-des- appareils-de-protection-respiratoire-apr-en-elastomere-reutilisables

3M document on cleaning and disinfecting: Cleaning_Disinfecting_RR_Coronavirus_v4

ECRI document also a base document for evidence to support use: COVID-ECRI-N95- Respirators_2020-03

CDC poster describing differences / use of respirators: UnderstandingDifference3-508

Jan. 4, 2021 COVID-19 Reusing and Disinfection of Elastomeric Respirators (half face respirator) 3 Adapted from McGill University Health Centre

OSHA/NIOSH/CDC document on respirators which includes elastomerics: OSHA3767 Literature on feasibility from Journal of Infection Control: PIIS0196655315000899

AUTHORS of McGill University Health Centre Original Guidance Document

Dr Frederic Dankoff Dr Dan Deckelbaum Cristina Nagy, Perioperative and MDR Coordinator Dr Ewa Rajda Ramona Rodrigues, Nurse Manager Infection Prevention and Control

Jan. 4, 2021 COVID-19 Reusing and Disinfection of Elastomeric Respirators (half face respirator) 4 Adapted from McGill University Health Centre

July 14, 2020 COVID-19 Reusing and Disinfection of Elastomeric Respirators (half face mask) 5 Adapted from McGill University Health Centre