ELASTOMERIC HALF FACE USE

DOCUMENT TYPE: PROCEDURE

Purpose To provide guidance for staff that require use of the Elastomeric Half Face Respirator (EHFR) and can not be fit tested to N95 model . This is applicable to health care staff providing direct patient care and/or performing activities in sterile environments and/or aseptic procedures.

Site Applicability All staff requiring an EHFR where and model is not an option.

Practice Level/Competencies Basic Skill – All staff assigned to wear Elastomeric Half-Face Respirators (EHFR). Fit testing of the EHFR is required prior to first use and annually thereafter.

Policy Statement(s)  A medical must cover the exhalation valve on the EHFR to protect the patient and the sterile environment.  Use only workplace provided EHFR. Use of personally purchased PPE, including EHFR, is not supported.  Fit testing of the EHFR is required by a trained department fit tester or Workplace Health prior to first use and annually thereafter.  A health care provider required to wear a respirator which requires an effective seal with the face for proper functioning must be clean shaven where the respirator seals with the face.  Health care providers must not share the EHFR during a shift.  A health care provider must disinfect their dedicated EHFR between each task and at the end of shift.  Filters must be discarded if wet/submersed or soiled.

Equipment & Supplies  Elastomeric Half-Face Respirators (EHFR)  HEPA Filters ( & Airborne Infection Disease) - 7093 Particulate Filters  Hospital-grade disinfectant wipes  Plastic storage bag, bulldog clip and Sharpie pen for labelling

Procedure

EHFR Assembly and Storage STEPS RATIONALE 1. PERFORM hand hygiene and inspect the EHFR for Inspection of the EHFR ensures the health care provider use. has a respirator that offers protection against airborne contaminants. 2. VISUALLY INSPECT each part of the EHFR to identify Inspecting the EHFR prior to use ensures health care potential defects as follows: provider safety and timely identification of defective a. FACEPIECE: Cracks, deformities, tears, dirt, and equipment. any modifications. b. STRAPS: straps must be elastic and have points of Refer to 3M Half Facepiece Respirator 6000 Series attachment to the face piece; no modifications are product insert for part details and visual aids. allowed. c. INHALATION AND EXHALATION VALVES: Cracks or tears, distortion, foreign materials (e.g., hair, lint, dirt). Make sure valves lay flat on valve

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assembly. Assure that exhalation valve cover is in place and not cracked or broken. d. FILTERS/FILTER HOLDERS, O- RINGS/THREADS: Cracks or other defects.

3. When EHFR has been inspected and confirmed for use: Filters expire 1 year from date of opening. e. CHECK the filters for expiry date; if there is no date Filters in original packaging are labelled with expiry date. OR if expired replace the expired filter with a new set. 4. ASSEMBLE the EHFR by placing filters in the EHFR f. ALIGN smallest opening on back of filter, with Aligning the filters accurately to the side of the EHFR is smallest notch on EHFR necessary in order to twist and lock the filter in place.

Left-showing back of filter with arrow indicating smallest of three openings. Right-showing side of EHFR mask with arrow indicating smallest notch.

5. FIT filter into opening—this should happen with ease. If the filter does not fit onto the mask with ease, the notch 6. Gently TWIST the filter to lock in place. The cartridge may not be aligned with the opening. Reposition and try will be level with the bottom of the respirator, in final again. position. Do not use force when fitting and/or twisting the filter as Final position of filter when properly installed this can damage both the EHFR and filter.

Correct Incorrect 7. LABEL plastic bag with health care provider name EHFRs are placed in labelled plastic bags and kept with using masking tape or clear tape, or a removable the health care provider, to allow health care providers to Sharpie pen directly on the bag. keep their designated EHFR secure, and easily identifiable. 8. CLIP labelled EHFR onto uniform or pocket for storage. EHFR kept with health care provider during shift to keep it secure and available immediately for patient care.

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DOCUMENT TYPE: PROCEDURE

Donning the EHFR STEPS RATIONALE 1. PERFORM Hand Hygiene and DON/PUT ON For ordering of PPE donning, refer to Donning (Putting on) gown. Personal Protective Equipment: Droplet & Contact and Airborne Precautions (Includes -Generating Medical Procedures)

Routine Practices for Infection Prevention and Control require proper hand hygiene before and after touching any patient and/or their environment. Hand hygiene is one of the most effective measures to prevent the spread of infection.

Wearing a long sleeved, water resistant gown protects forearms and clothing. OPTIONAL STEP for staff with dermatologic This removes residue from hospital grade wipes that may sensitivity: cause dermatologic sensitivity. 2. WET a paper towel and wipe down the exterior of the EHFR where it seals with face; 3. DRY with a dry paper towel

4. Perform hand hygiene 5. Apply pediatric medical mask to the EHFR, The exhalation valve must be covered with a medical cover the exhalation port and place ear loops mask. around the filters. 6. Adjust procedure mask as needed. Ensure the To cover the exhalation valve to ensure protection of mask, including ear loops, will not interfere with patient from exhaled pathogens and ensure sterile the seal between the respirator and your face. environment is maintained

*If a pediatric mask is not available then use an adult The procedure mask must be changed between each procedure mask to cover the port. patient or every 4 hours if one patient interaction is over 4 hours. It must be changed if it is noted to be contaminated or damaged.

7. PLACE the respirator over your nose and mouth with bottom (neck) straps unfastened.

8. Take bottom straps in both hands, place them at the back of your neck and hook them together

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DOCUMENT TYPE: PROCEDURE

9. Position facepiece low on the bridge of your nose for optimal visibility and best fit.

10. ADJUST top straps first, then lower the neck straps by pulling on the ends. Do not pull too tight.

11. PERFORM Positive seal check EHFR failure is related to poor fit and leakage at face seal. a. Ensure procedure mask and its ear loops do not Seal check must be performed every time an EHFR is interfere with the tight seal. used and after any adjustment. b. Place the palm of your hand over the mask, press to block exhalation valve cover and exhale gently. Refer to Appendix A Seal Check Procedures to review the If facepiece bulges slightly and no air leaks are detailed positive and negative seal check procedure. detected between your face and the facepiece, you have a proper fit. c. If you detect face seal air leakage, reposition the respirator on your face and/or readjust tension of the elastic straps to end the leakage. d. Repeat above steps until you have a good face If you cannot achieve a proper seal, do not enter the seal contaminated area. See your supervisor.

12. PERFORM Negative pressure seal check e. Press on the outside surface of the filter, squeeze filter covers with your hand towards the facepiece to restrict airflow into the breathing tube of filters and inhale gently (ensuring not to apply too much pressure that you deform the mask). If you feel facepiece collapse slightly and pull closer to your

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DOCUMENT TYPE: PROCEDURE

face with no leaks between your face and the facepiece, a proper fit has been obtained. f. If you detect face seal air leakage, reposition respirator on your face and/or readjust tension of straps to end the leakage. g. Repeat above steps until you have a tight face seal.

13. DON/PUT ON remaining PPE ( then gloves) and ENTER patient room/area.

Doffing the EHFR STEPS RATIONALE 1. BEFORE exiting the patient room: Routine Practices for Infection Prevention and Control a. REMOVE gloves and gown require proper hand hygiene before and after touching any b. PERFORM hand hygiene patient and/or their environment. Hand hygiene is one of the most effective measures to prevent the spread of infection.

For order of PPE donning, refer to Donning (Putting on) Personal Protective Equipment: Droplet & Contact and Airborne Precautions (Includes Aerosol-Generating Medical Procedures) 2. EXIT patient room to hallway or anteroom and PERFORM hand hygiene 3. DOFF/TAKE OFF eye protection and DISPOSE of or Refer to current policies and procedures on ePOPS, DISINFECT per Standard Work: Goggle Cleaning for including: Re-Use COVID -19 Application of PPE Emergency Prioritization Framework COVID-19: Emergency Prioritization in a Pandemic Personal Protective Equipment (PPE) Allocation Framework 4. PERFORM hand hygiene and DOFF/TAKE OFF Hand hygiene is required between removing each item EHFR: of PPE.

c. Unhook lower straps from base of neck. Bending forward while doffing helps prevent contaminated d. Gently pull head harness and remove it straps from touching body or clothing. over the head. Avoid touching the surface of procedure mask. Straps are used to handle the EHFR to avoid staff e. Unloop the procedure mask and dispose. contamination. 5. PERFORM Hand Hygiene Dispose procedure mask after every patient encounter OR every four (4) hours whichever comes first.

EHFR Cleaning and Disinfection between Tasks/Patient Care Activities STEPS RATIONALE

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DOCUMENT TYPE: PROCEDURE

1. PERFORM hand hygiene and DON/PUT ON Refer to: COVID-19: PPE use –Application of PPE clean gloves Emergency Prioritization Policy 2. Wipe interior and exterior of respirator and filter cartridges using hospital grade disinfectant wipes Disinfection between patients protects against transmission. Ensure surfaces remains wet with disinfectant, 3. for the appropriate contact time as recommended Filters do not need to be removed for disinfection between by the manufacturer patient care tasks/activities; filters are only removed for 4. Place respirator in clean area to air-dry for 10 disinfection at the end of shift. min and store in an appropriately labelled personal plastic storage bag once it is visibly dry. EHFR must be completely dry before placing into storage bag. 5. CLIP storage bag containing clean, dry EHFR to uniform or pocket and store between uses. Refer to: Guideline: Use, Cleaning, Maintenance and Storage of Reusable Elastomeric Respirators for additional detailed cleaning instructions.

WARNING: If grossly soiled respirator should be disassembled and manually cleaned prior to disinfection; OR follow approved specific guidelines and protocols for managing grossly soiled EHFRs. 6. DOFF/TAKE OFF gloves 7. PERFORM hand hygiene

EHFR Cleaning and Disinfection - End of Shift Process STEPS RATIONALE 1. DON clean gloves Refer to: Guideline: Use, Cleaning, Maintenance and Storage of Reusable Elastomeric Respirators for additional detailed cleaning instructions 2. REMOVE filters and clean and disinfect: Filters are removed and disinfected at the end of shift to a. WIPE all sides of filters using hospital grade reduce contamination as much as possible. disinfectant with contact time of 3 minutes If a filter becomes wet/submersed or soiled – DISCARD. b. PLACE on clean surface to air dry

When filters are VISIBLY DRY: c. PLACE filters in a clean clear plastic bag, and store in unit-specific storage area. 3. Clean and Disinfect EHFR a. Remove headband/yoke, by pulling from the bottom. Do not pull plastic straps.

b. Remove exhalation valve (1 piece)

c. Remove gaskets x 2 (1 per side)

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DOCUMENT TYPE: PROCEDURE

d. Remove inhalation valves x 2 (1 per side)

e. Using one disinfectant wipe at a time, wipe the interior, exterior and all components, of the respirator, thoroughly. f. Ensure items remain wet with disinfectant, for the applicable wipe contact time. g. Allow to air-dry

Reassemble the respirator by putting all the components back together. 4. DOFF/TAKE OFF gloves and PERFORM hand hygiene 5. STORAGE EHFR in a clean labeled bag.

Related Documents:  COVID -19 Application of PPE Emergency Prioritization Framework  COVID-19: Emergency Prioritization in a Pandemic Personal Protective Equipment (PPE) Allocation Framework  COVID-19: PPE use –Application of PPE Emergency Prioritization Policy  Donning (Putting on) Personal Protective Equipment: Droplet & Contact and Airborne Precautions (Includes Aerosol-Generating Medical Procedures)  Doffing (Taking Off) Personal Protective Equipment: Droplet & Contact And Airborne Precautions (Includes Aerosol-Generating Medical Procedures)  Standard Work: Reprocessing of Single-Use (Disposable) Eye Protection and/or Reusable Eye Protection (Goggles or )  Mask Use in Health Care Facilities during the COVID-19 Pandemic

References

3M Half Facepiece Respirator 6000 Series. Accessed March 30, 2020. https://www.3m.com/3M/en_US/company- us/all-3m-products/~/All-3M-Products/Personal-Protective-Equipment/Reusable-Respirators/Safety/Worker-Health-Safety/Half- Facepiece-Respirators/?N=5002385+8709322+8711017+8711405+8720539+8720550+8720785+8726639+3294857497&rt=r3

3M™ Particulate Filter 7093, P100. March 2009.

3M™ Technical Bulletin. March 2020. Cleaning and Disinfecting 3M Reusable Elastomeric Half and Full Facepiece Respirators following Potential Exposure to Coronaviruses. Hawes Clever, L; Rogers, BMR; Yost, OC; Liverman CT. Committee on the Use of Elastomeric Respirators in Health Care. 2019. Consensus Study Report: Reusable Elastomeric Respirators in Health Care. Considerations for Routine and Surge Use.

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DOCUMENT TYPE: PROCEDURE

Provincial Infection Control Network of BC (PICNET). November 19, 2009. Recommendations for the Use of Reusable Half-Facepiece Elastomeric Respirators in Healthcare Settings

Standard Work: Reprocessing of Single-Use (Disposable) Eye Protection and/or Reusable Eye Protection (Goggles or Face Shield) http://policyandorders.cw.bc.ca/resource-gallery/Documents/Infection%20Control/C-0506-16- 60578%20Standard%20Work%20Reprocessing%20of%20Single- Use%20Eye%20Protection%20and%20or%20Reusable%20Eye%20Protection.pdf

Wear it Right. Accessed March 30, 2020. https://www.3m.com/3M/en_US/company-us/all-3m-products/~/3M-Half- Facepiece-Reusable-Respirator-6100-07024-AAD-Small-24-EA- Case/?N=5002385+8709322+8711405+3294780296&preselect=8720539+8720550+8720785+8726639&rt=rud

WorkSafe BC OHS Regulation Section 8.39 (2): Face Seal

Definitions ‘Elastomeric half-face respirators’ (EHFR) – are tight fitting reusable respirators (full facepiece that have a flexible, rubber-like face piece with either permanent or removable filters or cartridges or both. They remove contaminants from air by passing it through the filter medium. Depending on which filter medium is used, reusable respirators provide protection from particulates/bioaerosols (e.g. , Varicella or Zoster, Cytotoxic drugs, etc.) vapors/gases (e.g. Formaldehyde, Xylene) or combination thereof (e.g. chemicals).

Appendix  Appendix A: Seal Check Procedures

Version History DATE DOCUMENT NUMBER and TITLE ACTION TAKEN 26-Mar-2020 C-0506-12-60597 Elastomeric Half Face Developed by CW COVID Response Working Group; Respirator Use Approved by Professional Practice Director 12-May-2020 “ Updated; Approved by Professional Practice Director 22-May-2020 “ Updated; Approved by Professional Practice Director 01-Oct-2020 “ Updated; Approved by Professional Practice Director May 18, 2021 “ Updated; Approved by Professional Practice Director

Disclaimer This document is intended for use within BC Children’s and BC Women’s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA.

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DOCUMENT TYPE: PROCEDURE

Appendix A – Seal Check Procedures

User seal checks consist of both positive and negative pressure checks as described below.

A. Positive Pressure Check 1. Put on the respirator and any other associated personal protective equipment. Tighten the straps until the respirator feels snug but comfortable. Wear the respirator for a few minutes so that it will warm up and conform to your face better. 2. Close off the exhaust valve opening by covering it with the palm of your hand and breathe out slightly to force air into the facepiece. Hold for 10 seconds. 3. If you have a good seal, the facepiece should bulge out and stay out. No air should leak out of the facepiece past the sides, top or bottom. 4. If the air does leak out, check the inhalation valves and try repositioning the respirator on your face and adjusting the head straps. 5. If it is not possible to get a good fit, do not use the respirator and do not perform the task for which the respirator is required. Inform your supervisor/manager and contact Workplace Health.

B. Negative Pressure Check 1. Put on the respirator and any other associated personal protective equipment. Tighten the straps until the respirator feels snug but comfortable. Wear the respirator for a few minutes so that it will warm up and conform to your face better. 2. Close off the inlet opening of the cartridges or filters by covering them gently with the palms of your hands (In some cases you may have to remove the cartridges so you can cover the inlet valves.). 3. Breathe in slightly to create a vacuum, hold for 10 seconds. 4. If you have a good seal, the facepiece should collapse slightly against your face and stay collapsed. No air should leak into the facepiece past the sides, top or bottom. 5. If the air does leak out, check the exhalation valve(s) and try repositioning the respirator on your face and adjusting the head straps. 6. If it is not possible to get a good fit, do not use the respirator and do not perform the task for which the respirator is required. Inform your supervisor/manager and contact Workplace Health.

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