ELASTOMERIC HALF FACE RESPIRATOR 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 respirators. 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 N95 respirator 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 mask 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 (particulates & Airborne Infection Disease) - 3M 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 C-0506-12-60597 Published Date: 18-May-2021 Page 1 of 9 Review Date: 18-May-2024 This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current. ELASTOMERIC HALF FACE RESPIRATOR USE DOCUMENT TYPE: PROCEDURE 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. C-0506-12-60597 Published Date: 18-May-2021 Page 2 of 9 Review Date: 18-May-2024 This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current. ELASTOMERIC HALF FACE RESPIRATOR USE 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 Aerosol-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 C-0506-12-60597 Published Date: 18-May-2021 Page 3 of 9 Review Date: 18-May-2024 This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current. ELASTOMERIC HALF FACE RESPIRATOR USE 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 pressure 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 C-0506-12-60597 Published Date: 18-May-2021 Page 4 of 9 Review Date: 18-May-2024 This is a controlled document for BCCH& BCW internal use only – see Disclaimer at the end of the document. Refer to online version as the print copy may not be current. ELASTOMERIC HALF FACE RESPIRATOR USE 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 (eye protection 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.