Implementation Guide to Support Use of Elastomeric Half Mask Respirators in Healthcare Authors Hines, Stella; THURMAN, PAUL; McDiarmid, Melissa A. Publication Date 2021-02-03 Abstract Elastomeric half mask respirators (EHMRs) provide similar or higher level of protection as do N95 filtering facepiece respirators (N95 FFRs) and are designed to be reused. Supply chain shortages of respirators at the onset of COVID-19 surge prompted... Keywords elastomeric respirator; N95; respiratory protection; pandemic; hospital; decontamination; personal protective equipment Rights Attribution-NoDerivatives 4.0 International Download date 07/10/2021 15:24:19 Item License http://creativecommons.org/licenses/by-nd/4.0/ Link to Item http://hdl.handle.net/10713/14748 Implementation Guide to Support Use of Elastomeric Half Mask Respirators in Healthcare Prepared as part of Centers for Disease Control and Prevention (CDC) Contract # 75D30120P09044 Best Practices and Preferred Uses of Reusable Elastomeric Half Mask Respirators (EHMR) in Healthcare September 15, 2020 Revised October 12, 2020 Revised December 17, 2020 Final Revision February 3, 2021 Submitted by: The University of Maryland-Baltimore Stella E. Hines, MD, MSPH Paul Thurman, PhD, RN Melissa McDiarmid, MD, MPH ii CONTENTS II. Abbreviations ................................................................................................ v III. Table of Figures .......................................................................................... vii IV. Executive Summary ......................................................................................1 Conclusions ............................................................................................... 4 V. Background ...................................................................................................5 Hospital respirator use ............................................................................... 5 Elastomeric respirator overview ................................................................. 6 Original Elastomeric Respirator Use at the University of Maryland Medical Center ........................................................................................................ 8 Elastomeric Respirator Use post-2009 ...................................................... 9 Elastomeric Respirator User Survey .......................................................... 9 National Recommendations..................................................................... 10 Solutions to Implementation Gaps ........................................................... 11 Facilitation of EHMR Use During COVID-19............................................ 12 VI. Determinants of User Device Assignments ................................................. 14 Risk ......................................................................................................... 14 Duration of User ...................................................................................... 14 Mobility .................................................................................................... 15 Sterile procedures ................................................................................... 15 VII. Fit-testing Program ...................................................................................... 17 Medical Clearance ................................................................................... 17 Mask Selection ........................................................................................ 17 Fit-testing ................................................................................................. 19 Donning and Doffing the EHMR .............................................................. 20 Teaching Tools ........................................................................................ 21 Scaled Fit-testing ..................................................................................... 22 VIII. Logistics ...................................................................................................... 25 Dispensing and Return ............................................................................ 26 Additional Resources designed for Ambulatory Practices: ...................... 31 Tracking ................................................................................................... 31 Storage .................................................................................................... 33 iii Respirator Use and Transport ................................................................. 34 Filter Change-out Schedule ..................................................................... 35 Parts replacement ................................................................................... 35 Environmental Storage Conditions .......................................................... 36 Additional Resources ............................................................................... 36 IX. Responsibilities of Key Program Leaders .................................................... 37 Respirator Program Administrator ........................................................... 37 Fit-testing program .................................................................................. 37 Respirator reprocessing and centralized distribution ............................... 37 Materials management. ........................................................................... 38 Human resources (HR) or information technology systems specialist. .... 38 Facilitators ............................................................................................... 38 X. Costs ........................................................................................................... 40 Additional Resources: .............................................................................. 44 XI. References .................................................................................................. 45 XII. Appendices ................................................................................................. 52 Appendix A. Respirator Comparison Matrix to Assist in Determining User Assignment and Implementation Strategy ............................................... 52 Appendix B. Medical Clearance Questionnaires, excerpted from OSHA- NIOSH Hospital Respiratory Protection Program Toolkit38 ...................... 55 Appendix C: Selected Fit Test Protocols, excerpted from OSHA-NIOSH Hospital Respiratory Protection Program Toolkit38 .................................. 63 Appendix D. Tug Test ............................................................................. 73 Appendix E. Unit Signage ........................................................................ 74 Appendix F. Donning and Doffing the 3M 7500 Series EHMR with 3M P100 7093 filter cartridges ....................................................................... 77 Appendix G. Checklist for Re-using Reusable Elastomeric Respirator ... 79 Appendix H. Qualitative Respirator Fit Testing Form ............................... 80 Appendix I. Standard Work for Reprocessing Elastomeric Half Respirators46 ........................................................................................... 81 Appendix J. Outpatient Practice Decontamination Protocol for Reusable Elastomeric Respirators .......................................................................... 83 Appendix K. Role: PPE Point Person ...................................................... 84 iv Appendix L. Role: Pick up and Return of Respiratory PPE .................... 86 Appendix M. Information Sheet: Use of a Shared Pool of Elastomeric Respirators .............................................................................................. 89 Appendix N. Prevention of Pressure Injuries Associated with Respirators ................................................................................................................ 90 XIII. Acknowledgments ....................................................................................... 91 v ABBREVIATIONS AGP Aerosol Generating Procedure APF Assigned Protection Factor ARA Applied Research Associates CDC Centers for Disease Control and Prevention CMO Chief Medical Officer CNO Chief Nursing Officer CSP Central Sterile Processing DOP Dioctyl phthalate ED Emergency Department EHMR Elastomeric Half Mask Respirator FFRs Filtering Facepiece Respirators FPI Faculty Physicians Incorporated HCP Healthcare Personnel HR Human Resources ILI Influenza-like Illness MD Medical Doctor MICU Medical Intensive Care Unit N95, N95 FFR N95 filtering facepiece respirator NaCl Sodium Chloride NICU Neonatal Intensive Care Unit NIOSH National Institute for Occupational Safety and Health NP Nurse Practitioner OMFS Oral, Maxillo-facial Surgery OSHA Occupational Safety and Health Administration PA Physician Assistant PAPR Powered Air-Purifying Respirator PICU Pediatric Intensive Care Unit PLCHP Physician or Licensed Health Care Practitioner PPE Personal Protective Equipment RN Registered Nurse RPA Respirator Program Administrator vi RPD Respiratory Protective Devices RPP Respiratory Protection Program RT Respiratory Therapist TJC The Joint Commission TCID50 Tissue culture infectious dose (50%) UMMC University of Maryland Medical Center UMSOM University of Maryland School of Medicine vii TABLE OF FIGURES Figure 1. Elastomeric Half Mask Respirator Information Sheet. 27 ....................... 7 Figure 2. Negative Pressure Test.