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Morris Garcia

Morris Garcia

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Why not optimally protect our front line emergency personnel?

Irvine, CA – May5, 2009 - Front line laboratory, medical, and civil service personnel are critical to the containment and cure of the virus. While out there working to save our lives, are they deployed with proper Personal Protective Equipment (PPE) to keep them safe?

Or, are they only minimally protected due to out-of-date information? News reports everywhere are full of images of people wearing simple masks. Some are N95 respirator masks. Rarely, as recently in some AP photos (right), do we see use of more optimum PPE for protection against aerosolized and

droplet pathogens as bacteria and virus.

Is it because protection from different devices is about the same? Definitely Not. Most masks in current news reports are simple dust masks or surgical masks that were not even designed to provide OSHA recommended protection against the spread of bacteria and virus. OSHA only recommends N95 Mask Respirators as the minimum PPE for these situations, but they are limited to a 95% filtration efficiency rating.

What is less known is that this performance is only valid when the N95’s have been properly fit tested. Fit testing must be done in a test environment, which is no assurance that the mask is properly fit when in actual use. Actual on the job working efficiencies for those that pass a fit test are difficult to maintain.

Worse, many people with different facial irregularities, particularly men with facial hair (mustaches, beards) will not pass fit testing. Masks are not recommended if you don’t pass a fit test.

Another, higher performance respirator type is the PAPR, Powered Air Purifying Respirator. Brands and configurations of PAPRs are readily available, as the MAXAIR System from Bio-Medical Devices Intl, and provide 99.97% filtering efficiency due to their HE Level filters. Because of their positive pressure design, (versus negative pressure masks) they do not need to be fit tested. PAPRs achieve this much higher protection level for virtually anyone who wears them, without testing and regardless of facial characteristics.

Microbiologist Gilbert Ortiz, left, handles samples while testing for swine flu along with lead scientist Lupe Garbalena, right, at the Houston Department of Health and Human Services Wednesday, April 29, 2009 in Houston. A Mexico City toddler who traveled to Texas with family to visit relatives is the first confirmed death in the U.S. from swine flu. (AP Photo/David J. Phillip)

MAXAIR 2000-800 System

Aren’t PAPRs only for in-laboratory use? Quite the contrary. PAPRs can be lightweight and compact to allow normal activity maneuverability in most any environment. MAXAIR, for example, has even eliminated the awkward air hose and bulky belt mounted blower unit of conventional PAPR designs so that simple activities, like mowing the lawn, can be comfortable. Are they safe enough for daily use? PAPRs are routinely acquired by hospitals to protect their staff for emergency preparedness situations. Designs like the MAXAIR 700 even provide real time visual display status of continuously self-monitored filter air flow and battery charge remaining. This insures the wearer that everything is fine, all during actual use.

Aren’t PAPRs too costly? They may be for individuals who are not that likely to be close, within 3 feet, of a person infected with the H1N1 Influenza. But not for those with a likely high exposure to a

critically infectious and potentially death causing disease.

For multiple personnel, particularly our front line laboratory, medical and civil service people, this is not the case. They are often in high risk positions and they should have the optimum protection to be able to safely continue their work to contain and develop cures for these infectious diseases.

With continuing decreases in disposable costs as with the cuff and face seal of the MAXAIR PAPR, the overall 3-5 year useful life cost projections are comparable, and can even be less than the proper implementation of masks.

And, in another perspective, individuals will spend $800-$1,200 and more for an exercise tread mill because its long term use can help maintain their health. A PAPR like MAXAIR is less than that, will last as long as a tread mill, and may save their life!

About Bio-Medical Devices:

Bio-Medical Devices is a recognized leader in developing, manufacturing, and marketing innovative and cost effective personal respiratory systems for health, pharmaceutical, bio-research, and industrial applications.

For more information contact Marketing, Bio-Medical Devices Intl, 800-443-3842, This email address is being protected from spambots. You need JavaScript enabled to view it., or visit www.maxair-systems.com.

Cal/OSHA standards become first in the nation protections against infectious airborne diseases

The nation’s first standard to safeguard workers from the spread of airborne diseases was approved yesterday by California’s Office of Administrative Law and filed with the Secretary of State. With full support from labor and management stakeholders, on May 21 the Cal/OSHA Standards Board unanimously approved the Aerosol Transmissible Disease (ATD) standard which is designed to protect workers in healthcare and related industries from the spread of diseases such as tuberculosis, measles, influenza, and other pathogens spread by coughing and sneezing. The standard becomes effective on August 5.

“This first in the nation standard is a milestone in workplace safety,” said Department of Industrial Relations Director John C. Duncan. “It is designed to protect employees who are likely to come in contact with transmittable diseases which is especially significant due to recent events such as the H1N1 swine flue outbreak. I applaud the efforts of our Cal/OSHA program for once again being on the leading edge of worker safety.”

The new ATD standard will be added to the California Code of Regulations as Title 8, section 5199, and will cover healthcare and related workplaces that typically treat, diagnose, or house individuals who may be ill such as hospitals, clinics, nursing care facilities, correctional facilities, and homeless shelters.  It will also cover emergency responders, who often are the first point of contact of the healthcare system with patients who can transmit disease.

Designed to protect workers with duties that increase their risk of exposure to infectious diseases, the ATD standard requires healthcare employers and others at increased risk to develop exposure control procedures and train employees to follow them.  Employees must be made part of the process by involving them in the periodic review and assessment of these procedures.  Basic exposure precautions such as source control, hand hygiene, and cleaning and decontamination procedures are a fundamental part of the standard.

Currently there are no specific requirements outlining the responsibilities for employers to address aerosol transmissible diseases as a workplace safety hazard for their employees.

“The ATD standard provides guidance on how to protect employees from exposure to diseases that are well known, like TB, and those that are novel, like what we have just experienced with the recent appearance of H1N1 flu,” said Cal/OSHA Chief Len Welsh.  “This standard provides a set of safety practices and precautions tailored to the level of healthcare-related service provided by the employers covered, so they can respond in an organized and intelligent fashion to situations ranging from day-to-day management of a potentially infectious patient to emergency surges that may be brought on by a pandemic.  The standard is designed not only to protect healthcare workers, but the functionality of the healthcare system itself, since the system cannot run without them. ”

Also accompanying the ATD standard is the Zoonotic Disease standard, which addresses employees working around animals where many infectious diseases originate.  The standard requires employers to control workplace exposures to infectious diseases in animals such as Hantavirus, monkey pox, anthrax, avian influenza, and bovine tuberculosis.

For more information about the ATD and Zoonotic Disease standard visit or web site at www.dir.ca.gov/DOSH.

Would you be interested in participating in research related to respiratory protection against airborne (aerosol and droplet)/ infectious particulates? Sharing your successful solution benefits not only you, but also the industry. We publish these articles on our Web site – and print and distribute many of them to editors. We also feature select case studies in our newsletters, brochures, and other marketing materials.  

Contact us below.

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My name is Anesia Carter and I am currently the Employee Health Nurse for Citrus Memorial Hospital.  We are a 198-Bed Hospital, with about 1400 employees.  I have been at the hospital for 16 years and since 2007 I have been the Employee Health Nurse.  As soon as I came on board, it was decided by OSHA, employees would need to be fitted annually with the N95 mask.a_carter_inside

From the moment I stepped into this position, I had a big job trying to figure out how to get these employees fitted and finding masks to fit them.

At the time, we only had one type of N95, which was the 1860 (3M 1860 N95) in small and medium and of course not everyone could fit into those.  I did introduce the 1870 (3M 1870 N95) and not everyone fits into those. I ended up with another type of mask, called the 3000 and by this time had 3 types of masks.  It was taking 45 minutes to find a correct fitting mask and that was not conducive for anybody.

By my second year, I hired an outside company, but it was very time consuming and costly.

I actually had some help during my third year, which meant they had to get certified.  The certification process is very time consuming on its own and sometimes you feel like you are better off just doing it yourself.  Around this time I was introduced to a PAPR supplier, but I just wasn’t happy with them and neither was the Director of Human Resources or the Chief Nursing Officer. We eventually put the PAPR aside.

When MAXAIR contacted me concerning the 710-DLC CAPR® this year. I was immediately excited and will tell you why.

The MAXAIR representative came at the perfect time, without hesitation introducing herself and everybody to the CAPR. She toured the hospital with me and offered lots of feedback, providing the information we needed.

MAXAIR has been nothing but helpful and willing to go out of their way for me.  That alone, has made a positive impact on us. I must say, the previous person with the bulky PAPR system, did not accomplish a single request of ours.

Initially, some people kicked up their heels saying, “No.. no, no way,” but once they donned the MAXAIR CAPR, they realized this was a better solution. The simple fact that you have constant air circulating, a wider field of vision and it is lightweight, clearly makes a difference .... Read the entire Citrus Memorial Interview ..... complete the form below.

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Mask Facts:

  • Masks aren’t interchangeable.
  • Masks are designed to protect patients, and HCWs only from splash—not aerosols.
  • Masks aren’t required to be fitted-gaps OK.
  • Masks are designed for one-time use; masks are often re-used.
  • Masks are often worn incorrectly.
  • Masks are insufficient to protect against airborne particulates.

N95 (Mask) Respirator Facts:

  • N95s must be fitted to the wear’s face and seal tested.
  • A fit test determines size of N95.
  • A seal check determines whether it has been donned and adjusted properly.
  • N95s should be performed at least annually, or at the occurance of facial changes, including
    • Scarring
    • Noticable weight loss
    • Cosmetic surgery
    • Dental changes
    • Facial hair

Summary of key points relative to general use of respirators in healthcare environments.

  • Respirators must be NIOSH approved.
  • Employers must establish and implement a written respiratory protection program, to include:
    • Respirator selection
    • Medical evaluation (employee fitness to wear identified respirators)
    • Fit testing
    • Training
    • Use
    • Care (maintenance)

NOTE:

Many, even healthcare professionals “erroneously” believe that the need/not need of respirators is based on TB patients.

  • TB patient frequency is only the most obvious justification for protection against airborne pathogens.
  • Even low incidence of patients and conditions that may produce airborne pathogens is not a justification for not being optimally prepared—
  • If you are not properly prepared, you will not be able to avoid an incident when the conditions occur.
  • Even one incident is costly.
  • What is the cost of one incident?
    • A couple dozen MAXAIRs? Several dozen? More?
    • Even an “innocuous” case of TB could cost an RN incident for the equivalent of 15-25 MAXAIRs—enough to cover the N.P. rooms of most hospitals.

Key to insuring infection prevention is compliance. Without it the risks of infection significantly increase - an incident will occur; it is only a matter of when. PAPRs’ inherently higher filtration efficiencies (v. N95 Masks) provide the best protection. More importantly, they can lead to improved compliance versus N95s.

N95 Mask compliance is confounded by high percentages of HCWs not passing fit testing. These personnel need alternate protection or must be “managed around”. Many, who do use masks, re-use them, which is inappropriate. All this leads to cost and management burdens and poor compliance and safety.

Many who are unfamiliar with PAPRs perceive they are too costly, too difficult. In practice, they find PAPRs can be more comfortable, better for patient communication, quite easy to use, and more cost effective to implement. More user and patient friendly PAPRs enhance compliance, which leads to better infection control.

5 key parameters in evaluating PAPRs:

  1. Donning and doffing ease. How much time and paraphernalia – less is better.
  2. Comfort. Not restrictive to breathing with air-flow adjustment matching activity level; not hot to wear for long periods; not too close fitting to cause claustrophobic feelings; quiet so communication is not hampered.
  3. Bulk and weight - interference with maneuverability. Check for components extending away from the body for catching or snagging or that make moving around the patient’s bed and other equipment more difficult and a hazard.
  4. Universal between uses and between HCWs. Eliminate need for variable and unreliable results and the costs of fit testing; easily decontaminated between users so all HCWs can always be protected with minimal training and no fit testing.
  5. Ensure confidence in HCWs’ safety in hazardous environments. N95s are always suspect - one isn’t sure of the fit of the mask they don on any given day. Many PAPRs conceal filters and batteries - HCWs can’t tell, without disassembly, if filters are installed and installed properly, and checking and swapping a run down battery for one fully charged is a chore. These key components should be visible and easily assessable - they ensure proper air filtration and flow. Look for real time visual indicators that provide air flow and battery status continuously during use, unobtrusively. This adds confidence to convenience and comfort; together they facilitate compliance, and improve infection prevention.

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Vivamus accumsan vitae. Nulla torquent feugiat non accumsan parturient. Urna diam risus sit turpis ligula. Erat ligula eros. Nec nunc interdum. A luctus convallis quisque quis velit. Amet varius leo. Eget ullamcorper dui. Pharetra ac pretium. Sed sodales justo. Felis lacus corrupti. Non non sapien. Tincidunt sed semper ab morbi.

Ut viverra senectus

Amet lorem suscipit. Lorem vehicula morbi. Augue sed amet. Non viverra id. Non nam consectetuer. Non reprehenderit neque velit nunc ornare consectetuer.

Ut ac aenean. Id curae lectus. Quis mauris dapibus. Nunc vel cras. Rutrum elit consequatur. Quam praesent est interdum a quis. Nullam non in mollis.

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