Jeffrey (Jeff) C. Nesbitt, CIH, supervisor of industrial hygiene at Mayo Clinic and assistant professor of preventive medicine, explains where to find guidance for respirator use during the COVID-19 pandemic; when to wear a respirator; and precautionary measures for health care providers before using reprocessed N95 masks.
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Welcome to Mayo Clinic Cove in 19 expert insights and strategies. The following activity is supported in part by an independent medical education grant from Pfizer Inc and is in accordance with a C CMI guidelines. Hi, my name is Jeff Nesbitt from Mayo Clinic. Occupational Safety. Today I will be talking about covert 19 respiratory protection updates. Thank you for time In reviewing this presentation at the end of this section, participants will be able to recall where to find guidance for respirator use. During Colvin, 19 went to wear a respirator and when to extend, use or re use of a respirator. At Gmail Clinic, we use a multi disciplinary team to build expert clinical guidance and to make risk based decisions. Our guidance on risk and controls for aerosol generating procedures is available online from the map. Ask me OH expert application. The CDC provides infection prevention and control recommendations, and resource is in the links provided on the slide. Current CBC data suggests that close range aerosol transmission by droplet and inhalation and contact, followed by self delivery to the eyes, nose or mouth are likely routes of transmission. Long range aerosol transmission, such as seen with measles has not been a feature of SARS. Cov too, and the resulting disease terms cold in 19 face masks are routinely used for the care of patients with Corbyn. 19. The use of respirators are prioritized by activity type. Face masks are replaced with respirators during aerosol generating procedures as discussed in the previous line. Search capacity is a useful framework outlined by the CDC to prioritize respirator usage based on availability during the Cove in 19 pandemic, where conventional usage of respirators is not practical. This framework consists of three levels. Conventional contingency and crisis capacities. Contingency capacity would be considered a time of expected shortage For extended use of disposable N 95 respirators would be allowed. Extended use refers to the practice of wearing the same and 95 respirator for repeated close contact encounters with multiple patients infected with the same pathogen without removing the respirator between patient and owners. The maximum recommended period of 8 $12 Christ. This capacity would be considered a time of known shortages where re use of the N 95 respirators may become necessary. Reuse refers to the practice of using the same respirator for multiple encounters with patients, but we're moving it after each encounter. It is stored in between encounters to be put on again prior to the next encounter of the patient. If no manufactured guidance is available, limit the number of re uses to no more than five for restoration. 95 respirators maybe warn saved and reused if appropriate precautions were taken to Don and doff properly and store the respirator safely between reuses. Re use is recommended on Lee of a full face shield is warned to protect the respirator during high risk activities. A link to the guidance document within the asked Mayo expert application has been provided on the slide. Re use is not recommended. If the respirator is visibly soiled or damaged or cannot pass the user seal check. The next section focuses on re processing of 95 respirators. During times of anticipated shortages, the following learning objectives will be covered. Identify when it is appropriate to reprocess in 95 respirators. Recall quality and performance requirements for reprocessed in 95 respirators. Identify suitable re processing methods and quality indicators. Identify quality checks and precautionary measures that health care providers should take prior use of reprocessed in 95 respirators and 95 filtering face piece respirators are disposable protective devices. 100 indicates that, and 95 should be reprocessed Onley when there's a shortage of new respirators. CO. 19 has created shortages of respirators in some areas, leading to the evaluation of suitable re processing methods for N 95 respirators. To be successfully reprocessed, filtration must continue to meet same specifications as new respirators. The product must continue to provide adequate fit and be saved for the user. Chemical residue or remaining viable Kobe to deposits would be examples of unsafe reprocesses. A number of methods for re processing in 95 respirators has been discussed in the literature and by the media during the cold 19 pandemic in April of 2023 methods were designated by C. D. C and in 95 manufacturers as having the most promise and available scientific data to support their use in re processing respirators. Ultraviolet German saddle radiation, moist heat and vaporized hydrogen peroxide. Reprocess you VE G is a promising method often used for small scale re processing, no harmful residual chemicals. Air left on the N 95 after radiation with UV and filtration efficiency has been found adequate after approximately three cycles of the radiation, Disinfection efficiency is dependent on dose and the following limitations have been noted. UV lamps different intensity so the time of disinfection varies by lamp. Disinfection efficiency decreases with distance from the UV source. Shadows and areas not able to be exposed to UV decrease effectiveness and UV. A radiation can reduce the elasticity of N 95 respirator straps over time. Moist heat is best suited to small scale re processing and 95 respirator fit and filtration efficiency have been phone acceptable after three cycles of re processing, this method has a very limited amount of data available to support. Accuse it this time vaporized hydrogen peroxide. Re processing has been done on a large scale, which may include thousands of N 95 during a single run, and 95 respirators have been reported to be reprocessed of reprocessed upto 50 times with VHP. Without negatively affecting the fit for filtration of the respirator, the HP has been demonstrated to achieve a six log reduction of biological organisms, including Hobart. 19. The HP is an environmentally friendly process where hydrogen peroxide breaks down rapidly after this type was completed. Toe oxygen water, leaving no hazardous chemical residue or order on the respirator. FDA has granted numerous companies emergency use, authorization, authorization for the use of the HP to reprocess and 95 respirators. The photo on this slide depicts an actual VHP re processing module. The photo In the photo You can see how the vapor how the N 95 respirators air open to the briefing prior to re processing to better expose all surfaces to adequate vapor concentration as part of male clinics vhe BHP re processing Quality Assurance program. Chemical and biological indicators are utilized during each we processing run chemical indicators ensure that an adequate concentration of BHP is provided and maintained. Do the re processing run biological indicators and sure adequate organism killers achieved. Biological indicators. Air red after seven days to determine if the six log reduction and viable microorganisms has been achieved to ensure that all respirators air free from damage, soiling or other defect each and 95 is inspected prior to and after reprocesses. Any product with a noted defect is discarded. A representative sample of respirators and each load are quantitatively fit. Tested to confirm adequate fit has been maintained. Ah, healthcare provider, who has given a reprocessed in 95 should do a final assessment prior to use, which includes washing hands of soap and water or an alcohol based hand sanitizer. And after handling an N 95 respirator, visually inspect the respirator to look for any visible defects such as loose straps. Warren knows bridge damage or soil it, if any damage to the N 95 rest. Where is visible or successful user Seal check cannot be performed. Discard the N 95 Respirator Never used in 95 respirator, new or reprocessed. If the user seal check is unsuccessful in summary, it may be necessary to reprocess and 95 respirators. When there's a shortage of new respirators, you've G I moist heat and vaporized hydrogen peroxide. Re processing methods were designated by the 595 respirators as manufacturers as having the most promise and available scientific data to support their use in re processing, the HP has been demonstrated to achieve a six long reduction. Micro organisms, including stars Kobe to virus. A re processing cycle is successful when the chemical and biological indicators demonstrate that BHP was distributed to all areas of the re processing room. Quality checks and precautionary measures taken as part of the re processing procedure are essential for the safety of patients and staff. Thank you.