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Respiratory Protection
Respiratory Protection
To Fit or Not To Fit
November 7/05
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Infectious agents
Health Care Health & Safety Association
 Respiratory protection prevents the inhalation of
infectious agents that are airborne or suspended
as droplets in the air (aerosols).
Viruses
Mould/fungi
Some bacteria
 Viruses and bacteria may be found in respiratory
secretions of infected people, aerosolized during
coughing or other activities.
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Significant diseases
Health Care Health & Safety Association
Other infectious diseases that can be
airborne
 Tuberculosis and SARS
 Infection by moulds and fungi such as
Aspergillus and Histoplasma
 Viral diseases such as smallpox, hemorrhagic
fevers, measles and chicken pox
 Some bacterial infections causing respiratory
illness, such as Legionnaires’ Disease
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Significant Diseases
Health Care Health & Safety Association
Other Infectious Diseases that can be
spread by droplet.
 Influenza
 Febrile Respiratory Illness
 Mumps- Pertussis
 Common Cold
 Adenovirus (respiratory strain)
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Importance of Protecting
Workers
Health Care Health & Safety Association
Most important resource!
A healthy and effective workforce
is especially important during a
crisis.
Legislative requirements ...
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Importance of Protecting
Workers
Health Care Health & Safety Association
“Despite anything in any general or
special Act, the provisions of this
Act and the regulations prevail”
Occupational Health and Safety Act,
Sec. 2(2)
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Legislation, standards and
guidelines
Health Care Health & Safety Association
Occupational Health and Safety Act
 Section 25 - Duties of Employer to provide PPE
train about hazards and controls.
 Section 27 -Duties of Supervisors to ensure
workers use PPE
 Section 25 and 27 -take every reasonable
precaution in the circumstances for the protection
of a worker,”
 Section 28 - Duties of Workers to use PPE
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Legislation, standards and
guidelines
Health Care Health & Safety Association
Regulations for Health Care and
Residential
Facilities
 Sections 8, 9 - Employer to develop written measures
and procedures for such issues as:
Safe work practices
Safe working conditions
The control of infections
Hazards of biological, chemical or physical agents
The use wearing and care of personal protective
equipment
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Legislation, standards and
guidelines
Health Care Health & Safety Association
Regulations for Health Care and
Residential Facilities
Section 10 - Where a worker is required to
wear personal protective equipment the
employer must ensure proper training
regarding limitations, use, maintenance
etc., and must ensure proper fit of the
equipment.
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Legislation, standards and
guidelines
Health Care Health & Safety Association
Standards and Guidelines
 Canadian Standards Association
 CSA Standard Z94.4-02 - Selection, Use and Care of
Respirators
 Infection Control Guidelines
 Health Canada
 NIOSH
 MOHLTC-PIDAC
 Specific Directives
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Respirator selection
Health Care Health & Safety Association
 For many infectious agents, the identification of
appropriate respirators has been done by
experts such as Health Canada or the Centers
for Disease Control and Prevention.
 Infection control is a dynamic field and it is
important for employers to keep current on what
is being officially recommended.
 The selection of respirators appropriate for
infectious agents relies on the careful application
of infection control and occupational hygiene
knowledge.
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Classification of respirators
Health Care Health & Safety Association
Air purifying respirators
Atmosphere supplying respirators
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Respirator selection
Health Care Health & Safety Association
N95 Respirators:
Currently the accepted
standard
When an N95 is required, the
MOL requires a NIOSH
certified respirator (the
PCM2000 is not NIOSH
certified)
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Particulate air purifying
respirators
Health Care Health & Safety Association
 NIOSH certification scheme means that the
respirator is tested with a challenge agent
meant to simulate a “worst case” scenario.
The particle size used is between approx.
0.1 and 0.3 microns in size
The flow rate is 85 l/minute.
A respirator given the N95 classification is at
least 95% efficient at these conditions (given
a proper fit).
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Particulate air purifying
respirators
Health Care Health & Safety Association
Surgical masks are…….
NOT respirators!!!
But……….. they do provide some protection
against contamination of the nose and mouth
from contact with contaminated hands and
from disease spread only by large droplets.
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Surgical masks
Health Care Health & Safety Association
 Where surgical masks are recommended for the
protection of a health care worker, (such as
when a febrile respiratory illness has been
identified), they are part of the personal
protective equipment that the worker requires.
 Employers must ensure that staff have received
training on the proper use, function and
limitations of the mask in order to be in
compliance with the OHS Act and the Health
Care and Residential Facilities Regulations.
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Surgical masks
Health Care Health & Safety Association
PIDAC’s Preventing Febrile Respiratory
Illnesses document September 2005
states workers must wear a “good quality
surgical/procedure mask covering the
mouth and nose” when providing care to
clients/patients requiring droplet
precautions
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PIDAC-FRI
Health Care Health & Safety Association
Febrile Respiratory Illness (FRI):
used to describe a wide range of dropletspread respiratory infections, such as
colds, influenza, influenza-like illness and
pneumonia, which usually present with
symptoms of a fever of greater than 38
AND new or worsening cough or
shortness of breath.
 Note:the elderly and immunocompromised may not
have a fever
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
To Fit or Not To Fit
Health Care Health & Safety Association
Legislation does not specify the % of
workers that must be fit tested
Employer (in consultation with the
JHSC) must assess the potential for
their workers to be exposed to an
infectious disease and determine
which workers require respiratory
protection
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
To Fit or Not To Fit
Health Care Health & Safety Association
The Risk Assessment should include
The potential for airborne precautions to
be put into effect
The potential for an emergency or
outbreak to occur (SARS- TB - Legionella)
The time it will take for proper training and
fit testing in response to an outbreak
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
To Fit or Not To Fit
Health Care Health & Safety Association
Some facilities are fit testing a core
group of workers in the event of an
outbreak
PLUS- training managers or workers
as fit testers so that training and fit
testing can be ramped up if
necessary.
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Developing a respiratory
protection program
Health Care Health & Safety Association
Program Elements:
• Roles and
responsibilities
• Hazard
assessment
• Respirator
selection
• Health assessment
• Fit testing
• Training and
education
• Use of respirators
• Program
evaluation
• Record keeping
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Fit testing
Health Care Health & Safety Association
Fit testing is required for all tight-fitting
respirators including the N95 respirators
that have been selected to protect workers
from hazards associated with infectious
agents.
Fit testing must be done AFTER the
employer has completed the employee’s
health assessment and BEFORE they are
required to wear the respirator at work.
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Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Fit testing
Health Care Health & Safety Association
Fit testing should be carried out:
 after employee has completed a health
assessment and prior to initial use of respirator
 at least every two years, although it is
preferable annually (CSA Standard)
 whenever there is a change in face-piece
 whenever there is a significant change to the
user’s physical condition (e.g. dental work, facial
injury, >10% increase or decrease in weight)
 with any other PPE required
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Resources
Health Care Health & Safety Association
CSA Standard Z94.4-02 - Selection, Use and
Care of Respirators
Health Canada- Infection Control Guidelines –
http://www.phac-aspc.gc.ca/publicat/ccdrrmtc/02vol28/28s1/index.html
PIDAC- preventing FRIhttp://www.health.gov.on.ca/english/providers/
program/infectious/diseases/ic_fri.html
HCHSA- www.hchsa.on.ca
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
HCHSA’s Respiratory Protection Training
Program
Health Care Health & Safety Association
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
HCHSA Teleconference
Health Care Health & Safety Association
Ventilation Systems and Prevention of
Respiratory Illness
Wednesday, November 9/05
2:00pm- 3:00pm
Dr Leon Genesove, Provincial Physician,
Ontario Ministry of Labour
416-640-3407 (GTA)
1-866-322-8798 (rest of Ontario)
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.
Health Care Health & Safety Association
© Copyright 2005 HCHSA. All rights reserved/ tous droits réservés.
Reproduction in whole or in part by any means without express written consent of HCHSA is prohibited by law.