Respiratory Protection Program Manual

1 Uncontrolled copy when printed Clinical Excellence Commission Respiratory Protection Program Manual Version - 21 December 2021 Page 1 of 149 Clinical Excellence Commission Respiratory Protection Program Manual December 2021 Version Uncontrolled copy when printed Clinical Excellence Commission Respiratory Protection Program Manual Version - 21 December 2021 Page 2 of 149 CHAPTER 1: OVERVIEW OF Respiratory Protection IN HEALTHCARE 5 Introduction 5 Purpose 5 Definitions 6 Infection prevention and control components of an RPP 7 Governance 16 Legal and legislative framework 18 Appendix 1A: Respirator fit testing algorithm 20 Appendix 1B: Instructions for use of prophylactic dressings under tight fitting respirators 21 CHAPTER 2: Respiratory Protection Program IMPLEMENTATION RESOURCES 25 Introduction 25 Program elements 25 Program requirements 28 Appendix 2A: RPD allocation by task or location 37 Appendix 2B: Fit testing risk assessment 38 Appendix 2C: Fit testing implementation checklist and compliance self-assessment 40 Appendix 2D: Sample respirator fit testing consent 41 Appendix 2E: Calibration, maintenance and transport 43 CHAPTER 3.

2 REUSABLE Respiratory PROTECTIVE DEVICES MANAGEMENT AND USE 45 Introduction 45 Guiding principles for utilisation of RPDs 45 Selecting reusable RPDs 45 Training, education and assessment 46 Use of a trained observer to supervise the correct use of PPE 47 Contents Uncontrolled copy when printed Clinical Excellence Commission Respiratory Protection Program Manual Version - 21 December 2021 Page 3 of 149 HW responsibility 48 Biomedical Engineering responsibilities 48 Sterilising Departments responsibilities 48 Elastomeric respirators 49 Powered air-purifying respirators (PAPR) 52 CleanSpace HALO PAPR respirator 55 References 66 Appendix 3A: Reusable Respiratory protective device (RPD) implementation checklist 68 Appendix 3B: General instructions for donning elastomeric half-face respirators 70 Appendix 3C: Donning elastomeric reusable half-face respirator 71 Appendix 3D: Doffing elastomeric reusable half-face respirator 74 Appendix 3E: Donning elastomeric reusable half-face respirator for use within a sterile field 77 Appendix 3F: Doffing PPE with elastomeric reusable half-face respirator for use within a sterile field 80 Appendix 3G: Donning PPE with CleanSpace HALO PAPR 83 Appendix 3H: Doffing PPE with CleanSpace HALO PAPR 87 Appendix 3I: Donning PPE with CleanSpace HALO PAPR 90 Appendix 3J: Doffing PPE with CleanSpace HALO PAPR 94 Appendix 3K.

3 Donning Loose fitting Powered Air Purifying Respirator (PAPR) 97 Appendix 3L: Doffing Powered Air Purifying Respirator (PAPR) 100 Appendix 3M: Difference between elastomeric, loose Fitting PAPR and tight fitting PAPR 102 CHAPTER 4: FIT TESTING USING THE PORTACOUNT OR ACCUFIT MACHINE 107 Introduction 107 Fit testing 107 Quantitative fit testing protocols 108 Quantitative fit testing process 108 Respirator fit test requirements 110 PortaCount / AccuFit Respirator theory of operation 110 Fit testing using a PortaCount or AccuFit machine 111 Appendix 4A: Use of Respiratory protective device with beard cover technique 134 Uncontrolled copy when printed Clinical Excellence Commission Respiratory Protection Program Manual Version - 21 December 2021 Page 4 of 149 Appendix 4B: Fit test assessor -Quick reference guide 141 Appendix 4C: Fit test fact sheet 143 Appendix 4D: Sample check list for fit test assessor (FTA) 144 Appendix 4E: PortaCount / AccuFit quick prompt guide 146 Appendix 4F: Cleaning and disinfection consideration during quantitative fit testing 148 Uncontrolled copy when printed Clinical Excellence Commission Respiratory Protection Program Manual Version - 21 December 2021 Page 5 of 149 Chapter 1.

4 Overview of Respiratory Protection in healthcare Introduction With the emergence of global infectious diseases such as COVID-19 and Severe Acute Respiratory Syndrome (SARS), there is an increasing need to ensure that health workers (HWs) are able to work safely and are protected against exposure to Respiratory pathogens. For this to be done systematically, Local Health Districts (LHDs), Specialty Health Networks (SHNs) and New South Wales (NSW) Ambulance are required to implement a Respiratory Protection Program (RPP). This document provides guidance for LHDs/SHNs and NSW Ambulance regarding Respiratory Protection which uses a risk management approach based on the risk of exposure to infectious pathogens spread by the droplet or airborne routes.

5 It is expected that an RPP will complement existing Infection Prevention and Control (IPAC) and Work Health and Safety (WHS) programs. The Chief Executive of the LHD/SHN or NSW Ambulance assigns leadership responsibility, personnel, and resources to implement and comply with this guidance. This guidance document focuses on Respiratory Protection in relation to the use of respirator masks and what is required to ensure they are managed, worn and used safely. It does not address other aspects of IPAC or other types of personal protective equipment (PPE). For information on infectious diseases that require the use of PPE that are not addressed in this document refer to the Infection Prevention and Control Policy Directive, the NSW Infection Prevention and Control Practice Handbook and the COVID-19 Infection Prevention and Control Manual .

6 Existing Respiratory Protection controls (transmission-based precautions, introduced in 1996) within NSW health have successfully provided Protection to our HWs against Respiratory communicable diseases. Fit checking of respirators on each occasion of use has been and continues to be the most reliable method of ensuring the HW has achieved an optimal fit and required seal in real time, therefore, any RPP should continue to promote fit checking along with the other controls detailed in this document. This document should be used in conjunction with national guidelines and NSW policies, procedures and guidelines. Purpose Respiratory protective devices (RPDs) are designed to protect the wearer from inhalation hazards such as airborne infectious agents and in some cases, dusts and other particles.

7 Risks for HWs are not uniform and this document is designed for those HWs who are at the highest risk of exposure because they are attending to patients with suspected or confirmed Respiratory infection or communicable diseases with potential for airborne transmission ( , pulmonary or laryngeal Tuberculosis, Measles or Chicken pox). Respiratory Protection is one aspect of both IPAC as well as WHS strategies for ensuring HW safety at work. Implementation of RPP requires a comprehensive supporting Program and depending on the RPD design, guidance should be developed on the selection, facepiece fit testing and use of an RPD. Uncontrolled copy when printed Clinical Excellence Commission Respiratory Protection Program Manual Version - 21 December 2021 Page 6 of 149 Definitions Term Definition Aerosol generating behaviour (AGB) Activities such as shouting, singing and coughing, especially in in an enclosed, poorly ventilated space, can increase the amount of droplet production and range of droplet dispersal.

8 Aerosol generating procedure (AGP) AGPs produce droplet nuclei (< 5 micrometres in size) or airborne particles (aerosols) due to air or gas flowing rapidly over a moist or wet surface. AccuFIT 9000 PRO The AccuFIT9000 Pro is a device used for fit testing and measures particles inside and outside a respirator in order to calculate a fit factor. Air-purifying respirator A respirator with an air-purifying filter, cartridge, or canister that removes specific air contaminants by passing ambient air through the air-purifying filter. Assigned Protection Factor (APF) The workplace level of Respiratory Protection that a respirator or class of respirators is expected to provide to health workers. Canister or cartridge A container with a filter, sorbent or catalyst, or combination of these items, which removes specific contaminants from the air passed through the container.

9 Elastomeric A respirator facepiece made of a natural or synthetic elastic material such as natural rubber or silicone. Filtering facepiece A negative pressure particulate respirator with a filter as an integral part of the facepiece or with the entire facepiece composed of the filtering medium. Fit check A Manual procedure that is used each time a respirator is used to ensure a seal is achieved. Fit factor A quantitative estimate of the fit of a respirator to a specific individual and typically estimates the ratio of the concentration of particles in ambient air with its concentration inside the respirator. Fit test A procedure to evaluate the fit of a respirator either qualitatively or quantitatively. Loose-fitting facepiece A respirator that is designed to form a partial seal with the face.

10 PortaCount A PortaCount machine is a device used for fit testing and measures particles inside and outside the respirator in order to calculate a fit factor. Powered air-purifying respirator (PAPR) A respirator that uses a blower to force ambient air through a filter for the wearer. Uncontrolled copy when printed Clinical Excellence Commission Respiratory Protection Program Manual Version - 21 December 2021 Page 7 of 149 Qualitative fit testing Qualitative fit testing is a pass/fail test method that uses taste or smell, or a reaction to an irritant in order to detect leakage into the respirator facepiece. Quantitative fit testing Quantitative fit testing uses a machine to measure the actual amount of leakage into the facepiece and does not rely upon taste, smell, or irritation in order to detect leakage.