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PPE from A to Z:
Exploring the Latest Standards and Regulations
for Health Care Personnel
PAPRs FOR RESPIRATORY PROTECTION
�NETEC:
A Partnership for Preparedness
Setting the gold standard for special pathogen preparedness and
response across health systems in the U.S. with the goals of driving best
practices, closing knowledge gaps, and developing innovative resources.
�Regional Emerging Special Pathogens
Treatment Centers
CT, ME, MA, NH, RI, VT
Massachusetts General Hospital
NJ, NY, PR, VI
NYC Health + Hospitals / Bellevue
DC, DE, MD, PA, VA, WV
Johns Hopkins Hospital
MedStar Washington Hospital Center
AL, FL, GA, KY, MS, NC, SC, TN
Emory University Hospital
UNC Health
IL, IN, MI, MN, OH, WI
University of Minnesota Medical Center
CoreWell Health
AR, LA, NM, OK, TX
University of Texas Medical Branch
IA, KS, MO, NE
University of Nebraska Medical Center/Nebraska Medicine
CO, MT, ND, SD, UT, WY
Denver Health & Hospital Authority
AZ, CA, HI, NV, AS, MP, FM, GU, MH, PW
Cedars-Sinai Medical Center
Locate your regional contacts, including physician, nursing, pediatric,
and operations leadership, as well as local and state health partners.
AK, ID, OR, WA
Providence Sacred Heart Medical Center & Children’s Hospital
�Areas of Focus
CONSULTATION &
ASSESSMENT
EDUCATION &
TRAINING
RESEARCH
NETWORK
INTERNATIONAL
PARTNERSHIPS
Empower hospitals to gauge
their readiness using selfassessment
Deliver didactic and handson simulation training via
in-person courses
Provide direct feedback to
hospitals via on-site
assessment
Provide self-paced
education through online
trainings
Build a central IRB
process for rapid
implementation of clinical
research protocols
Organize, plan, and
implement strategic
international
collaborations
Provide on-site and remote
guidance
Compile an online
repository of tools and
resources
Develop policies,
procedures, and data
capture tools to facilitate
research
Strengthen relationships
with global special
pathogens programs
Provide emergency on-call
mobilization
Develop customizable
exercise templates based
on the HSEEP model
Create the infrastructure
for a specimen
biorepository
Cross cutting, supportive activities
Establish mechanisms to
facilitate sharing of best
practices and
knowledge among special
pathogens programs
�Overview
Welcome:
Jennifer Cuzzolina , RN, MSN-CIC
PAPRs as Part of a Respiratory Protection Program (RPP) at Your institution:
Deciding the Best Respiratory Protection Tools for Your Institution:
Beth Beam, PhD, RN
PAPR Selection:
ILC Dover & 3M:
MAXAIR:
Transport:
Jackson Gruber, BS
Brooke Brewer, BSN, RN, MS, CIC
Morgan Shradar, RN, BSN, MPH
Brooke Henriksen, RN, BSN, CCRN
Bethany Little, BSN, RN
Questions and Answers
NETEC Resources:
Jennifer Cuzzolina , RN, MSN-CIC
�Disclaimer
The content presented in this webinar about Powered Air-Purifying Respirators
(PAPRs) is intended for educational purposes only. NETEC does not endorse or
promote any specific brand or manufacturer of PAPRs. The information
provided is meant to offer general guidance and knowledge about PAPRs and
their use in health care settings. Participants are encouraged to conduct their
own research and consult with appropriate experts or regulatory bodies when
considering the selection or purchase of PAPRs for their specific needs. Any
references to particular brands or products are purely for illustrative purposes
and should not be interpreted as an endorsement by NETEC. We strive to provide
unbiased and impartial information to support health care professionals in
making informed decisions regarding infection prevention and control.
�PAPRs as Part of a Respiratory Protection
Program (RPP) at Your Institution
Beth Beam, PhD, RN
�Implementing PAPRs
Looking for OSHA Requirements?
• 29 CFR1910.134
Where to find RPP documents
• Often managed by Infection Prevention
• May also be handled by Safety, Occupational Health, or other Emergency
Management roles depending on the size of the organization
Key Elements for all kinds of respiratory protection
• Health Assessment
• Required even if not fit testing for a filtering facepiece respirator (N95)
• Education & Training
• Integrate this into your annual competency trainings
• Content areas:
• Setup, decon & maintenance, donning & doffing, adding other PPE
�Where to Find RPP Documents & Tools
RPP Toolkit:
https://www.cdc.gov/niosh/docs/2015-117/default.html
OSHA Respirator Medical Evaluation Questionnaire:
https://www.osha.gov/sites/default/files/publications/OSHA3790.pdf
OSHA Hospital Respiratory Protection Program Toolkit:
https://www.osha.gov/sites/default/files/publications/OSHA3767.pdf#page=59
Required elements for medical evaluation:
https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134AppC
Long-Term Care Tools:
https://www.cdc.gov/longtermcare/prevention/viral-respiratory-toolkit.html
�Deciding the Best Respiratory Protection Tools for Your Institution
Risk assessment is part of the respiratory protection program
What are your "big picture" institutional risks?
• Chemical
• Risk examples: Hazardous drugs, decontamination, or first receivers.
• Who: Care providers, essential services/facilities, environmental services, etc.
• Biological
• Risk examples: Dust, isolation rooms, infectious particles, bone saws,
centrifuge, bronchoscopy, etc.
• Who: Care providers, laboratorians, pathologists, environmental services,
essential services/facilities, health professions students, etc.
Ø PAPR ensembles can be used for some of these "big picture" risks.
Ø Some may also be fine using filtering facepiece N95 respirators along
with other standard precautions.
�Take Home Message
Some PAPRs models can be used for both biological and
chemical response.
• Hoods are made of different materials (eg. butyl rubber,
polyolefin, polypropylene, etc.).
• Filters will have different protection (eg. HEPA, OVAG, CBRN, etc.).
Please do not bring a biological PAPR ensemble to a chemical event!
• They are different in suit materials and filtration.
• They will not protect your personnel.
Our program today focuses specifically on the biological PAPR products
typical to our NETEC special pathogen care focus.
�PAPR Selection
Morgan Shradar, MPH, BSN, RN
Jackson Gruber, BS
�ILC Dover
Single platform can support multiple
user types and protection requirements
Photos: ILC Dover
�ILC Dover
ILC Dover hood options – Various types, including disposables and butyl hoods
Bioshield Full Hood - Disposable
• 1000 APF, offering 100X protection over N95
• Sewn and taped seam construction
• Latex free
• Passes ASTM F 1670 – 14 and
ASTM F 1671-13; required by CDC to
protect against synthetic blood and
blood-borne pathogens
• Exhale flows between the dual shrouds
• Cushioned head strap, adjustable to wearers
• Skirt/exhaust system fully inflates suit for
improved protection
• No fit tested required
Photos: ILC Dover
Head Covers and Hoods - Disposable
• Head Cover
• Offers 2.5x protection over N95s; no fit
testing required
• Single-size head cover reduces need for
multiple sizes
• Compatible with stethoscope
• Secure threaded breathing tube connection
• Clear Hood
• Offers 100x protection over N95, no fit
testing required
• Unique hood provides 320-degree field of
view, increased safety
• No internal head suspension increases
comfort
• Accommodates most head, hearing, and
vision protection
�ILC Dover
ILC Dover hood options – Various types, including disposables and butyl hoods
CBRN CAP 2 Conversion Kits – Butyl
• Butyl hood assembly
• Double shroud, adjustable head strap
• Attached breathing tube
• 3 CBRN cartridges
• Multiple uses: hospital decon, CBRN threats (Filter type dependent)
Ø Options to wear include belt or backpack
Photos: ILC Dover
�ILC Dover
Other components
• Breathing tube
• Polyurethane coating over rigid plastic helix
• Has disposable plastic overlay with twist ties
• PAPR filters
• Filter compatibility – HE,OV/AH/HE, and CBRN filters to provide higher level of respiratory
protection
• Blower motor
• Rugged, sealed nylon protective
shell, floating internal blower
assembly, dual chambered
provided durability
• Noise level <75 dB
• Low voltage alarm, flashing red
LED light along with buzzer
• Belt
• Airflow tester
�ILC Dover
• Battery
Other components
• Rechargeable battery pack
• Sealed external cover with blower connection
• Snap-on configuration
• 1.65 labs
• 8 hours of charge, 5 hours of recharge
• Charger
• AC/DC for sealed NiMH battery
• Red/green LED
• 2 amps, auto switch to trickle charge
• Alkaline battery pack
• Internal receptacles to hold 5 D cell batteries with
external sealed cover
• Snap-on configuration
• 1.95 pounds
• 10 hours of charge
Photos: ILC Dover
�ILC Dover: Cleaning and Disinfection of PAPR Components
CRBN cartridges
• Used cartridges should be handled as a contaminated or potentially contaminated objects.
Disposal of cartridges should be in accordance with state and local environmental regulations.
General cleaning
• Solvents should not be used to clean PAPR blower, battery pack, waist belt hose, or hood.
• Solvents may weaken the plastic components.
• Decontamination solutions may be applied with a cloth, paper towels, or spray method.
• Never submerge or immerse any ILC Dover PAPR component.
• Rinsing should occur using a cloth or paper towel and water.
• Ensure all components are dry before reuse.
�ILC Dover: Pros and Considerations
Pros
Considerations
1. Variety of uses/PPE configurations
• Emergency management decon
to CBRN
• Full hood to half hood
• Butyl hood
2. Flexible charging options
• Rechargeable or battery
operation
3. Option for reusable components
1. More components to assemble
• Risk for possible incorrect assembly
2. Flexible tube may pose risk for staff
injury if caught during use
3. Depending on the hood style, may
diminish the view of the wearer
4. No alarm if filter space is not filled
5. Battery charge not shown
• Alarm for low battery time is variable
�3M
3M Versaflo PAPRs
TR – 300
TR – 600
TR – 800
Photos: 3M
�3M
3M Versaflo hood options – Disposable and non-disposable
Bioshield Full Hood – Disposable (typically single use)
• Typical use in healthcare facilities.
Bioshield Full Hood – Non-disposable (reusable)
• Typical use in industries such as metalworking, woodworking,
construction, and fields with high particulate matter volume.
• These hoods are reused and are built for this reuse strategy; however,
it would not be advised for use in a high-level isolation unit.
Photos: 3M
�3M
3M Versaflo TR – 600 components
Blower motor – Blows the filtered air through the breathing tube to the PAPR hood.
• Buttons - The 3M TR-600 has two buttons.
• The buttons include a power button and a flow control button.
• The flow control button allows the user to increase and decrease the fan speed as needed.
• Indicators –There are three indicator lights on a 3M TR-600 Versaflo PAPR.
• Vibratory alarms are only available on the TR-600 and 800 models, not the TR-300.
• Airflow setting indicator – shows the user the current airflow setting.
• Battery charge status level & alarm indicator – shows the user the current battery level.
• Filter Loading & alarm indicator - The filter loading indicator monitors the pressure drop in
the system.
Photos: 3M
�3M
3M Versaflo TR – 600 components
PAPR filters –Filters the air that the wearer breathes.
• Prefilter – Used to extend the life of a HEPA filter by collecting large particles prior to entering the
HEPA filter.
• HEPA Filters – High Efficiency Particulate Absorbing Filter collets particulate matter in the air. This
protects the wearer from those contaminants.
• Typically used in Healthcare environments, HVAC uses, Airlines, and Motor vehicles.
• Cartridges – Numerous Types – Numerous Functions
• Typical uses in metalworking, chemical manufacturing, and patient decontamination.
Photos: 3M
�3M
3M Versaflo TR – 600 components
• Breathing tube - Connects the PAPR hood to the PAPR blower motor.
• With the 3M design, the breathing tube is easily connected to the PAPR
blower motor by inserting into the blower motor and a ¼ turn to the
right.
• Belt – Used for securing the blower to the wearer.
• Use of belt extender may be advised to fit the wearer.
• Air flow tester - Used to determine whether the PAPR is functioning
appropriately.
• Should be completed prior to donning the respirator.
• Battery – Used to power the blower.
• Typically, 7-10 hours of use with the standard battery, 10.5-19 hours of
use with the high-capacity battery.
• Battery life will depreciate over time and is subjective to the
blower motor setting.
Photos: 3M
�3M
3M Versaflo – Models and functions comparison
3M™ Versaflo™ TR-300+ PAPR
3M™ Versaflo™ TR-600 PAPR
3M™ Versaflo™ TR-800 PAPR
NIOSH Approved Configurations
Yes
Yes
Yes
Gas and Vapor Cartridges
No
Several Options
Several Options
System
Battery Run Time (~ Hours)
Battery Charge Time (~ Hours)
TR-332: 8-12 hrs
<3.5 hrs
TR-630: 4 – 13 hrs
TR-632: 8 – 19 hrs
< 3.5 hrs (TR-630)
< 4.5 hrs (TR-632)
TR-830: 4 – 8hrs
< 4 hrs
Wipe down only
Wipe down, or rinse or submerge with
use of TR-653 Cleaning & Storage Kit
Wipe down, or rinse or submerge with use
of TR-653 Cleaning & Storage Kit
Blower Alarms
Visual/Audible
Visual/Audible/Vibratory
Visual/Audible
User Interface
Battery charge, filter loading and airflow
status alarm
Battery charge, filter loading and airflow
status alarm
Battery charge, filter loading and airflow
status alarm
Approximate Blower Weight without
battery (lbs)
0.85 pounds
1.4 pounds
1.5 pounds
Approximate Battery Weight (lbs)
0.8 pounds
Approximate Blower Dimensions
with HE filter and cover
8” w x 7” h x 3” d
Cleaning (Blower Only)
TR-630: 1 pounds
TR-632: 1.3 pounds
10” w x 8” h x 3” d
1.5 pounds
10” w x 8” h x 3” d
�3M: Cleaning and Disinfection
General guidance
1. Cleaning is recommended after each use.
2. With any disinfecting agent, follow the User Instructions and/or EPA label in regard to usability,
application, and contact time.
3. Ensure all components are thoroughly rinsed with clean, warm water and thoroughly dried before use
or storage.
Ø Cleaning - If cleaning to remove gross soil before disinfection, clean all parts of the PAPR assembly
with a clean, soft cloth dampened with warm water containing a mild pH neutral (pH 6-8) detergent.
Ø Disinfection - Disinfect the PAPR assembly with the disinfectant cleaner. Follow the user instructions
and/or EPA label for the selected disinfectant. Surfaces must be visibly wet with disinfectant for the
full specified contact time.
Ø If submerging the PAPR, be sure to use the 3M™ Cleaning and Storage Kit TR-653 to protect the internal
components.
Use of EPA-registered disinfectant:
• Clorox Healthcare® Bleach Germicidal Disinfectant Wipes (EPA Reg. No. 67619-12)
• 3M™ C.diff Solution Tablets (EPA Reg. No. 71847-6)
• ECOLAB® KLERCIDE™ 70/30 IPA (EPA Reg. No. 1677-249
�3M: Pros and Considerations
Pros
Considerations
1. Smaller profile as compared to other
models of PAPRs
2. Access to information and setting
changes while wearing
1. E.g., airflow, battery, filter health
3. Various options for cleaning and
disinfection
4. Reduced weight as compared to
other models of PAPRs
5. Usability across biological and
chemical threats
1. More components to assemble
2. Flexible tube may allow for needed
control to reduce inadvertent contact
3. Depending on the hood style, may
diminish the view of the wearer
�PAPR Selection
Brooke Brewer, BSN, RN, MS, CIC
Brooke Henriksen, RN, BSN, CCRN
�MAXAIR Controlled Air Purifying Respirator (CAPR)
MAXAIR CAPR options – Various types, including cuffs, shrouds, and hoods
• Cuff version
• Disposable lens cuff (DLC)
• Reusable HE XP filter under filter cover cap
• NIOSH 99.97% HE efficiency
• Average decibel level is below 62 dB.
• Typical systems weigh 2.26 pounds
• 1.76 pounds for the helmet
• 0.5 pounds for the battery
• COVID, other respiratory viruses
Photos: MAXAIR
�MAXAIR Controlled Air Purifying Respirator (CAPR)
MAXAIR CAPR options – Various types, including cuffs, shrouds, and hoods
• CAPR with shroud
• Provides protection of face, head, and neck
• Reusable HE XP filter under filter cover cap
• 99.99% filtration efficiency
• Single-use Disposable shroud
• May be used in a Biocontainment situation
Photos: MAXAIR
�MAXAIR Controlled Air Purifying Respirator (CAPR)
MAXAIR CAPR options – Various types, including cuffs, shrouds, and hoods
• CAPR with Filter Integrated Hood
• Single-use disposable filter integrated hood with a
Heavy Loading Filter (HLF)
• Provides full head to below shoulders coverage
• Shroud AAMI Level 4 fluid impermeability
• Filter AAMI Level 3 fluid impermeability
• Available in single or double-shroud options
• May be used in a Biocontainment situation
Photos: MAXAIR
�MAXAIR Controlled Air Purifying Respirator (CAPR)
MAXAIR CAPR options – Various types, including cuffs, shrouds, and hoods
• CAPR with reusable High Fluid Resistance Filter Cover Cap (HFR FCC)
• Single-use disposable filter integrated hood
• Provides full head to below shoulders coverage
• Provides complete fluid/splash protection of hood filter
• NIOSH 99.97% HE efficiency
• May be used in a Biocontainment situation
Photos: MAXAIR
�MAXAIR Controlled Air Purifying Respirator (CAPR)
MAXAIR components summary
MAXAIR
Other versions of
filter hoods
Filter with
hard shell
Battery
Fan Speed/Filter check
Components
• Standard battery life
8-10 hrs
• Extended battery life
12-15 hrs
• Visible indicator lights
• 3 speeds
• Auto filter check – yellow
light indicates need for
filter change
• Filter changed in Clinical
Engineering
• Blower - helmet
• Battery with charger
• Power cord
• 8-10 hrs
• Extended battery life
12-15 hrs
• Visible indicator lights
• 3 speeds
• Auto filter check – yellow
light indicates need from
new filter hood
•
•
•
•
Blower – Helmet
Battery with charger
Power cord
Optional: high fluid
resistant filter cover
cap (HFR FCC)
Consumables
• Comfort strips
• Lens cuff (SM &
ML)
• Filters
• Comfort strips
• Single or double
shroud hood
(SM & ML)
*Filter is
incorporated into
hood
�MAXAIR CAPR: Cleaning and Disinfection
Follow hospital protocols
MAXAIR recommends:
• PDI Super Sani-cloth Germicidal Disposable Wipe
• Clorox Healthcare Hydrogen Peroxide Cleaner Disinfectant
General guidance:
• Wipe all areas of the outside and inside of the CAPR helmet, battery cord,
and battery pack.
• Allow disinfectant to remain wet per manufacturer instructions for use
• All filters, cuffs, shrouds, and hoods are one-time use only and should be
discarded after use.
Photos: MAXAIR
�MAXAIR CAPR: Pros and Considerations
Pros
1.No-hose system eliminates the chance of
snagging and increases ease of movement
2.Various options for cleaning and
disinfection (quaternary ammonia, bleach,
etc.)
3.Versatile system that can be configured
into a cuff, shroud, or hood depending on
situations
4.Lightweight system with a helmet similar
to a bicycle helmet and battery pack that
is attached to the waist
5.Visible light displays for battery life and
filter life
Considerations
1.Diminished hearing ability with the noise
from the blower and/or muffle of the
wearer's voice
2.Wearers may find the helmet uncomfortable
after prolonged wear due to the headgear
component. Ensuring a proper fit is vital
�Transport
Bethany Little, BSN, RN
�PAPR Considerations: Transport
PAPR selection
• When considering the various PAPRs, evaluation of all the components can
help with selection:
• Motor
• Power source
• Filter
• Hood configurations
• As you've seen, these components and the way they are configured vary. We
will explore the various considerations of the different PAPRs as they relate to
donning, wear, and doffing.
Donning considerations
• Space
• Assistance required
�PAPR Considerations: Transport
Wear considerations
• Adverse weather exposure
• Ensuring availability of hood/shroud configurations that are safe & remain
protective against adverse weather conditions.
• Ensuring PAPR components (motor, power source, and filter) are able to be
exposed or have a way to be protected.
• Wear configurations
• PAPRs that are worn outside PPE versus under PPE.
- This influences the ability to troubleshoot or change out a power source
and/or filter if needed.
- Tubing that may get caught on another object.
�PAPR Considerations: Transport
Wear considerations
•Consider transport environment space
•Confined space
•Sitting for prolonged periods
•Leaning over patient to work
•Potential length of transport (time in suit)
• Communication
• PAPR noise level in combination with transport noise (vehicle/aircraft)
• How does this affect communication with team members and the patient
• If using radios for transport, ensure the PAPR system can be worn with it.
(may need to change wear configuration)
• Will you still be able to hear indicator alarms
• PAPR alarms
• Patient monitoring alarms
�PAPR Considerations: Transport
Doffing Considerations
• Maybe doffing in unfamiliar settings, confined settings
• Doffing assistance
• Doffing buddy
• Doffing tools (chair, IV pole, etc.)
• Plan to handle reusable and disposable contaminated equipment/supplies
�PAPR/CAPR Comparison Summary
PAPR/CAPR Type
Capability/Function
3M Versaflo
ILC Dover
MAXAIR CAPR
CBRN Capability
x
x
x
Submergible Cleaning & Disinfection
x
Visual Indicators
x
x
x
Audible Indicators
x
x
Vibratory Indicators
x
Various Hood Sizes
x
x
Various Fan Speeds
x
x
Weight of Battery + motor unit
• 2.4 lbs.
• 2.7 lbs.
• 2.65 lbs.
• 2.95 lbs.
Battery Life
• 4-13 hrs
• 8-19 hrs
•8 hrs
•10 hrs
Unit Noise Level
≤ 75 dB at ear
≤ 75 dB at ear
• Integrated motor-fan built
into helmet + hood. 1.76 lbs.
• Battery .5 lbs.
• 8-10 hrs
• 12-15 hrs
≤ 75 dB at ear
Typically ≤ 62
�Questions
and
Answers
�NETEC Support & Services
REQUEST A TSS
START THE SPORSA
CONTACT US
Submit a request online or email
info@netec.org.
Submit a request online to receive a
link to start the SPORSA.
Send us an email at info@netec.org or
fill out the Contact Us form.
ONLINE EDUCATION &
TRAINING
ADDITIONAL ONLINE
RESOURCES
STAY IN TOUCH
Sign up for a free online course for
continuing education credit.
Browse our Resource Library to find
tools, resources, and research related
to all stages of preparedness and
response.
Sign up for our e-newsletter to be the
first to know about upcoming
trainings, webinars, and new courses
for continuing education credit.
Read the NETEC blog for the latest
news and updates.
Follow NETEC on social media:
Browse our YouTube channel for
webinar recordings and just-in-time
training videos.
Listen to NETEC's podcast,
"Transmission Interrupted."
�NETEC Resources
NETEC IS HERE TO HELP
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
ASK FOR HELP!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Podcasts
NETEC Skill videos
courses.netec.org
“Transmission Interrupted”
youtube.com/thenetec
(On all major podcast players)
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Resource Library
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Mar 22, 2024 12:00 PM in EDT.
Objectives
CONTINUING EDUCATION<br /><br />Continuing Education credits are not available for this event.<br /><br /><br />MODERATOR<br /><br />Jennifer Cuzzolina, RN, MSN-CIC <br />Special Pathogens Program Coordinator <br />Cedars-Sinai Medical Center <br /><br /><br />PANELISTS<br /><br />Elizabeth L. Beam, PhD, RN <br />Assistant Professor, UNMC College of Nursing <br />HEROES Program Director & Education Researcher <br />UNMC Interprofessional Academy of Educators, Academic Affairs<br /><br />Brooke Brewer, BSN, RN, MS, CIC <br />Program Manager, Infection Prevention Department<br />Program Manager, Special Pathogen Response Center<br />UNC Health<br /><br />Jackson Gruber, BS <br />Regional Special Pathogens Program Coordinator <br />Nebraska Medicine <br /><br />Brooke Henriksen, BSN, RN, CCRN <br />Training and Education Coordinator, Special Pathogens Program <br />Providence Sacred Heart Medical Center & Children's Hospital <br /><br />Bethany Little, BSN, RN <br />Nursing Operations Director<br />Biocontainment Unit Training Education Coordinator<br />MedStar Washington Hospital Center<br /><br />Morgan Shradar, RN, BSN, MPH <br />Nursing Professional Development Specialist, Nebraska Biocontainment Unit <br />Co-Director, National Disaster Medical Disaster Infectious Disease Training Program <br />Nebraska Medicine
Event Type
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Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC Webinar Series (3/22/24): PPE from A to Z: PAPRs for Respiratory Protection
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p>A NETEC hosted <span class="markm42zgps81">webinar</span>, “PPE <span class="markw5om4stlu">from</span> A to Z: PAPRs for Respiratory Protection,” on March 22 at 12 p.m. EST. <br /><br />Panelists discuss the role of multiple types of PAPRs in protecting health care workers, what health care workers should know about the use and maintenance of PAPRs, and how PAPRs fit into a health care respiratory protection program.</p>
<p>You learn the answers to questions like:</p>
<ul>
<li>
<p>What are the key elements of a respiratory protection program?</p>
</li>
<li>
<p>How does the care delivery setting affect the choice of PAPR?</p>
</li>
<li>
<p>What do you need to consider when selecting PAPRs?</p>
</li>
</ul>
<p class="x_last-child">This <span class="markm42zgps81">webinar</span> is part of the PPE <span class="markw5om4stlu">from</span> A to Z series designed to help health care personnel understand and make informed decisions about the personal protective equipment (PPE) available in their facilities. You can watch the other videos in the series on the <a href="https://www.youtube.com/thenetec" target="_blank" title="NETEC YouTube channel" rel="noreferrer noopener">NETEC YouTube channel.</a><br />The <span class="markm42zgps81">webinar</span> is free and open to all health care professionals, frontline workers, physicians, EMS, and infection preventionists.</p>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2024-03-22
Type
The nature or genre of the resource
Webinar only
Identifier
An unambiguous reference to the resource within a given context
PPE
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-03-22
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
PPE Selection
R-PPE
Webinar
-
https://repository.netecweb.org/files/original/d6fe04c46df343f62052439716035036.png
e9e0d30064657be48589523d70b1c84f
https://repository.netecweb.org/files/original/3aae8b74e7e270bbbacbffa96ca5d38b.pdf
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PDF Text
Text
PPE from A to Z:
Exploring the Latest Standards and Regulations
for Health Care Personnel
N95s AND RESPIRATORY PROTECTION
�NETEC:
A Partnership for Preparedness
Setting the gold standard for special pathogen preparedness and
response across health systems in the U.S. with the goals of driving best
practices, closing knowledge gaps, and developing innovative resources.
�Regional Emerging Special Pathogens
Treatment Centers
CT, ME, MA, NH, RI, VT
Massachusetts General Hospital
NJ, NY, PR, VI
NYC Health + Hospitals / Bellevue
DC, DE, MD, PA, VA, WV
Johns Hopkins Hospital
MedStar Washington Hospital Center
AL, FL, GA, KY, MS, NC, SC, TN
Emory University Hospital
UNC Health
IL, IN, MI, MN, OH, WI
University of Minnesota Medical Center
CoreWell Health
AR, LA, NM, OK, TX
University of Texas Medical Branch
IA, KS, MO, NE
University of Nebraska Medical Center/Nebraska Medicine
CO, MT, ND, SD, UT, WY
Denver Health & Hospital Authority
AZ, CA, HI, NV, AS, MP, FM, GU, MH, PW
Cedars-Sinai Medical Center
Locate your regional contacts, including physician, nursing, pediatric,
and operations leadership, as well as local and state health partners.
AK, ID, OR, WA
Providence Sacred Heart Medical Center & Children’s Hospital
�Areas of Focus
CONSULTATION &
ASSESSMENT
EDUCATION &
TRAINING
RESEARCH
NETWORK
INTERNATIONAL
PARTNERSHIPS
Empower hospitals to gauge
their readiness using selfassessment
Deliver didactic and handson simulation training via
in-person courses
Provide direct feedback to
hospitals via on-site
assessment
Provide self-paced
education through online
trainings
Build a central IRB
process for rapid
implementation of clinical
research protocols
Organize, plan, and
implement strategic
international
collaborations
Provide on-site and remote
guidance
Compile an online
repository of tools and
resources
Develop policies,
procedures, and data
capture tools to facilitate
research
Strengthen relationships
with global special
pathogens programs
Provide emergency on-call
mobilization
Develop customizable
exercise templates based
on the HSEEP model
Create the infrastructure
for a specimen
biorepository
Cross cutting, supportive activities
Establish mechanisms to
facilitate sharing of best
practices and
knowledge among special
pathogens programs
�Overview
Welcome:
Jill Morgan, RN, BSN
Respiratory Protection for Healthcare Professionals:
Fit Testing Options and Considerations:
Operational and Cost Considerations:
Details of N95 Use:
NETEC Resources:
Brooke Henriksen, RN, BSN, CCRN
Angela Vasa, RN, MSN
Ryan Thatcher, RN, MSN, CMSRN
Questions and Answers
Jill Morgan, RN, BSN
Jill Morgan, RN, BSN
�Respiratory Protection for
Healthcare Professionals
Jill Morgan, RN, BSN
�Why is Respiratory Protection Needed
https://www.science.org/doi/10.1126/science.abd9149
�Why is Respiratory Protection Needed
Phases involved in airborne transmission of respiratory viruses
r
https://www.science.org/doi/10.1126/science.abd9149
�CDC PHIL https://phil.cdc.gov
�Category
Mask or Respiratory
Protection
Eye Protection
AIIR
Use
Routine Air
Precautions
Mask
Per Standard
Precautions
Not Routinely
Recommended
• Common or endemic
respiratory pathogens
• spread predominantly over
short distances
• Individuals and communities
likely to have some degree of
immunity
Special Air
Precautions
NIOSH approved N95
or higher
Yes
Not Routinely
Recommended
• New or emerging respiratory
pathogens
• Not anticipated to spread over
long distances (ventilation)
• More than mild illness
• Immunity or vaccines not
available
Extended Air
Precautions
NIOSH approved
N95 or higher
Per Standard
Precautions
Yes
Pathogens that are observed to
spread efficiently across long
distances, over extended times,
Room air needs to be contained
https://www.cdc.gov/hicpac/pdf/DRAFT-2024-Guideline-to-Prevent-Transmission-of-Pathogens-2023-10-23-508.pdf
�What is an N95 Respirator
Filtering Facepiece Respirators
Reduce exposure to inhaled particles
Several styles, filtering efficiency, and designations
•
•
•
•
•
•
N - indicates not resistant to oil
R - Somewhat resistant to oil
P - Strongly resistant to oil
95 - 95% of airborne particles
99 - 99% of airborne particles
100 - 99.97% of airborne particles
https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html
�How Do Particulate Filters Work?
Filtration mechanisms: the four ways virus carrying droplets get stuck to fibers
Inertial impaction: With this
mechanism, particles having too
much inertia due to size or mass
cannot follow the airstream as it
is diverted around a filter fiber.
This mechanism is responsible
for collecting larger particles.
Diffusion: Small particles are
constantly bombarded by air
molecules, which causes them to
deviate from the airstream and
come into contact with a filter fiber.
This mechanism is responsible for
collecting smaller particles.
Interception: As particles pass
close to a filter fiber, they may be
intercepted by the fiber. Again,
this mechanism is responsible for
collecting larger particles.
Electrostatic attraction:
Oppositely charged particles are
attracted to a charged fiber. This
collection mechanism does not
favor a certain particle size.
Filtration mechanisms definitions - https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/
Filtration mechanisms images - https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/pdf/how-masks-work-1.pdf
�How Do Particulate Filters Work?
Both medical face masks and respirators use multi-layered particulate filters to
trap or repel particles of all kinds. A respirator’s tight fit helps ensure all the air
moving in or out has been through the filter rather than leaking around the edges
of looser fitting masks.
Procedure masks
have multiple nonwoven layers that
make a tricky maze
for droplets to get
through. And the
static charge of the
fivers causes droplets
to stick to them
N95 has a dense mesh
work of non-woven,
static-charged fibers
that filter in both
directions and allow
you to breath. Check
the NIOSH website list
of up-to-date NIOSHapproved FFRs.
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/pdf/how-masks-work-1.pdf
�Fit Testing Options
and Considerations
Brooke Henriksen, RN, BSN, CCRN
�Other Types of Respirators Used in Healthcare
Today we are focusing on N-95's or Filtering
Facepiece Respirators (FFR's).
Stay tuned for more information regarding
the next NETEC PPE: A to Z Series: Powered
Air-Purifying Respirators (PAPR's)
https://www.cdc.gov/niosh/npptl/pdfs/FY17_N95infographicWhatAreAPR-508.pdf
�Factors to Consider
OSHA Compliance
• Any "tight-fitting" respirator used in a respiratory
protection program requires yearly fit testing
Employee safety
Availability of supplies
Cost of supplies
Costs for maintenance of the program
Sources:
https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134
Licina, A. & Silvers, A. (2020). Use of powered air purifying respirator (PAPR) as part of protective equipment against SARSCoV-2- a narrative review and critical appraisal of evidence. American Journal of Infection Control. 49(2021) 492-499. DOI
�Fit Testing
A fit test is conducted to verify that a respirator correctly fits the user and is comfortable.
Fit test methods are classified as either qualitative or quantitative.
A qualitative fit test is a pass/fail test
that relies on the individual’s sensory
detection of a test agent, such as
taste, smell, or involuntary cough (a
reaction to irritant smoke).
Qualitative testing may not
be possible in those with impaired
taste post-COVID.
A quantitative fit test uses an
instrument to numerically
measure the effectiveness of
the respirator.
Quantitative fit testing of FFRs can
deplete crucial supplies during
shortages.
Image Credits: TSI
Medical clearance records must be maintained for 30 years after termination of employment.
�Fit Testing
• Fit testing is one of the most important parts of the respirator program. It is the only
recognized tool to assess the fit of a specific respirator model and size to the face of the
user.
• OSHA requires employers to make available a sufficient number of models and sizes of
respirators so that staff can be provided with a respirator that is comfortable and fits well.
r
• Staff are only allowed to use the make, model, style, and size of respirator or respirators
for which they have been successfully fit-tested.
• Medical Clearance:
“The standard does not require medical reevaluation on a specific schedule. The employer must provide
reevaluation when recommended by the physician or other licensed healthcare professional (PLHCP)
providing the evaluation, when an employee reports a change in signs or symptoms (e.g., asthma,
difficulty breathing) that may affect the ability to use a respirator, or when the supervisor or the RPA
becomes aware of a change in employee health status or in physical job demands that may impact
respirator use. Many hospitals, however, elect to provide medical clearance on an annual basis.”
https://www.cdc.gov/niosh/docs/2015-117/pdfs/2015-117revised042022.pdf?id=10.26616/NIOSHPUB2015117
CDC Frequently asked questions about respiratory protection: https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource3.html
�Not all facial hair negates the ability to fit test/wear an N-95 mask.
The entire sealing surface of the mask must be in direct contact with the wearer’s skin.
�Operational and Cost
Considerations
Angie Vasa, RN, MSN
�Estimated Costs for Implementation and Maintenance
Loose Fitting Respirator
paired with PAPR
Tight Fitting Respirators (FFR/N95)
Initial Purchase
~$2-4/N95
~$1400-2800 (full kit)
Inventory Replenishment
One time use (Does not account for extended use and Reusable (Dependent on the type of PAPR device purchased.)
assumes HCP working three 12-hour shifts/week.)
Consumables replaced periodically:
~5 respirators/user/day=$20/user/day or
Filters: Variable duration ~$30-40/filter
$60/user/week (Does not include costs for eye
(Cost estimate based on changing filters monthly. Frequency is
protection commonly worn with FFR.)
based on function and environment of care.)
Hoods: Variable duration ~$25-$40/hood (monthly)
Annual Fit Testing
~$50-80/user
Not required
Staff Training
~15 mins/user/year
~45 min/user
Total First Year Costs/user
~$4000
$3760
Subsequent Year Costs/user
$4000
$960 (assuming changing filter and hood monthly)
Industry Partners: https://www.gvs-rpb.com/discover/industry-compliance/the-real-cost-of-your-respirator
N95 purchasing:
https://www.honeywellstore.com/store/category/honeywell-respiratory-protection-face-masks.htm
https://www.hopkinsmedicalproducts.com/product/3M-1870-N95-Respirator-Surgical-Mask-HM699870?gad_source=1&gclid=EAIaIQobChMIu5WzsJ3kggMVaBitBh2K6ARWEAQYAiABEgJi-PD_BwE
PAPR purchasing:
https://www.airgas.com/search?q=3m+pa+pr%3AtopRated%3AProductType%3APowered%2BAir%2BPurifying%2BRespirator%2BKit
https://www.mopec.com/product/maxair-capr-starter-pack/
https://ui.mkpl.3m.com/buyingOptions/7100153841
�Average Costs for Fit Testing
FIT TESTING METHODS
There are two kinds of respirator fit tests:
qualitative and quantitative.
Qualitative Fit Testing (QLFT)
• More common method
• Normally used for half-mask respirators
• Relies on the user’s senses
Quantitative Fit Testing (QNFT)
• Uses a machine to numerically measure
leakage into the facepiece
QLTF Average Costs QNTF Average Costs
Medical Evaluation- $30
$35/user
$65/user
Considerations for Fit Testing:
• Outsourcing or Internal Support
o FTE
o Contractor costs
o Number of employees to complete
fit test
• QLFT or QNFT
o Supplies to perform test
o FTE to support testing
o Length of time for each test
o Conventional, Contingency or
Crisis situations
§ Availability of respirators
Occupational Training and Supply: https://www.otssafety.com/respirator-fit-testing
�Industry Profile for an OSH Standard Results
https://www.osha.gov/ords/imis/industryprofile.stand?p_stand=19100134&p_state=FEFederal&p_type=2&p_esize=
�Top 10 Most Frequently Cited Standards
4
Respiratory Protection
1910.134
2,412 violations
https://www.osha.gov/top10citedstandards
�Details of N95 Use
Ryan Thatcher, RN, MSN, CMSRN
�Donning an N95
N95 Respirators
ü Check to ensure the N95 is free
from defects
ü Perform hand hygiene
ü Cover nose, mouth and chin
ü Top strap on crown of head
ü Bottom strap at the nape of the
neck under the ears
ü Mold the nose piece
ü Perform a seal check
�Details of Use | User Seal Checks
Seal Check EVERY TIME
Complete both Positive and Negative pressure check
If there is an air leak DO NOT EXPOSE YOURSELF
o Readjust the respirator
o Team Member may need to be fit tested to a
different style or size of respirator if unable to
get a proper seal.
�Doffing an N95
ü To remove the N95 bend slightly forward and pull one strap at a time over
your head, beginning with the bottom strap.
ü As the top strap is removed, keep hold of the strap and use it to guide the N95
respirator into the trash.
ü Perform hand hygiene after it is removed.
�Links/References
• NETEC Webinar (2022) on Respiratory Protection Standards: https://www.youtube.com/watch?v=AsVEndZkXdo
• NETEC Webinar (2022) on Respiratory Protection Programs in non-acute healthcare
settings: https://www.youtube.com/watch?v=47M1N_ppUTY
• Facial Hairstyles and Filtering Facepiece Respirators (cdc.gov)
• DHHS (NIOSH) Publication No. 2018-128, Filtering out Confusion: Frequently Asked Questions about Respiratory
Protection, Respirator Reuse and Extended Use (cdc.gov)
• NIOSH Certified Equipment List: https://wwwn.cdc.gov/niosh-cel/
• Voluntary rescissions and revocations: https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/default.html
• Evaluation of KN95s: https://www.cdc.gov/niosh/npptl/respirators/testing/NonNIOSHresults.html
• CDC Poster on performing user seal checks: https://www.cdc.gov/niosh/docs/2018-130/pdfs/2018-130.pdf
• HICPACs Evidence Review and Analysis: https://www.cdc.gov/hicpac/pdf/HCP-N95Mask-SLR-MainAppendix-202311-01-Draft-508.pdf
• HICPAC draft guidelines: https://www.cdc.gov/hicpac/pdf/DRAFT-2024-Guideline-to-Prevent-Transmission-ofPathogens-2023-10-23-508.pdf
• Article on airborne transmission: Airborne Transmission of Respiratory Viruses
• OSHA Respiratory Protection Toolkit: https://www.cdc.gov/niosh/docs/2015-117/default.html
• OSHA guidance on agency or contract staff fit
testing: https://www.osha.gov/sites/default/files/publications/OSHA3952.pdf
�Questions
and
Answers
�NETEC Support & Services
REQUEST A TSS
START THE SPORSA
CONTACT US
Submit a request online or email
info@netec.org.
Submit a request online to receive a
link to start the SPORSA.
Send us an email at info@netec.org or
fill out the Contact Us form.
ONLINE EDUCATION &
TRAINING
ADDITIONAL ONLINE
RESOURCES
STAY IN TOUCH
Sign up for a free online course for
continuing education credit.
Browse our Resource Library to find
tools, resources, and research related
to all stages of preparedness and
response.
Sign up for our e-newsletter to be the
first to know about upcoming
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Read the NETEC blog for the latest
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Follow NETEC on social media:
Browse our YouTube channel for
webinar recordings and just-in-time
training videos.
Listen to NETEC's podcast,
"Transmission Interrupted."
�NETEC Resources
NETEC IS HERE TO HELP
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
ASK FOR HELP!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Podcasts
NETEC Skill videos
courses.netec.org
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youtube.com/thenetec
(On all major podcast players)
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Resource Library
Email
netec.org
repository.netecweb.org
info@netec.org
��
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Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Nov 29, 2023 01:00 PM in Eastern Time
Objectives
<div class="pdl-xs w-sp zm-col zm-col-18">PANELISTS: <br />Jill Morgan, RN Emory University Hospital <br />Brooke Henriksen, BSN, RN, CCRN Providence Sacred Heart Medical Center and Children’s Hospital <br />Ryan Thatcher, MSN, RN, CMSRN Corewell Health <br />Angela Vasa, MSN, RN Nebraska Medicine</div>
Event Type
Webinar, watch at link below.
URL
https://youtu.be/qDGyAG5bmyo?si=o_CMIGxYlzth-vDb
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/qDGyAG5bmyo?si=o_CMIGxYlzth-vDb" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
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NETEC Webinar Series (11/29/23): PPE from A to Z: N95s and Respiratory Protection
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Join NETEC for a webinar, “PPE from A to Z: N95s and Respiratory Protection,” on November 29 at 1 p.m. EST. Panelists will discuss the role of N95s in protecting health care workers and what to know about maintaining compliance. This webinar is part of the PPE from A to Z series designed to help health care personnel understand and make informed decisions about the personal protective equipment (PPE) available in their facilities.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-10-29
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-10-29
Type
The nature or genre of the resource
Webinar only
Mask
Mask Education
Mask Rules
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Respirator
Respiratory Protection
-
https://repository.netecweb.org/files/original/164a5f10dd275e444f4e4eb6d64dbf3a.pdf
879405016dc8985c7999641c4a1f286a
PDF Text
Text
PPE from A to Z:
Exploring the Latest Standards and Regulations
for Health Care Personnel
DECODING MASKS
�NETEC:
A Partnership for Preparedness
Setting the gold standard for special pathogen preparedness and
response across health systems in the U.S. with the goals of driving best
practices, closing knowledge gaps, and developing innovative resources.
�Regional Emerging Special Pathogens
Treatment Centers
CT, ME, MA, NH, RI, VT
Massachusetts General Hospital
NJ, NY, PR, VI
NYC Health + Hospitals / Bellevue
DC, DE, MD, PA, VA, WV
Johns Hopkins Hospital
MedStar Washington Hospital Center
AL, FL, GA, KY, MS, NC, SC, TN
Emory University Hospital
UNC Health
IL, IN, MI, MN, OH, WI
University of Minnesota Medical Center
CoreWell Health
AR, LA, NM, OK, TX
University of Texas Medical Branch
IA, KS, MO, NE
University of Nebraska Medical Center/Nebraska Medicine
CO, MT, ND, SD, UT, WY
Denver Health & Hospital Authority
AZ, CA, HI, NV, AS, MP, FM, GU, MH, PW
Cedars-Sinai Medical Center
Locate your regional contacts, including physician, nursing, pediatric,
and operations leadership, as well as local and state health partners.
AK, ID, OR, WA
Providence Sacred Heart Medical Center & Children’s Hospital
�Areas of Focus
CONSULTATION &
ASSESSMENT
EDUCATION &
TRAINING
RESEARCH
NETWORK
INTERNATIONAL
PARTNERSHIPS
Empower hospitals to gauge
their readiness using selfassessment
Deliver didactic and handson simulation training via
in-person courses
Provide direct feedback to
hospitals via on-site
assessment
Provide self-paced
education through online
trainings
Build a central IRB
process for rapid
implementation of clinical
research protocols
Organize, plan, and
implement strategic
international
collaborations
Provide on-site and remote
guidance
Compile an online
repository of tools and
resources
Develop policies,
procedures, and data
capture tools to facilitate
research
Strengthen relationships
with global special
pathogens programs
Provide emergency on-call
mobilization
Develop customizable
exercise templates based
on the HSEEP model
Create the infrastructure
for a specimen
biorepository
Cross cutting, supportive activities
Establish mechanisms to
facilitate sharing of best
practices and
knowledge among special
pathogens programs
�Overview
Welcome:
Beth Beam, PhD, RN
Fundamentals for Medical Masks: Origins, Types, Purpose, Approval, Testing
Classification, and Overall Utility:
Jeff Stull, MS, ChE
Panel Discussion:
Brooke Henriksen, BSN, RN, CCRN
Craig DeAtley, PA-C
Jeff Stull, MS, ChE
Jill Morgan, BSN, RN
Questions and Answers with NETEC
NETEC Resources:
Jill Morgan, RN, BSN
�Fundamentals for Medical Masks
Jeff Stull, MS, ChE
�What is a Medical Face Mask?
r
Current FDA Definition:
• Loose-fitting, disposable device
• Creates a physical barrier between the mouth
and nose of the wearer and potential
contaminants in the immediate environment
• Meant to help block large-particle droplets,
splashes, sprays, or splatter from reaching
wearer’s mouth and nose
• Help prevent wearer’s saliva and respirator
secretions from reaching others (source control)
Source: CDC (2021)
�How Have Medical Face Masks Changed Over Time?
Up to mid-1990s
Exclusively for
patient protection
Mid-1990s to 2020
2020s to current
Also became PPE for
blood borne
pathogen protection
Added belief that
masks provide some
protection to wearer
r
• Disposable (non-cloth) products gained greater acceptance with availability of cheap
disposable non-woven high filtration materials
• Concern for HIV and Hepatitis exposure from infectious liquids led to fluid resistance
requirements (to protect wearer)
• COVID-19 pandemic resulted in varying expectations for medical mask function
�What Are the Types of Medical Face Masks?
r
• May be labeled as surgical, isolation,
procedure, or dental masks
• Surgical masks have separate ties
• Isolation and procedure masks use ear
loops
• Dental masks are intended for
dentistry
• Some masks may have attached
shields
�How are Medical Face Masks Constructed?
r
• Different layers of non-woven
polypropylene used
• Usually, 3-4 different layers
• All processes are machine-driven
with few manual steps
• Straps or ear loops may be
separately attached
�Are Medical Masks Approved by the FDA?
r
FDA PROCESS
• Considered a Class 2 medical device
• Use of recognized standards
• Require FDA review of product testing
and claims to be cleared for use
• Manufacturers and distributors of
foreign products must be registered
with FDA
• Manufacturer registration must list
medical device product (not reviewed
by FDA)
Available at the FDA website:
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfrl/textsearch.cfm
�How Are Medical Face Masks Evaluated or Tested?
ASTM F2100 – Standard Specification for Materials Used in Construction
of Medical Face Masks
What is Tested
r
• Bacterial filtration efficiency
• Particle filtration efficiency
• Differential pressure
(breathing resistance)
• Fluid resistance
• Flammability
• Biocompatibility
Not Evaluated
• Fit (sizing)
• Fit (leakage)
• Retention (on head)
• Bioburden
• Restricted substances
• Face shield effectiveness
• Face shield fogging
�How is Medical Face Mask Fluid Resistance Evaluated?
r
Blood Projection
ASTM F1862 / ISO 22609 Test Apparatus
Blood
Strike-Through
Test intended to simulate arterial spurt contacting mask
�What Are the Different Medical Face Masks Levels?
Level 1
Barrier
Level 2
Barrier
Level 3
Barrier
Bacterial filtration efficiency,
%
≥95
≥98
≥98
Differential pressure, mm
H2O/cm2
<5.0
<6.0
<6.0
Sub-micron particulate
filtration efficiency, %
≥80
≥85
≥85
Resistance to penetration by
synthetic blood, minimum
pressure in mm Hg for pass
result
80
120
160
Class 1
Class 1
Class 1
Characteristic
r
Flame spread
Level 1
• Low fluids
• Vein pressure
• Patient wear
Level 2
• Low to moderate fluids
• Arterial pressure
• Nursing staff/clinical
Level 3
• High fluids
• Trauma situations
• Surgical use
�What Should I Understand About Medical Mask Use?
üThey are not respirators
üSome features or accessories can improve fit but still do
not replace respirators
r
üIntended for single-use
üShould be replaced when soiled, damaged,
contaminated, or difficult to breathe through
üReplacement frequency will depend on use
circumstances
üWhen saturated with moisture, will be less effective
�Panel Discussion:
Mask Levels
�Panel Discussion:
Registration Questions Answered
�Questions
and
Answers
�NETEC Support & Services
REQUEST A TSS
START THE SPORSA
CONTACT US
Submit a request online or email
info@netec.org.
Submit a request online to receive a
link to start the SPORSA.
Send us an email at info@netec.org or
fill out the Contact Us form.
ONLINE EDUCATION &
TRAINING
ADDITIONAL ONLINE
RESOURCES
STAY IN TOUCH
Sign up for a free online course for
continuing education credit.
Browse our Resource Library to find
tools, resources, and research related
to all stages of preparedness and
response.
Sign up for our e-newsletter to be the
first to know about upcoming
trainings, webinars, and new courses
for continuing education credit.
Read the NETEC blog for the latest
news and updates.
Follow NETEC on social media:
Browse our YouTube channel for
webinar recordings and just-in-time
training videos.
Listen to NETEC's podcast,
"Transmission Interrupted."
�NETEC Resources
NETEC IS HERE TO HELP
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
ASK FOR HELP!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Podcasts
NETEC Skill videos
courses.netec.org
“Transmission Interrupted”
youtube.com/thenetec
(On all major podcast players)
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Resource Library
Email
netec.org
repository.netecweb.org
info@netec.org
��
https://repository.netecweb.org/files/original/bcf8b6e98c79e0186912797ffb6de3d6.png
879a3117a504d3156eae37fd6b46f0b7
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Sep 20, 2023 01:00 PM in EDT
Objectives
PANELISTS<br /><br />Jill Morgan, RN <br />Emory University Hospital<br /><br />Brooke Henriksen, BSN, RN, CCRN <br />Providence Sacred Heart Medical Center and Children’s Hospital<br /><br />Elizabeth L. Beam, PhD, RN <br />University of Nebraska Medical Center College of Nursing<br /><br />Craig DeAtley, PA-C <br />MedStar Washington Hospital Center<br />MedStar National Rehabilitation Hospital<br /><br />Jeff Stull, MS, ChE<br />International Personnel Protection, Inc
Event Type
Webinar, watch at link below.
URL
https://youtu.be/OYXfIdT7gtc?si=SUjsFCkPSK7EL5At
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/OYXfIdT7gtc?si=SUjsFCkPSK7EL5At?authoplay=0" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC Webinar Series (9/20/23): PPE from A to Z: Decoding Masks
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Join this NETEC webinar to gain a comprehensive understanding of mask definitions and standards. A panel of experts in PPE, infection prevention, and PPE design and evaluation will discuss the various mask types and standards. You will also learn about essential safety considerations and best practices for mask selection, use, care, and storage in health care settings. Ensure you're equipped with the knowledge to protect yourself and others by registering now.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-09-20
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-09-20
Type
The nature or genre of the resource
Webinar only
Mask
Mask Education
Mask Rules
Masks
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/8c2c18125ffbcda8f7960d30d9cb9869.png
545e2f9bf21e760bc46aa16d18ba354a
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://netec.org/2023/08/03/health-care-ppe-updates-liquid-barrier-protection-for-gowns/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Health Care PPE Updates: Liquid Barrier Protection for Gowns
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p>During a recent webinar, experts in personal protective equipment (PPE) and infection prevention and control presented updates to liquid barrier protection standards for PPE to help health care personnel make informed decisions about the PPE in their facilities. </p>
<p>The webinar follows a revision to the ANSI / AAMI PB70 (PB70) standards document that was released in early 2023. PB70 standards cover barrier performance and classification of gowns, protective apparel, and drapes intended for use in health care facilities. </p>
<p><a href="https://repository.netecweb.org/items/show/1779" target="_blank" rel="noreferrer noopener">Watch the webinar, “PPE from A to Z: Exploring the Latest Standards and Regulations for Health Care Personnel.”</a></p>
<h4>Read more on the NETEC blog post: <a href="https://netec.org/2023/08/03/health-care-ppe-updates-liquid-barrier-protection-for-gowns/" target="_blank" rel="noreferrer noopener">Health Care PPE Updates: Liquid Barrier Protection for Gowns </a></h4>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-08-03
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-08-03
Gown
Healthcare Worker Safety
Mpox
Occupational Exposure
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/bd7d45a163e2f79b0b75fc44e4614143.pdf
9d3265ac1e03bbb324b77e1068757fe8
PDF Text
Text
PERSONAL PROTECTIVE EQUIPMENT:
LIQUID BARRIER PROTECTION FOR GOWNS
When selecting a gown: ü Consider your risk of exposure to blood and body fluids.
ü Check the packaging for AAMI Level and Gown Type to ensure that you will be protected.
ANSI/AAMI PB70:2022
AAMI Level
Most
Protection
Implications for Use
None: Protective qualities are unknown
Tasks with no anticipated exposure to blood or body fluids
in covered areas.
1
AATCC: 42: Water resistance, impact penetration
Tasks with limited fluid exposure, minimal splash risk.
2
AATCC 42, AATCC 127, (or NWSP 80.3) 20cm: Water resistance,
impact penetration, hydrostatic pressure
Tasks with some fluid exposure, splash risk;
some resistance to pressurized water.
3
AATCC 42, AATCC 127, (or NWSP 80.3) 50cm: Water resistance,
impact penetration, increased hydrostatic pressure
Tasks with some fluid exposure, splash risk;
increased resistance to pressurized water.
4
F1670/F1671: Synthetic blood and viral penetration
Resists penetration of pressurized synthetic blood and viral-sized
particles; tasks with anticipated exposure to blood and body fluids.
Unrated
Least
Protection
Test
Gown Type
Isolation
Procedure
Surgical
Surgical-E
Decontamination
Coverage - entire
gown, except cuffs, ties,
and attachment points,
offer the same level of
protection.
Full Coverage – entire garment
protective and intends to cover
back of wearer.
Critical zones – will be noted
on packaging and indicate the
portions of the garment that
offer protection level claimed.
The remainder of the garment
may not be protective.
Extended critical zone –
includes the shoulders, arms,
and entire front of garment
from neckline to hem. The
back of the garment may not
be protective.
Coverage - entire gown,
except cuffs, ties, and
attachment points, offer
the same level of
protection.
Minimum protection level
= AAMI Level 1
Minimum protection level
= AAMI Level 1
Minimum protection level
= AAMI Level 3
Non-Protective Back – front
and sleeves offer protection;
the back of the gown does not.
Open back– does not intend to
cover the back of wearer.
Minimum protection level
= AAMI Level 1
Minimum protection level
= AAMI Level 1
7.21.2023
�
https://repository.netecweb.org/files/original/60c728eca3dec633157c2ebd44fab50b.pdf
9db236445d83d44c1d7785ae69ae97cb
PDF Text
Text
PPE from A to Z:
Exploring the Latest Standards and Regulations
for Health Care Personnel
UPDATES IN LIQUID BARRIER PROTECTION
IN HEALTH CARE FACILITIES
�NETEC:
A Partnership for Preparedness
Setting the gold standard for special pathogen preparedness and
response across health systems in the U.S. with the goals of driving best
practices, closing knowledge gaps, and developing innovative resources.
�Regional Emerging Special Pathogens
Treatment Centers
CT, ME, MA, NH, RI, VT
Massachusetts General Hospital
NJ, NY, PR, VI
NYC Health + Hospitals / Bellevue
DC, DE, MD, PA, VA, WV
Johns Hopkins Hospital
MedStar Washington Hospital Center
AL, FL, GA, KY, MS, NC, SC, TN
Emory University Hospital
UNC Health
IL, IN, MI, MN, OH, WI
University of Minnesota Medical Center
CoreWell Health
AR, LA, NM, OK, TX
University of Texas Medical Branch
IA, KS, MO, NE
University of Nebraska Medical Center/Nebraska Medicine
CO, MT, ND, SD, UT, WY
Denver Health & Hospital Authority
AZ, CA, HI, NV, AS, MP, FM, GU, MH, PW
Cedars-Sinai Medical Center
Locate your regional contacts, including physician, nursing, pediatric,
and operations leadership, as well as local and state health partners.
AK, ID, OR, WA
Providence Sacred Heart Medical Center & Children’s Hospital
�Areas of Focus
CONSULTATION &
ASSESSMENT
EDUCATION &
TRAINING
RESEARCH
NETWORK
INTERNATIONAL
PARTNERSHIPS
Empower hospitals to gauge
their readiness using selfassessment
Deliver didactic and handson simulation training via
in-person courses
Provide direct feedback to
hospitals via on-site
assessment
Provide self-paced
education through online
trainings
Build a central IRB
process for rapid
implementation of clinical
research protocols
Organize, plan, and
implement strategic
international
collaborations
Provide on-site and remote
guidance
Compile an online
repository of tools and
resources
Develop policies,
procedures, and data
capture tools to facilitate
research
Strengthen relationships
with global special
pathogens programs
Provide emergency on-call
mobilization
Develop customizable
exercise templates based
on the HSEEP model
Create the infrastructure
for a specimen
biorepository
Cross cutting, supportive activities
Establish mechanisms to
facilitate sharing of best
practices and
knowledge among special
pathogens programs
�Overview
Welcome:
Jill Morgan, RN, BSN
ANSI/AAMI PB70:
Jill Holdsworth, MS, CIC, FAPIC, NREMT, CRCST
The Importance of Choosing the Correct PPE for the Job:
Brooke Henriksen, BSN, RN, CCRN
Group Discussion
Questions and Answers with NETEC
NETEC Resources:
Jill Morgan, RN, BSN
�ANSI/AAMI PB70
Jill Holdsworth, MS, CIC, FAPIC, NREMT, CRCST
�REVIEW OF THE MAIN SECTIONS OF ANSI/AAMI PB70
1.3 Exclusions
The standard does not cover the following:
a) Protective apparel for the hands, such as surgical
gloves, patient examination gloves, and other
medical gloves;
r
b) Protective apparel for the face, and eyes, such as
goggles, non-integrated face shields, surgical
masks, and non-integrated respirators;
c) Other types of protective apparel worn by
health care personnel that is not intended or
labeled as a barrier to liquid or microorganisms;
d) Absorbent operating room (OR) towels;
NOTE: Exclusion are from a) to m)
�REVIEW OF THE MAIN SECTIONS OF ANSI/AAMI PB70
4.1 Labeling Requirements
• 4.1.1 Device Labeling
• Each gown, e.g., decontam gowns, surgical gowns,
surgical drapes, etc. “shall be prominently labeled
with its class of barrier performance.”
r
• 4.1.2 Packaging Labeling
• Each package e.g., decontam gowns, surgical gowns,
surgical drapes, etc. “shall be prominently labeled
with the class of barrier performance.”
• Each package “shall be labeled with the following.”
• a) full coverage gown
• b) non-protective back gown; or
• c) open back gown
• 4.1.3.2 “in addition, technical literature to be included”
• Processing instructions (when applicable)
• Specification on performance
• Inspection instructions
ANSI/AAMI PB70, Level 3 Protection
�REVIEW OF THE MAIN SECTIONS OF ANSI/AAMI PB70
4.1.4 Education
“Manufacturer shall provide technical information and/or training explaining the
barrier performance classification system and implication for the end-user.”
r
“Thereafter, the end-user is responsible for making judicious selections of
products according to:”
a) Barrier performance class of the product, and
b) The anticipated degree of exposure during a given procedure or activity
�REVIEW OF THE MAIN SECTIONS OF ANSI/AAMI PB70
4.2.1.2 Classification Levels of Barrier Performance
• Critical zones of e.g., surgical gowns, other gowns,
etc. “shall be sampled and tested according to
section 5.2.1 and classified”
r
Definition: (AQL) Acceptable Quality Level & (RQL) Rejectable Quality Level
Level 1 tested for water resistance (impact penetration)
Level 2 tested for water resistance (impact penetration)
Level 3 tested for water resistance (impact penetration)
Level 4 tested for resistance to bacteriophage (definition:
type of virus that infects only bacteria)
Note
Test methods for meeting the
requirements are in section 4.
NOTE: AATCC 42 is a water resistance impact penetration test & AATCC 127 is
water resistance: Hydrostatic pressure test & ASTM F1670 standard test
penetration by synthetic blood & ASTM F1671 standard test method
penetration by blood-borne pathogens using bacteriophage penetration
�REVIEW OF THE MAIN SECTIONS OF ANSI/AAMI PB70
Annex A 4.2.1 Barrier Performance
r
“The level of barrier protection needed depends primarily on the potential for exposure
to blood, body fluids, and OPIM (Other Potentially Infectious Material).”
�REVIEW OF THE MAIN SECTIONS OF ANSI/AAMI PB70
Annex B (Informative)
Examples of barrier performance classification of surgical gowns, surgical gowns-E,
isolation gowns, other protective gowns, surgical drapes, hoods, togas, and other
protective apparel
r
Examples of critical zones (highlighted in grey)
�REVIEW OF THE MAIN SECTIONS OF ANSI/AAMI PB70
Annex D (Informative) Rationale for
changes to the 2012 edition of PB70
• The last version before the current
revisions
r
• “The most significant revision to
PB70 involves adding additional
defined protective apparel
categories.”
• “Additional labeling requirements
were included in addition to that of
FDA labeling regulations.”
�RECENT REVISIONS IN ANSI/AAMI PB70
Additional protective apparel categories added to the PB70 include:
Surgical gown-E (a surgical gown with extended critical zones)
Procedural gown
r
Decontamination gown
Protective Hoods, Togas, Other protective apparel
Labeling requirements
�RECENT REVISIONS IN ANSI/AAMI PB70
A.4.2.3.5 Other gowns
(e.g., procedure gown, decontamination gown)
• “the design and construction of protective gowns (gowns
that are non-surgical and not isolation gowns) are based
on the anticipated location and degree of liquid contact,
given the expected conditions of use.”
r
• “Therefore, there are three design types, each with
following critical zones:”
a) Full-coverage gowns
b) Non-protective back gowns Note: Non-protective
back gowns are only used when exposure to the back is
not anticipated.
c) Open-back gowns
�RECENT REVISIONS IN ANSI/AAMI PB70
• Additional Labeling Requirements
r
• For each of non-surgical gown, stating that
the gown packaging should inform users of
the type of protection:
a) Full coverage
b) Non-protection back gown
c) Open back gown
�IN CONCLUSION
• While PB70 is intended to be used primary by device manufacturers in qualifying,
classifying, and labeling the barrier performance of their products.
r
• Understanding the protective properties each label promises will also prove
invaluable for healthcare professionals (the end-user).
• So, the end-user can make informed decisions when selecting appropriate PPE.
• Keeping in mind that the document does not cover PPE equipment such as
medical gloves, surgical masks, or goggles
�The Importance of Choosing the
Correct PPE for the Job
Brooke Henriksen, BSN, RN, CCRN
�Group Discussion
�Discussion
Procedure and decontamination gowns description:
• Full coverage
• Non-protective back
• Open back
r
Isolation Gown
Isolation gowns have the same
protection on all sides and from
top to bottom, including sleeves,
except for cuffs
Surgical Gown
Critical zones (delineated by the
manufacturer & illustrated on
packaging) mark where the
claimed level of protection is found
Surgical Gown - E
Extended surgical gowns
protection covers a larger critical
zone from top to bottom on the
front and sleeves of the gown
�Discussion
Level
Test
Purpose
One
AATCC 42
Water resistance, impact
penetration
Two
AATCC 42
AATCC 127
(or NWSP 80.3)
20cm
Water resistance, impact
penetration, hydrostatic pressure
AATCC 42
AATCC 127
(or NWSP 80.3)
50cm
Water resistance, impact
penetration, increased hydrostatic
pressure
F1670/F1671
Liquid and viral penetration
r Three
Four
Isolation
Surgical - E
Surgical
AATCC: American Association of Textile Chemists and Colorists
NWSP: Non-Woven Standard Procedures
Unrated or unclassified gowns are considered unprotective from fluid exposure risk.
�Discussion
r
�Discussion
r
What tasks am I performing?
What exposures can I anticipate?
What are my risks?
• Wound irrigation
• Bed bath
• Incontinence care
• Complex debridement
• Pediatrics
What are the pathogens?
What other tools do I have to
mitigate exposure risk?
• Chux or blue pad
• Towel, underpad
• Extended cuff gloves
• Drape, sheet
• Sleeve length
• Hand hygiene
�Resource Links
Explanation of test methods for F1670/1671
https://www.astm.org/f1671_f1671m-22.html
“ It is known that body fluids penetrating protective clothing materials are likely to carry microbiological contaminants; however, visual detection methods are not sensitive enough to
detect minute amounts of liquid containing microorganisms (1-3).7 This test method uses media containing Phi-X174 Bacteriophage. The visual detection technique of this test method is
supplemented with a biologically based assay capable of detecting virus under the specified test conditions.
5.3 Test Method F1670/F1670M allows the screening of protective clothing materials for resistance to penetration with synthetic blood as a challenge liquid. Test
Method F1670/F1670M uses the same penetration test cell and technique, but exposes material specimens to synthetic blood with visual detection of liquid penetration. Materials passing
Test Method F1670/F1670M should then be tested against bacteriophage penetration using this test method to verify performance.
r
5.4 This test method has been specifically designed for measuring penetration of a surrogate microbe for Hepatitis (B and C) and the Human Immunodeficiency Viruses. The surrogate, PhiX174 Bacteriophage, used in this test method is similar to HCV in size and shape but also serves as a surrogate for HBV and HIV. ”
ANSI/AAMI PB70-2022
APIC Conference June 2023
CDC Guidance LTC EBP
PPE Donning Doffing Sequence
NETEC PPE Resources
https://www.aami.org/standards/ansi-aami-pb70-2022
https://annual.apic.org/presentation/isolation-gown-compliance-education-and-risk-assessment/
https://www.cdc.gov/hai/containment/PPE-Nursing-Homes.html
https://www.cdc.gov/hai/pdfs/ppe/PPE-Sequence.pdf
https://netec.org/?s=PPE
�Questions
and
Answers
�NETEC Support & Services
REQUEST A TSS
START THE SPORSA
CONTACT US
Submit a request online or email
info@netec.org.
Submit a request online to receive a
link to start the SPORSA.
Send us an email at info@netec.org or
fill out the Contact Us form.
ONLINE EDUCATION &
TRAINING
ADDITIONAL ONLINE
RESOURCES
STAY IN TOUCH
Sign up for a free online course for
continuing education credit.
Browse our Resource Library to find
tools, resources, and research related
to all stages of preparedness and
response.
Sign up for our e-newsletter to be the
first to know about upcoming
trainings, webinars, and new courses
for continuing education credit.
Read the NETEC blog for the latest
news and updates.
Follow NETEC on social media:
Browse our YouTube channel for
webinar recordings and just-in-time
training videos.
Listen to NETEC's podcast,
"Transmission Interrupted."
�NETEC Resources
NETEC IS HERE TO HELP
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
ASK FOR HELP!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�
https://repository.netecweb.org/files/original/7bf255f1cd98dcb8d98f4e916c0ee6a6.png
0d82fa41fbd3c28ae7a7801e77688990
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Jun 14, 2023 02:00 PM in Eastern Time
Objectives
You will learn the answers to questions like: <br /><br />What do PPE standards mean for your facility?<br />What questions should health care personnel be asking when reviewing PPE protocols and inventory?<br />How can healthcare workers match their risk of exposure to the right level of protection?<br /><br />PANELISTS<br /><br />Jill Morgan, RN - Moderator<br />Emory University Hospital<br /><br />Brooke Henriksen, BSN, RN, CCRN <br />Training and Education Coordinator<br />Special Pathogens Program Region 10<br />Providence Sacred Heart Medical Center and Children’s Hospital<br /><br />Jill Holdsworth, CIC, FAPIC, NREMT, CRCST<br />infection Prevention Manager<br />Emory University Hospital Midtown<br /><br />Caroline Croyle Persson, MPH, MPA, CPH, CIC <br />Program Director<br />Mountain Plains Regional Disaster Health Response System<br />Biocontainment Unit<br />Denver Health
Event Type
Webinar, watch at link below.
URL
https://youtu.be/y38fsOPk2j8
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/y38fsOPk2j8" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
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Title
A name given to the resource
NETEC Webinar Series (6/14/23): PPE from A to Z: Exploring the Latest Standards and Regulations for Health Care Personnel – Updates in Liquid Barrier Protection in Health Care Facilities
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Learn about updates to the standards for liquid barrier protection of PPE in health care facilities, and what those updates mean for your facility's PPE selection.<br /><br />Hear from experts in PPE, infection prevention, and PPE standards development as they discuss the updated standard for Barrier Performance from the Association for the Advancement of Medical Instrumentation (AAMI) and what that means for those who choose, purchase, and wear protective garments in healthcare.<br /><br />Webinar slides attached.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-06-14
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-06-14
Type
The nature or genre of the resource
Webinar only
Flyer
Gown
Healthcare Worker Safety
One-pager
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/978567002b294231b1171a8d37ba69f7.png
7d3c62d803a95149ddaeafb561e5b825
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://netec.org/2022/11/03/guidance-on-personal-protective-equipment-ppe-breaches/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Guidance on Personal Protective Equipment (PPE) Breaches
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This NETEC blog post discusses breaches, contamination, how to develop a breach plan, and resources for health care facilities.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-11-03
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-11-03
Gloves
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/9169c62c8fc9662026e3e4aa58458f4a.png
3ffd8d642c479882bec6624ed65d964c
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://netec.org/2023/01/10/ppe-breaches-understanding-the-risks-and-how-to-respond/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE Breaches: Understanding the Risks and How to Respond
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This NETEC blog post discusses PPE breaches and identifying and mitigating risks.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-01-10
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-10
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/31ffc72f41c64e23b267b2e5e57e976f.png
31ac1e864a9e014c708ccfe134edb540
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Online Course
Access portal to an online course.
URL
https://netec.org/2022/10/26/course-ppe-breaches/
Access
Description of access information (e.g. itunes).
Freely available through netec.org.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC Guidance on Breach of Personal Protective Equipment
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This interactive educational resource discusses guidance on breach of personal protective equipment (PPE).<br /><br />Health care workers rely on personal protective equipment (PPE) to provide a barrier between themselves and potentially infectious materials and other forms of contamination. Breaks in this protective layer may occur. The risk associated with these breaks will depend on many situation-specific factors, including when, where, and under what circumstances a breach occurs. Each facility should create, maintain, and exercise breach protocols based on its chosen PPE ensemble, its unique physical infrastructure, and its facility exposure plan. In this course, you will be introduced to some general guidelines to prompt the development of a PPE breach policy for your facility.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-10-26
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-10-26
Relation
A related resource
Y - for questions beginning on row 26 and include questions 26, 27, 28
Type
The nature or genre of the resource
Online Course
Occupational Exposure
Occupational Health
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/a28f939e96266461ac7623da2ff3a54d.png
19743b6c0f102026be6662bd4f3ccc21
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
00:25:18
Objectives
<p><strong>Hosts</strong></p>
<p><strong>Jill Morgan, RN</strong></p>
<p>Emory Healthcare, Atlanta, GA</p>
<p>Jill Morgan is a registered nurse and a subject matter expert in personal protective equipment (PPE) for NETEC. For 35 years, Jill has been an emergency department and critical care nurse, and now splits her time between education for NETEC and clinical research, most of it centering around infection prevention and personal protective equipment. She is a member of the Association for Professionals in Infection Control and Epidemiology (APIC), ASTM International, and the Association for the Advancement of Medical Instrumentation (AAMI).</p>
<p><strong>Patricia Ann Tennill RN, BSN</strong></p>
<p>Associate Director of Nursing</p>
<p>NYC Health + Hospitals / Bellevue , New York, NY</p>
<p>Patricia Tennill is an Associate Director of Nursing in Staff Development and the nursing lead for the NYC Health + Hospitals / Bellevue Special Pathogens Program. Patricia has been involved with the Special Pathogens Program since 2014 as a nurse leader responsible for coordinating and overseeing all nursing operations on the Special Pathogens Unit, including the development of protocols concerning the movement and care of patients with special pathogens and the subsequent hands-on training for all staff involved in the Special Pathogens Program. </p>
<p><strong>Resources</strong></p>
<p>Transmission Interrupted, Ep 16: Back to the Basics – PPE and Mpox: <a href="https://netec.org/transmission-interrupted/back-to-basics-ppe-and-monkeypox/" target="_blank" rel="noreferrer noopener">https://netec.org/transmission-interrupted/back-to-basics-ppe-and-monkeypox/</a></p>
<p>NETEC PPE Resources: <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe" target="_blank" rel="noreferrer noopener">https://repository.netecweb.org/exhibits/show/ppe101/ppe</a></p>
<p>NETEC Viral Hemorrhagic Fever resources: <a href="https://repository.netecweb.org/items/browse?tags=Viral+Hemorrhagic+Fever" target="_blank" rel="noreferrer noopener">https://repository.netecweb.org/items/browse?tags=Viral+Hemorrhagic+Fever</a></p>
<p>NETEC Resource Library:<a href="https://repository.netecweb.org/" target="_blank" rel="noreferrer noopener"> https://repository.netecweb.org</a></p>
<p>Transmission Interrupted on the web: <a href="https://netec.org/podcast/" target="_blank" rel="noreferrer noopener">https://netec.org/podcast/</a></p>
<p><strong>About NETEC</strong></p>
<p><strong>A Partnership for Preparedness</strong></p>
<p>The National Emerging Special Pathogens Training and Education Center’s mission is to set the gold standard for special pathogen preparedness and response across health systems in the U.S. with the goals of driving best practices, closing knowledge gaps, and developing innovative resources.</p>
<p>Our vision is a sustainable infrastructure and culture of readiness for managing suspected and confirmed special pathogen incidents across the United States public health and health care delivery systems.</p>
<p>For more information, visit NETEC on the web at<a href="https://netec.org/" target="_blank" rel="noreferrer noopener"> www.netec.org</a>.</p>
<p><strong>NETEC Consultation Services</strong></p>
<p><em>Assess and Advance Your Readiness for Special Pathogens with Free, Expert Consulting.</em></p>
<p>NETEC offers free virtual and onsite readiness consulting to help healthcare facilities and EMS agencies prepare for special pathogen events. Our targeted support services are delivered by experts selected and assigned to each inquiry based on the unique needs of your organization. Have a question? Ask a NETEC expert.</p>
<p>For more information, visit <a href="https://netec.org/consulting-services" target="_blank" rel="noreferrer noopener">netec.org/consulting-services</a>.</p>
URL
https://netec.org/transmission-interrupted/back-to-the-basics-viral-hemorrhagic-fevers-and-ppe/
Player
Field for the html for a video player.
<div style="width:100%;height:200px;margin-bottom:20px;"><iframe style="width:100%;height:200px;" title="Viral Hemorrhagic Fevers and PPE Podcast" scrolling="no" src="https://player.captivate.fm/episode/72934ef2-bc58-4fe7-a7f5-6729522bfcdc"></iframe></div>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Transmission Interrupted Podcast: Back to the Basics – Viral Hemorrhagic Fevers and PPE
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p>In this episode of Transmission Interrupted, NETEC hosts Jill Morgan and Trish Tennill go back to the basics of viral hemorrhagic fevers and personal protective equipment. They discuss four of the most serious and deadly viral hemorrhagic fevers: Ebola, Marburg, Lassa, and Crimean-Congo Hemorrhagic fevers. </p>
<p>While cases in the U.S. are rare, recent outbreaks of Marburg in Ghana, Crimean-Congo Hemorrhagic Fever in Iraq, Lassa Fever in Nigeria, and Ebola in the Democratic Republic of Congo mean that health care workers need to know how to identify and treat these viral illnesses. Where do they get their names? What are the symptoms of viral hemorrhagic fevers? What can health care workers do to prevent transmission in health care settings? Learn the answers to these questions and more on the podcast.</p>
<p>Questions or comments for NETEC? Contact us at <a href="mailto:info@netec.org" target="_blank" rel="noreferrer noopener">info@netec.org</a>.</p>
<p>Visit us on the web at <a href="https://netec.org/podcast/" target="_blank" rel="noreferrer noopener">netec.org/podcast</a>.</p>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-08-31
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
Type
The nature or genre of the resource
Podcast
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Ebola
Marburg
Personal Protective Equipment (PPE)
Podcast
PPE Selection
R-PPE
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/0db5842ee122b07a30330aa4e6ea75fb.pdf
bf7a08cc8e18b744f966baffa2f643a7
PDF Text
Text
Space Recommendations for Donning and Doffing
Personal Protective Equipment (PPE)
in Biocontainment Areas
Space Attributes
and Features
Supplies, Equipment,
and Cleaning
Additional
Considerations
Introduction
The purpose of this document is to provide a general reference guide for safe
donning and doffing spaces. Zones of contamination help guide healthcare
personnel (HCP) risk assessment and risk reduction measures while working in and
moving through these spaces. Donning is to be conducted in a clean space, which
may be referred to as a “cold” space or zone, while the patient’s immediate
environment is considered contaminated, or “hot”. The doffing space is
transitional and should be as clean as possible when it is entered for doffing and is
considered “warm” once doffing has occurred. Waste management and
contamination mitigation measures should be established for doffing spaces.
These recommendations denote criteria that should be met to conduct safe
donning and doffing. Unless otherwise specified, the advice applies to both
donning and doffing spaces.
Space Attributes
and Features
Supplies, Equipment,
and Cleaning
Click each tab for more information
8.25.2022
Additional
Considerations
�Space Recommendations for Donning and Doffing
Personal Protective Equipment (PPE)
in Biocontainment Areas
Space Attributes
and Features
Supplies, Equipment,
and Cleaning
Additional
Considerations
Proximity The donning and doffing space should be close or adjacent
to and physically separate from the patient care space.
Rationale: Donning and doffing spaces that are physically separate from the patient care areas
help prevent contamination; however, some doffing activities may begin in a
designated area within the patient care room (e.g., removing contaminated gloves in a
double or triple glove scenario).
Size
The space size should be large enough to support
activities and allow freedom of movement.
Rationale: Freedom of movement allows the HCP to don or doff without contacting equipment
or surfaces that could create contamination or cause injury.
Lighting
Proper lighting accommodates patient care needs and
staff safety.
Rationale: Lighting that is too bright or from improper angles can cause distortion through eye
protection devices. Dim lighting and shadows can increase trip and contact hazards
and make it more challenging to detect PPE contamination.
Flooring
The flooring should be easy to clean and should not be
slippery in PPE footwear, including when wet.
Rationale: Flooring may need to be cleaned frequently and thoroughly to avoid the risk of
transfer of infectious materials. Slick flooring can lead to falls that could create
contamination or injury.
8.25.2022
�Space Recommendations for Donning and Doffing
Personal Protective Equipment (PPE)
in Biocontainment Areas
Space Attributes
and Features
Access
Supplies, Equipment,
and Cleaning
Additional
Considerations
Donning and doffing spaces should utilize engineering
controls (closed doors or barriers) and administrative
controls (signage and policy) to restrict entry to only
those with a need to be in the space.
Rationale: Physical barriers reduce the likelihood of contaminated items moving between zones
of contamination without adequate disinfection, and administrative barriers help
ensure that only the approved individuals are in these designated spaces. Fewer HCP
in these spaces reduce the likelihood of cross-contamination.
Directional
Donning, doffing, and care spaces should be clearly
Flow
marked or designated and are appropriate for the level
of PPE and the activities conducted.
Rationale: To reduce cross-contamination, it is important to make sure HCP have the proper
PPE for the zone of contamination they are entering and that they do not move from
a higher contamination area, such as a patient care space, back into a cleaner area
(e.g., a donning space) inadvertently.
Visibility
Patient care and doffing procedures can be visualized by
an observer outside of the space, either through windows
or by video access.
Rationale: Allows for a trained observer to observe that patient care and doffing activities are
being performed without risk of HCP or space contamination.
Usage &
Changes
Usage and changes to spaces need to comply with
building and fire codes.
Rationale: Any use of temporary walls and/or barriers should still comply with local building
and fire codes. Compliance with building and fire codes improves safety in the event
of a fire or other emergency.
8.25.2022
�Space Recommendations for Donning and Doffing
Personal Protective Equipment (PPE)
in Biocontainment Areas
Space Attributes
and Features
Supplies, Equipment,
and Cleaning
Additional
Considerations
Cleaning and disinfection: Spaces should be free from porous,
intricate, or un-wipeable surfaces.
Rationale: The space will need to be cleaned and disinfected frequently, and if not easily done
can reduce the quality of cleaning and increase the potential for cross-contamination.
Consider all walls, doors, wall coverings, curtains, furniture, or items used for balance
(e.g., chairs, handholds, etc.) in addition to floors, counters, and other surfaces.
Routine cleaning: The doffing area should be cleaned routinely and
frequently (e.g., after each doffing).
Rationale: Frequent cleaning reduces bioburden and addresses any contamination from each
doffing process.
Furniture and Equipment: Spaces should be free from excess
furniture and equipment.
Rationale: Frequent and thorough cleaning of these spaces will be required. Decreasing the
number of items in these spaces decreases the burden on HCP for cleaning and the
risk of inadvertent cross-contamination.
Supply storage: Close in proximity and in a designated clean space.
Rationale: Whether donning or doffing, it is important to have the necessary supplies
easily accessible.
8.25.2022
�Space Recommendations for Donning and Doffing
Personal Protective Equipment (PPE)
in Biocontainment Areas
Space Attributes
and Features
Supplies, Equipment,
and Cleaning
Additional
Considerations
Handwashing: Donning should begin, and doffing should end with
proper handwashing, even when hand sanitizers are also used
throughout these processes.
Rationale: Handwashing provides for the physical removal of potential contamination on the
hands, which reduces cross-contamination.
Alcohol-based hand sanitizer and EPA-approved disinfectant wipes
should be within reach and available in each area where donning,
doffing, and patient care takes place.
Rationale: Frequent cleaning, disinfection, and hand hygiene (or gloved hand hygiene) will
need to be performed, and each zone should have designated alcohol-based hand
sanitizer and disinfectant wipes to prevent cross-contamination.
Eye wash stations or supplies should be available within or near
the doffing area.
Rationale: Eyes become unprotected during the doffing process and are subject to risk of
splash or spray of contaminants or cleaning products.
Edges and Surfaces: Avoid and monitor for sharp, rough,
or burred surfaces.
Rationale: Sharp edges and burrs on furniture, equipment, shelving, and counters can catch
and tear PPE or injure HCP.
8.25.2022
�Space Recommendations for Donning and Doffing
Personal Protective Equipment (PPE)
in Biocontainment Areas
Space Attributes
and Features
Supplies, Equipment,
and Cleaning
Additional
Considerations
Signage: Easily visible and clear signage, guidance, or protocols.
Rationale: Signage may reinforce previously trained behavior and should be a quick visual
representation of proper infection control behaviors. This may include donning and
doffing checklists, contamination level designations, directional flow, and other
reminders/warnings. Laminating these signs allows for disinfection as needed.
Assistive devices for staff: Chairs, handholds, or grabbers should be
available to aid in the donning/doffing process.
Rationale: These processes can put HCP in odd physical positions that may require reaching,
bending, and stooping; these items help maintain balance and decrease the risk of
contamination or injury.
Trash: Leakproof biohazard containers must be available within
the doffing area.
Rationale: Used PPE must be assumed contaminated and disposed of completely in adequately
sized containers to reduce contaminations. Container placement should not be a
tripping hazard. Containers may be open or have a lid that is easily utilized without
increasing the risk of cross-contamination (e.g., a container with a foot pedal).
8.25.2022
�Space Recommendations for Donning and Doffing
Personal Protective Equipment (PPE)
in Biocontainment Areas
Space Attributes
and Features
Supplies, Equipment,
and Cleaning
Additional
Considerations
These recommendations will improve the overall safety of the donning and
doffing processes and should be implemented whenever possible.
Unidirectional Flow through the unit. Rationale: Staff and equipment following a single
directional path will reduce the potential for cross-contamination of the environment and HCP.
Ventilation and Filtration: The spaces should maintain at least six air changes per hour with
filtration of at least MERV-13. Rationale: Increased air changes help remove potentially
aerosolized contaminates and desiccate settled contaminates, reducing their ability to infect
individuals.
Distinct Anteroom adjacent to the patient care space. Rationale: A spacious anteroom with a
designated doffing space keeps contaminated items contained; provides physical separation from
both the clean donning area and contaminated patient care space; decreases the unintentional
entry of personnel not in PPE.
Separate Heating, ventilation, and air conditioning (HVAC) system that has the patient
room as negative pressure to the surrounding spaces (Air handling moves air into the
patient care unit and/or patient rooms). Rationale: A negative pressure HVAC system will
provide additional safety to those in the surrounding area and help reduce the chances of
aerosolized contamination escaping the biocontainment care area or zone.
Shower: Shower access should be accessible to the doffing area. Rationale: Whether part of
a facility-specific doffing process or not, a readily available shower is important to address PPE
breaches or other issues that result in actual or perceived contamination of HCP. Facility-specific
protocols should clarify what hygiene and attire are adequate to move from the doffing area to
the shower.
Mirrors in donning and doffing locations that allow HCP to observe themselves during
these procedures. Rationale: Complex multilayer PPE ensembles and glove use may decrease
HCP’s ability to tie, untie, straighten, or grasp individual articles of PPE as they are applied or
removed. Mirrors increase HCP's ability to observe breaches and areas of contamination on PPE.
8.25.2022
�Space Recommendations for Donning and Doffing
Personal Protective Equipment (PPE)
in Biocontainment Areas
Resources
CDC: PPE Guidance for Confirmed Ebola Patients
or Clinically Unstable PUIs
Click Here for CDC Website Page Link
CDC: Guidance for Environment Infection Control
in Health Care Facilities
Click here for CDC Website Page Link
OSHA: Exposure to Blood or Other Potentially
Infectious Materials
Click Here for OSHA Website Page Link
ASHRAE: Ventilation of Health Care Facilities
– Standard 170-2021
Click Here to Find the Standard 170-2021 Link
• Herlihey, T. A., Gelmi, S., Cafazzo, J. A., & Hall, T. N. (2017). The impact of
environmental design on doffing personal protective equipment in a healthcare
environment: a formative human factors trial. infection control & hospital
epidemiology, 38(6), 712-717.
• DuBose, J. R., Matić, Z., Sala, M. F. W., Mumma, J. M., Kraft, C. S., Casanova, L. M., ...
& CDC Prevention Epicenters Program. (2018). Design strategies to improve
healthcare worker safety in biocontainment units: learning from Ebola
preparedness. Infection Control & Hospital Epidemiology, 39(8), 961-967.
8.25.2022
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Space Recommendations for Donning and Doffing Personal Protective Equipment (PPE) in Biocontainment Areas
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The purpose of this document is to provide a general reference guide for safe donning and doffing spaces. Zones of contamination help guide healthcare personnel (HCP) risk assessment and risk reduction measures while working in and moving through these spaces. Donning is to be conducted in a clean space, which may be referred to as a “cold” space or zone, while the patient’s immediate environment is considered contaminated, or “hot”. The doffing space is transitional and should be as clean as possible when it is entered for doffing and is considered “warm” once doffing has occurred. Waste management and contamination mitigation measures should be established for doffing spaces.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-08-25
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-26
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - archive
2024-03-12 by Jill Morgan/archived in error - typo - reactivating
Relation
A related resource
Y? - noted in review Physical infrastructure?
Biosafety
Donning and Doffing
Infection Prevention and Control
Personal Protective Equipment (PPE)
Physical Infrastructure
R-PPE
-
https://repository.netecweb.org/files/original/51c2c26c2f346382fc8db5651c560aa1.pdf
c52eb229a3b45de793a7ea3dccbe7c8d
PDF Text
Text
Viral Hemorrhagic Fevers (VHFs)
This group of infectious diseases is caused by several distinct viral families. The term VHF
describes the conditions these pathogens can cause, which may affect many body systems,
including damaging the cardiovascular system. Some of these viruses produce mild disease,
while others can interfere with blood clotting, cause severe disease, and death.
Basic Viral Hemorrhagic Fever Signs & Symptoms:
VHFs share similar symptoms, including fever, headache, muscle or joint pain, nausea/vomiting, and fatigue. Patients
may present without obvious signs of bleeding.
CDC Information on Assessing VHF Risk in a Returning Traveler
Click Here
Viral Hemorrhagic Fever Testing:
Testing for VHFs may require coordination with public health, CDC, and the Viral Special Pathogens Branch.
CDC Information on Submitting Specimens to the Viral Special Pathogens Branch
Click Here
Viral Hemorrhagic Fever Cleaning & Disinfection:
VHFs are RNA, lipid-enveloped viruses. This makes them susceptible to many cleansers and surface disinfectants.
EPA List of Disinfectants for Emerging Viral Pathogens (EVPs)
Click Here
Remember: As soon as a VHF is suspected, initiate precautions
Identify
Early suspicion (symptoms, exposure, travel) and recognition help protect everyone.
Isolate
Choose PPE in conjunction with engineering and≈administrative controls; consider the potential infectious agent, patient
condition, your level of interaction, and tasks to be performed. https://www.cdc.gov/niosh/topics/hierarchy/default.html.
Inform
Promptly notify appropriate internal and external stakeholders,
including your infection prevention and public health professionals.
6.22.2023
�Personal Protective Equipment and Precautions
CDC Guidance on PPE Selection:
https://www.cdc.gov/niosh/npptl/topics/protectiveclothing/default.html
https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/index.html
Full body coverage: coverall or gown, shoe or boot covers,
and a head cover, hood, or shroud. This ensemble is used for
VHFs patients who are 'wet' - a term used to indicate patients
who are diaphoretic, vomiting, bleeding, or having diarrhea.
Blood and viral penetration resistance: gown = ANSI/AAMI PB70
Level 4 or coverall = ASTM F1671 or EN14126.
Standard precautions: include hand hygiene, the use of
gloves and other articles of PPE to prevent exposure to
blood and other potentially infectious materials, respiratory
etiquette, and safe sharps, injection, and lab practices.
Contact precautions: For known or suspected infections
that can be transmitted by touch or contamination of
surfaces and equipment. PPE = gloves and isolation gown.
Droplet precautions: For known or suspected infections
with pathogens that are transmitted when coughing,
sneezing, or speaking. Use source control mask on the
patient when able and when the patient is outside of the
private room or care area. PPE = medical face mask and eye
protection. Eyes, nose, and mouth should remain fully
covered while in close proximity to patient.
Isolation gown: choose the level of gown based on risk.
AAMI PB70 Level 1 – 3 have increasing levels of resistance to
fluids, and Level 4 is tested for viral penetration.
Eye protection: full face shield or goggles with
circumferential protection.
Airborne precautions: For patients with or suspected of
Respiratory protection: N95 or higher filtering face piece
respirator or PAPR (powered air purifying respirator).
Medical or surgical mask: for droplet or source protection
only. They do not provide respiratory protection.
Gloves: non-sterile medical exam gloves. Double gloving and
the use of extended cuff gloves may be advised.
6.22.2023
having a pathogen that can be transmitted by fine mist,
aerosol particles, and droplet nuclei, such as measles,
chicken pox, disseminated zoster (shingles), and
tuberculosis (TB). Use Airborne Infection Isolation Room
(AIIR) and source control mask on the patient when able.
PPE = fit-tested N95 respirator or higher.
Eye protection: Goggles or safety glasses that provide a
barrier from all sides; or a full-face shield that extends past
the sides of the face and to the chin.
�Virus Family
Common
Geography
Illness Caused
Ebola Virus Disease
Central, subSaharan Africa
Filoviridae
Marburg virus
Lassa fever
Arenaviridae
Junín
Machupo (Bolivian HF)
Guanarito (Venezuelan HF)
Sabia (Brazilian HF)
South America
Europe,
Mediterranean,
Middle East,
Africa, India, China
Hemorrhagic Fever
? Presumed
bat
YES
Fruit bat
Precautions
PPE
Contact,
Droplet/Airborne,
Eye
Rodents
YES
Tick, infected
livestock
Contact,
Droplet/Airborne,
Eye
YES
Contact,
Droplet/Airborne,
Eye
Worldwide
Rodent
Possible
Standard
Precautions unless
Andes virus
suspected
All of sub-Saharan
Africa
Mosquito
No
Standard
Precautions
Yellow Fever
Tropics
Mosquito
Blood 1
Dengue
Tropics
Mosquito
No
Tick
No
Hantaviruses
(HPS/HFRS*)
(Sin Nombre, Andes virus)
Rift Valley Fever
Flaviviridae
Person-toperson spread
West Africa
CCHF – Crimean Congo
Bunyaviridae
Vector or
Source
Kyanasur
India
Omsk
Siberia
HPS* - Hantavirus Pulmonary Syndrome
Comments
Dry phase =
impermeable gown to
mid-calf
Wet phase = Full body
coverage
Dry phase =
impermeable gown to
mid-calf
Wet phase = full body
coverage
Dry phase =
impermeable gown to
mid-calf
Wet phase = Full body
coverage
Contact,
Droplet/Airborne, Eye
for potential Andes
virus or contact/cleanup of rodent droppings
1 Potential risk of
Standard
Precautions
Yellow Fever
transmission in blood
transfusion, or
immediately post
vaccination
HFRS* - Hemorrhagic Fever with Renal Syndrome
Yellow Fever - 1 Transmission of the vaccine strain of Yellow Fever can occur thru blood transfusion and breastmilk. Blood donation & breastfeeding should
be avoided for 2 weeks after vaccination.
Full body coverage
Gown
Respiratory protection
by N95 or higher
Medical or
surgical mask
6.22.2023
Gloves
Eye protection
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Viral Hemorrhagic Fevers (VHFs) Matrix
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This group of infectious diseases is caused by several distinct viral families. The term VHF describes the conditions these pathogens can cause, which may affect many body systems, including damaging the cardiovascular system. Some of these viruses produce mild disease, while others can interfere with blood clotting, cause severe disease, and death.<br /><br />This document provides information Personal Protective Equipment and Precautions, and PPE selection for Viral Hemorrhagic Fevers.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-06-22
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-22
Argentine Hemorrhagic Fever
Crimean Congo Haemorrhagic Fever (CCHF)
Ebola
Junín virus
Lassa
Marburg
Personal Protective Equipment (PPE)
R-PPE
South American Hemorrhagic Fever
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Machry, H., Z. Matić, Y. Oh, J. R. DuBose, J. S. Morgan, K. L. Love, J. T. Jacob, and C. M. Zimring. 2022. "Healthcare design to improve safe doffing of personal protective equipment for care of patients with COVID-19." Infect Control Hosp Epidemiol:1-10. doi: 10.1017/ice.2021.526.
Abstract
<p id="as1title"><strong>Objective:</strong></p>
<p id="__p2" class="p p-first-last">Understand how the built environment can affect safety and efficiency outcomes during doffing of personal protective equipment (PPE) in the context of coronavirus disease 2019 (COVID-19) patient care.</p>
<p id="as2title"><strong>Study design:</strong></p>
<p id="__p3" class="p p-first-last">We conducted (1) field observations and surveys administered to healthcare workers (HCWs) performing PPE doffing, (2) focus groups with HCWs and infection prevention experts, and (3) a with healthcare design experts.</p>
<p id="as3title"><strong>Settings:</strong></p>
<p id="__p4" class="p p-first-last">This study was conducted in 4 inpatient units treating patients with COVID-19, in 3 hospitals of a single healthcare system.</p>
<p id="as4title"><strong>Participants:</strong></p>
<p id="__p5" class="p p-first-last">The study included 24 nurses, 2 physicians, 1 respiratory therapist, and 2 infection preventionists.</p>
<p id="as5title"><strong>Results:</strong></p>
<p id="__p6" class="p p-first-last">The doffing task sequence and the layout of doffing spaces varied considerably across sites, with field observations showing most doffing tasks occurring around the patient room door and PPE support stations. Behaviors perceived as most risky included touching contaminated items and inadequate hand hygiene. Doffing space layout and types of PPE storage and work surfaces were often associated with inadequate cleaning and improper storage of PPE. Focus groups and the design charrette provided insights on how design affording standardization, accessibility, and flexibility can support PPE doffing safety and efficiency in this context.</p>
<p id="as6title"><strong>Conclusions:</strong></p>
<p id="__p7" class="p p-first-last">There is a need to define, organize and standardize PPE doffing spaces in healthcare settings and to understand the environmental implications of COVID-19–specific issues related to supply shortage and staff workload. Low-effort and low-cost design adaptations of the layout and design of PPE doffing spaces may improve HCW safety and efficiency in existing healthcare facilities.</p>
<p class="sec"><strong class="kwd-title">Keywords: </strong><span class="kwd-text">COVID-19, PPE, doffing, infectious diseases, healthcare design, built environment</span></p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Pub Med Central
URL
https://pubmed.ncbi.nlm.nih.gov/35156598/
Read Online
Online location of the resource.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914142/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Healthcare design to improve safe doffing of personal protective equipment for care of patients with COVID-19
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Understand how the built environment can affect safety and efficiency outcomes during doffing of personal protective equipment (PPE) in the context of coronavirus disease 2019 (COVID-19) patient care.
Creator
An entity primarily responsible for making the resource
Herminia Machry, Zorana Matić, Yeinn Oh, Jennifer R DuBose, Jill S Morgan, Kari L Love, Jesse T Jacob, Craig M Zimring
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-02-14
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
2019-nCoV
COVID-19
Donning and Doffing
Example
Occupational Exposure
Patient Care
Personal Protective Equipment (PPE)
Physical Infrastructure
R-PPE
R-Res&Pub
Treatment and Care
-
https://repository.netecweb.org/files/original/ae630a57b5a965dfd7aa6a8572004249.png
54b970b693160dbae14686202aa25cd2
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
Objectives
<p><strong>Hosts</strong></p>
<p><strong>Jill Morgan</strong>, RN, Emory Healthcare, Atlanta, GA</p>
<p><strong>Patricia Ann Tennill</strong>, RN, BSN, Associate Director of Nursing, Bellevue Health & Hospitals, New York, NY</p>
<p><strong>Resources</strong></p>
<p>Monkeypox Information for Clinicians: <a href="https://www.cdc.gov/poxvirus/monkeypox/clinicians/index.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/poxvirus/monkeypox/clinicians/index.html</a></p>
<p>NETEC Monkeypox Resources: <a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox" target="_blank" rel="noreferrer noopener">https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox</a></p>
<p>NETEC Resource Library:<a href="https://repository.netecweb.org/" target="_blank" rel="noreferrer noopener"> https://repository.netecweb.org</a></p>
<p><strong>About NETEC</strong></p>
<p><strong>A Partnership for Preparedness</strong></p>
<p>The National Emerging Special Pathogens Training and Education Center’s mission is to set the gold standard for special pathogen preparedness and response across health systems in the U.S. with the goals of driving best practices, closing knowledge gaps, and developing innovative resources.</p>
<p>Our vision is a sustainable infrastructure and culture of readiness for managing suspected and confirmed special pathogen incidents across the United States public health and health care delivery systems.</p>
<p>For more information visit NETEC on the web at<a href="https://netec.org/" target="_blank" rel="noreferrer noopener"> www.netec.org</a>.</p>
URL
https://netec.org/transmission-interrupted/back-to-basics-ppe-and-monkeypox/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Transmission Interrupted Podcast: Back to Basics: PPE and Mpox
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p>A recent European outbreak of Mpox has captured the global healthcare community’s attention. As cases overseas continue to rise, the first cases of Mpox in the United States have recently been confirmed. With healthcare organizations across the country preparing to care for patients infected with the Mpox virus, now is the right time for facilities to review their Infection Control and Personal Protective Equipment (PPE) policies and procedures. </p>
<p>In this episode of Transmission Interrupted, NETEC hosts Jill Morgan and Trish Tennill as they take us back to the basics of PPE and Mpox. What PPE precautions should facilities deploy? What Mpox-related concerns should facilities and healthcare workers be taking into consideration to keep themselves safe while caring for patients? Join us as Jill and Trish share best practices, tips, and tricks to help healthcare workers get back to the basics of PPE at their facilities. </p>
<p>Questions or comments for NETEC? Contact us at <a href="mailto:info@netec.org" target="_blank" rel="noreferrer noopener">info@netec.org</a>.</p>
<p>Visit us on the web at <a href="https://netec.org/podcast/" target="_blank" rel="noreferrer noopener">netec.org/podcast</a>.</p>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-06-01
Type
The nature or genre of the resource
Podcast
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
Infection Prevention and Control
Mpox
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/eb690ee0e9060ac2d608d511c1a690a6.pdf
622be40051f967f235d838f512bf94c6
PDF Text
Text
�
https://repository.netecweb.org/files/original/462abcc303cdd3109f4cda5831aeab66.pdf
42d6f3bb812a61a8ecb97046a28ce1b7
PDF Text
Text
Mask Filtration and Fit Matter:
Mind the Gap!
What makes a good mask?
Mask fit is critical!
Introduction
As a health care professional, you depend on personal protective equipment (PPE) to help
keep you safe and healthy.
During a COVID-19 surge, influenza season, or any time there might be contagious particles
circulating in the air around you, it is important to choose the best filtering mask available to you.
Strategies such as physical distancing and improving ventilation in critical areas can help add a
buffer of protection but utilizing a well-fitting mask should be the healthcare professional’s
number one priority.
No matter how good the air filtration system claims to be, your goal should be to have your
mask filter ALL the air you breathe in and out, once donned.
What makes a good mask?
Mask fit is critical!
Click each tab for more information
3.16.2022
�Mask Filtration and Fit Matter:
Mind the Gap!
What makes a good mask?
Mask fit is critical!
Mask or Respirator Selection:
N-95 Respirator
Current CDC guidelines for health care personnel recommend using an N95 or better
respirator for the care of anyone suspected or confirmed of having COVID-19,
Tuberculosis (TB), chickenpox, measles, or disseminated zoster. So, if you have a choice,
a NIOSH-approved N95 respirator is the best option.
ü Be sure you know how to use it correctly
ü Make sure it has been fit tested
ü Perform a user seal check every time you put the respirator on
Medical and Surgical Mask
If an N95 respirator is not available, or you are caring for those without COVID-19 or other
suspected airborne pathogens, your next best option is a medical and surgical mask. Look
for ASTM F2100-21, available in three levels of fluid resistance.
ASTM F3502 masks meet the new standard as a barrier face covering, but not as a surgical mask.
They are intended to be a form of source control to protect others. These masks may not offer as much
protection for the wearer, especially in a higher-risk environment.
3.16.2022
�Mask Filtration and Fit Matter:
Mind the Gap!
What makes a good mask?
Mask fit is critical!
No matter how well a mask/respirator tests for filtration in a lab, it won’t offer the same
level of protection if it does not fit properly. The purpose of your mask/respirator is to
filter the air before it reaches your airway and lungs, and to filter what you exhale before
it can be inhaled by someone else.
Seal the Deal!:
When we are talking about RESPIRATORS, we talk about the SEAL. It's not enough to minimize
gaps; for tight-fitting respirators to function, they must make a seal against your face all the
way around. Initial and annual fit-testing makes sure the respirator you have can make this
seal. User seal checks are a vital step to ensure that the respirator is positioned correctly, and
the mask is sealed to your face. User seal checks should be performed every time you put on
your respirator.
Mind the Gap:
When we are talking about medical
face masks, we talk about achieving
the best fit possible to minimize air
leaking around the edges of the mask.
If your mask gaps along the sides of
your face, the bridge of your nose, or
under your chin, it won’t provide the
best level of protection.
Click to download Graphic
Tips for improving mask fit:
• Practice in front of a mirror until you find what works for the size and shape of your face
• Try the Face mask fit modifications that improve source control performance
• Using a mask with a nose wire can help avoid air leakage at the top of the mask
• Knotting, tying, or using a toggle on the straps can help you adjust fit CDC 'Knot & Tuck' your mask video
• Commercial mask braces can help hold the mask against your skin, forcing the air through the filter
instead of around the edges
• Follow the general CDC guidance on improving the fit and filtration of masks
• See the NETEC resource Most common mask-wearing mistakes
3.16.2022
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Take the Course at the URL below: <a href="https://netec.org/2022/03/11/course-mask-filtration-and-fit-matter/" target="_blank" rel="noreferrer noopener">Mask Filtration and Fit Matter</a>
URL
https://netec.org/2022/03/11/course-mask-filtration-and-fit-matter/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Mind the Gap! Facemask Fit Matters
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This printable flyer infographic "Mind the Gap! Facemask Fit Matters" contains information on mask and masks fit, fitting masks, as maximum mask-to-skin contact is essential.<br /><br />Mind the Gap:<br />Mask Filtration and Fit Matter:<br />Mind the Gap!<br />No matter how well a mask tests for filtration in a lab, it offers no protection if it does not fit<br />properly. The purpose of your mask is to filter all the air before it reaches your airway and<br />lungs, and to filter what you exhale before it can be inhaled by someone else. If your mask<br />gaps along the sides of your face, the bridge of your nose, or under your chin it won’t provide<br />the best level of protection.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-03-16
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
2019-nCoV
Coronavirus
COVID-19
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Respirator
Respiratory Pathogen
Respiratory Protection
-
https://repository.netecweb.org/files/original/ddcbc78f87768ebab2aeb9bbc58bd2d8.png
6f15c7d6756226e005548644bbd80967
https://repository.netecweb.org/files/original/4c26e9db6e9ddce6855fc4a98cc3a887.docx
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https://repository.netecweb.org/files/original/947a9b0180f9c26cee3472a72b1c1331.pdf
edbf6cb38793fb141b052c1318020163
PDF Text
Text
NETEC Webinar Series:
Respiratory Protection Program (RPP)
for the Non-Acute Healthcare Providers
�Overview
Welcome: Jill Morgan, RN, BSN
Respiratory Protection Program (RPP) for the Non-Acute Healthcare Providers
Key Components: Dr. Anna Fisher, CMDCP, CDP, QCP
Program Elements: Jerry Nevins, NHA, RN
Program Evaluation: Dr. Anna Fisher, CMDCP, CDP, QCP
Jerry Nevins, NHA, RN
Questions and Answers with NETEC
NETEC Resources: Jill Morgan, RN, BSN
�NETEC Vision
NETEC sets and advances the gold standard for
special pathogen preparedness and response across
health care delivery systems with the goals of driving
best practices, closing knowledge gaps, and
developing innovative resources.
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�Areas of Focus
Consultation
Education
Research Network
Deliver didactic and handson simulation training via
Build
Meet Fred
Empower hospitals to gauge
their readiness using
Self-Assessment
In-Person Courses
Measure facility and healthcare
worker readiness using
Central IRB Process
for rapid implementation of
clinical research protocols
Provide self-paced education through
Online Trainings
Metrics
Provide direct feedback to hospitals via
On-Site Assessment
Compile
Online Repository
Provide
of tools and resources
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
On-Site and Remote Guidance
Provide
Emergency On-Call
Mobilization
Develop customizable
Exercise Templates
based on the HSEEP model
Cross-Cutting, Supportive Activities
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Respiratory Protection Program (RPP)
for the Non-Acute Healthcare Providers:
Key Components
Dr. Anna Fisher, CMDCP, CDP, QCP
�Respiratory Protection Program: Key Components
Purpose
The purpose of any respiratory protection program (RPP):
• To maximize the protection afforded by respirators when they must be used
• Ensure that all staff are protected from exposure to airborne transmissible diseases
through appropriate use of respiratory protection
• Establish the procedures necessary to meet the regulatory requirements described in
OSHA’s Respiratory Protection Standard https://www.osha.gov/respiratory-protection
Scope and Application:
• The program applies to all staff who could potentially be exposed to airborne
respiratory hazards during routine work operations in the event of an influenza
pandemic or other infectious respiratory disease emergency
• Applies to all staff who are required to wear respirators when performing their job duties
�Respiratory Protection Program: Key Components
Example Policy
It is the policy of [facility name] to protect the health and safety of its staff by
• Eliminating hazardous exposures where feasible
• Using engineering and administrative controls to minimize hazardous exposures that
cannot be eliminated
• Using respiratory protection and other personal protective equipment when the
frequency and duration of exposures cannot be substantially reduced or eliminated
This program applies to all staff and contractors who are required to wear respiratory
protection due to the nature of their work at [facility name]
It applies to the use of air-purifying and air-supplying respirators, including filtering facepiece
respirators
Important
Important Staff should be trained, consistent with facility respirator use policies,
on how the resident’s signs and symptoms and clinical judgement about
potential diagnoses relate to risk-based decisions on respirator use
�Respiratory Protection Program: Key Components
Responsibilities – Program Administrator
Responsible for administering the Respiratory Protection Program
Responsibilities include but not limited to:
• Identifying situations requiring a mandatory use of respirators
• Selection of respiratory protection options that meet guidelines for the situation
�Respiratory Protection Program: Key Components
Responsibilities – Program Administrator
Responsible for administering the Respiratory Protection Program
Responsibilities include but not limited to:
• Identifying situations requiring a mandatory use of respirators
• Selection of respiratory protection options that meet guidelines for the situation
Monitoring respirator use to ensure that respirators are used in accordance
with their certifications
Arranging for and/or conducting respirator training
Ensuring proper storage, cleaning, inspections, and maintenance of respiratory stock
and testing equipment
�Respiratory Protection Program: Key Components
Responsibilities – Program Administrator
Responsible for administering the Respiratory Protection Program
Responsibilities include but not limited to:
• Identifying situations requiring a mandatory use of respirators
• Selection of respiratory protection options that meet guidelines for the situation
Monitoring respirator use to ensure that respirators are used in accordance
with their certifications
Arranging for and/or conducting respirator training
Ensuring proper storage, cleaning, inspections, and maintenance of respiratory stock
and testing equipment
Ensuring the conduct of fit testing
Administering the medical evaluation and surveillance program
Maintaining records required by the Program
Evaluating the Program
Updating the Program as needed
�Respiratory Protection Program: Key Components
Responsibilities - Supervisor
Responsibilities include but not limited to:
• Ensuring that the Respiratory Protection Program is implemented
• Ensuring that staff under their supervision (including new hires) have received
appropriate training as well as an annual medical evaluation and fit test if duties
involve use of a respirator
• Ensuring the availability of appropriate respirators
�Respiratory Protection Program: Key Components
Responsibilities - Supervisor
Responsibilities include but not limited to:
• Ensuring that the Respiratory Protection Program is implemented
• Ensuring that staff under their supervision (including new hires) have received
appropriate training as well as an annual medical evaluation and fit test if duties
involve use of a respirator
• Ensuring the availability of appropriate respirators
Being aware of tasks requiring the use of respiratory protection
Enforcing the proper use of respiratory protection when necessary
Ensuring that respirators are properly cleaned, maintained, inspected, and stored
according to the Respiratory Protection Program
�Respiratory Protection Program: Key Components
Responsibilities - Supervisor
Responsibilities include but not limited to:
• Ensuring that the Respiratory Protection Program is implemented
• Ensuring that staff under their supervision (including new hires) have received
appropriate training as well as an annual medical evaluation and fit test if duties
involve use of a respirator
• Ensuring the availability of appropriate respirators
Being aware of tasks requiring the use of respiratory protection
Enforcing the proper use of respiratory protection when necessary
Ensuring that respirators are properly cleaned, maintained, inspected, and stored
according to the Respiratory Protection Program
Ensuring that respirators fit well and do not cause discomfort
Coordinating with the Program Administrator on how to address hazards or other
concerns regarding the Program
�Respiratory Protection Program: Key Components
Responsibilities – Staff
Responsibilities include:
Wear respirators when and where required
Wear in the manner which they were trained for donning and doffing
Care for and maintain their respirators as instructed
How to wear a N95 respirator:
�Respiratory Protection Program: Key Components
Responsibilities – Staff
Responsibilities include:
Wear respirators when and where required
Wear in the manner which they were trained for donning and doffing
Care for and maintain their respirators as instructed
Inform supervisor if the respirator no longer fits
Inform supervisor or the Program Administrator of any respiratory hazards they feel are not
adequately addressed in the workplace, and of any other concerns regarding the Program
Inform supervisor when a medical re-evaluation is needed
�Content Outline (TOC)
Respiratory Protection Program (RPP)
for the Non-Acute Healthcare Providers:
Program Elements
Jerry Nevins, NHA, RN
�Respiratory Protection Program: Program Elements
Program Elements
A
Hazard Assessment and Respirator Selection
B
Medical Evaluation
C
Fit Testing
D
Respirator Use – Responsibilities for Staff
E
Emergency Procedures (respirator malfunction)
F
Cleaning, Maintenance, and Training
�Respiratory Protection Levels
Level A
Level B
Atmosphere-supplying Respirator
Atmosphere-supplying Respirator
• Self Contained Breathing Apparatus
[SCBA]
• Supplied Air Respirator [SAR])
• (Self contained breathing
apparatus [SCBA]
• Supplied Air Respirator [SAR]
Interior air supply
Level C
Exterior air supply
r
Level D
Air-purifying Respirator [APR]
•
Includes PAPRs and N95 FFPs
No respiratory protection
�Respiratory Protection Program: Program Elements
Respiratory Protection
Atmosphere-supplying respirator
Respirator supplies the respirator user with breathing air from a source
independent of the ambient atmosphere. Includes supplied-air respirators
(SAR) and self-contained breathing apparatus (SCBA) units.
Air-purifying respirator
Respirator with air-purifying filter, cartridge, or canister
that removes specific air contaminants by passing
ambient air through air-purifying element.
�Hierarchy of Controls
MOST
EFFECTIVE
ELIMINATION
PHYSICALLY REMOVE THE HAZARD
SUBSTITUTION
ENGINEERING
CONTROLS
ADMINISTRATIVE
CONTROLS
PPE
REPLACE THE HAZARD
r
ISOLATE PEOPLE FROM THE HAZARD
CHANGE THE WAY PEOPLE WORK
PROTECT THE WORKER WITH PERSONAL
PROTECTIVE EQUIPMENT
LEAST
EFFECTIVE
https://www.cdc.gov/niosh/topics/hierarchy/default.html
�Hazard Assessment and Respirator Selection
The Program Administrator will:
Conduct a hazard evaluation and document. The
r tasks to
hazard evaluation will involve a review of job
determine where potential exposures may occur with
any and all staff
Select respirators to be used based on the
airborne hazards to which staff are exposed and in
accordance with all applicable OSHA standards
Click here to download the CDC graphic
�Hazard Assessment and Respirator Selection
Revise and update hazard assessment as needed. If staff feel that respiratory protection is
needed during a particular activity, they are to contact their supervisor or the Program
Administrator who will then:
• Evaluate the potential hazard, arranging for outside evaluation as necessary
• Communicate results of hazard assessment to staff. If it is determined that respiratory
protection is necessary, all other elements of this Program will be in effect for those
tasks, and the Program will be updated accordingly
Hazard Assessment and Respirator Selection
Link to Respiratory Protection Plan Template
Link to Surgical Mask, FFRs and Surgical Respirators document
�Respiratory Protection Program: Program Elements
Medical Evaluation
Staff who are required to wear respirators, or choose to do so, and are covered by
this Program, must pass a medical evaluation before being permitted to wear a
respirator on the job
Staff are not permitted to wear respirators, as covered by this Program, until cleared
to do so by a physician or licensed healthcare professional
�Respiratory Protection Program: Program Elements
Medical Evaluation
Staff who are required to wear respirators, or choose to do so, and are covered by
this Program, must pass a medical evaluation before being permitted to wear a
respirator on the job
Staff are not permitted to wear respirators, as covered by this Program, until cleared
to do so by a physician or licensed healthcare professional
Staff who refuse the medical evaluation will not be allowed to work in a position
requiring respirator use
All impacted staff will be given a copy of the medical questionnaire to complete
�Fit Testing
• Fit testing is one of the most important parts of the respirator program. It is the only
recognized tool to assess the fit of a specific respirator model and size to the face of the user
• OSHA requires employers to make available a sufficient number of models and sizes of
respirators so that staff can be provided with a respirator that is comfortable and fits well
• Staff are only allowed to use the make, model, style, and size of respirator or respirators for
which they have been successfully fit tested
CDC Frequently asked questions about respiratory protection: https://www.cdc.gov/niosh/docs/2018-129/pdfs/2018-129.pdf
r correctly fits the user and is comfortable.
A fit test is conducted to verify that a respirator
Fit test methods are classified as either qualitative or quantitative.
A qualitative fit test is a pass/fail test
that relies on the individual’s sensory
detection of a test agent, such as
taste, smell, or involuntary cough
(a reaction to irritant smoke).
A quantitative fit test uses an instrument
to numerically measure the effectiveness
of the respirator.
The benefits of a fit test include better
protection for the employee and
verification that the employee is wearing a
correctly-fitting model and size of
respirator. Higher than expected levels of
exposure to a contaminant may occur if the
respirator has a poor face seal against the
user’s skin, which can result in leakage.
Image Credit: TSI
�Respiratory Protection Program: Program Elements
Emergency Procedures (Respiratory Malfunction)
For any malfunction of an N95, the respirator user must:
Go to a designated safe area (away from resident care areas)
Follow proper personal decontamination procedures
as per your facility's protocols
Inform supervisor there is an issue with the mask
The supervisor must ensure the staff’s N95 mask is replaced
�Respiratory Protection Program: Program Elements
Cleaning, Maintenance, and Training
This section should include specific procedures for each type of respirator:
Storage
Maintenance
Repair
Disposal
These procedures should include:
• A description of where respirators are stored in each unit or department
• How respirators should be stored between uses by respirator users (if allowed)
• How respirators will be maintained and who is responsible for maintenance
• Who is responsible for ensuring adequate respirator supply
�Content Outline (TOC)
Respiratory Protection Program (RPP)
for the Non-Acute Healthcare Providers:
Program Evaluation
Dr. Anna Fisher, CMDCP, CDP, QCP
Jerry Nevins, NHA, RN
�Respiratory Protection Program: Program Evaluation
Program Evaluation (Anna)
The Program Administrator will conduct periodic evaluations of the workplace to ensure:
• The provisions of the program are being implemented
• Information for resident care and staff training is documented
The evaluations will include regular consultations with staff who use respirators and their
supervisors, site inspections, and a review of records
Program evaluations should include documentation of discussion points with staff
Issues identified will be noted and corrected by the Program Administrator
�Respiratory Protection Program: Program Evaluation
Documentation and Record-Keeping (Anna & Jerry)
The following documentation and record-keeping will be maintained:
•
•
•
•
•
A written copy of the Program and the Respiratory Protection Standard. Kept in the Program
Administrator’s office and is available to all staff who wish to review it
Copies of training materials will be maintained in the Program Administrator’s office
Medical evaluation and examination records
• Program Administrator will maintain copies of medical evaluation and examination records
for all staff covered under the Program
• Records will be treated as confidential and will remain with the Program Administrator in a
locked and secure location with limited access
Copies of fit test records will be maintained in the Program Administrator’s office
(see next slide for record criteria)
Records will be updated as staff, both new and existing, receive training
�Fit Test Records (Jerry)
Fit test records must be kept on file until a new fit test is completed. There must always be a
record on file for each respirator user indicating a passed a fit test within the last 12 months,
or sooner if their face has any significant changes
Example Card
The Respiratory Protection standard requires that the following information be kept in
the fit test record:
ü Name or staff ID
ü Type of fit test performed
ü Specific make, model, style, and size of respirator tested
r
ü Date of test
ü Pass / fail result from qualitative test or printout from quantitative test
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Jill Morgan, RN, BSN
�NETEC Resources
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Podcasts
NETEC Skill videos
courses.netec.org
“Transmission Interrupted”
youtube.com/thenetec
(On all major podcast players)
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Resource Library
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Jan 14, 2022 12:00 PM in Central Time (US and Canada)
Objectives
CONTINUING EDUCATION<br /><br />CNE and CME continuing education credits will be provided for this activity. Participants will be asked to complete a post-webinar evaluation immediately following the webinar. We recommend accessing the webinar from a PC or Mac computer using the Chrome, Firefox, or Safari (Mac) web browser.
Event Type
Webinar, watch at link below.
URL
https://youtu.be/47M1N_ppUTY
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/47M1N_ppUTY?autoplay=0" title="YouTube video player" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (1/14/22): Respiratory Protection Program (RPP) for the Non-Acute Healthcare Providers
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Join us Friday, January 14th, at 12pm CST for the NETEC COVID-19 Webinar Series presentation, Respiratory Protection Program (RPP) for the Non-Acute Healthcare Providers. Topics will include OSHA standards for an effective respiratory protection program, the various levels of respiratory protection available and how to choose the correct protection for your facility, and an explanation of the documentation and records that are required to be maintained for successful program administration.<br /><br />PRESENTERS<br /><br />Anna Fisher, DHA, QCP, CMDCP, CDP<br /><br />Dr. Anna Fisher, DHA, QCP, CMDCP, CDP, serves as the Director of Education and Quality at Hillcrest Health Services in Eastern Nebraska. She is a health, quality, and nursing services education expert for business lines that include assisted living, memory support, adult day services, in-patient rehabilitation, outpatient therapy, home health care, private duty, telehealth, palliative, hospice, and skilled nursing care.<br /><br />Jerry Nevins, NHA, RN<br /><br />Jerry Nevins is the Assistant Administrator at the Rose Blumkin Jewish Home in Omaha, NE. Before joining the Rose Blumkin Jewish Home in 2017, Jerry was a nursing services surveyor with the long-term care survey team for the state of Nebraska. His knowledge of state and federal regulations, in addition to over 30 years’ experience providing healthcare in various capacities in Omaha including training and managing a local medical facility’s decontamination team for over 13 years. During that time, Jerry was HAZWOPER certified. Jerry is also active in leadership roles with the Omaha Health Care Coalition and is the Education Co-Chair for LeadingAge Nebraska.<br /><br />Webinar slides attached.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-01-14
Type
The nature or genre of the resource
Webinar only
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
2019-nCoV
Coronavirus
COVID-19
R-PPE
Respiratory Protection
-
https://repository.netecweb.org/files/original/24bc4b6f0742e3a35818136951703cba.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Your Guide to Masks
Subject
The topic of the resource
Infection Control
Description
An account of the resource
How to select (what to choose and what not to choose), properly wear, clean, and store masks.<br /><br />Special considerations like gaiters & face shields, children, cold weather, beards, and disabilities.
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-10-25
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
CDC
Example
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Respirator
-
https://repository.netecweb.org/files/original/47c0b7dffdd10f0bd85980fa54e2aaa6.pdf
096ca17f269948a1671f82bf275f1a77
PDF Text
Text
CONCEPTS IN DISASTER MEDICINE
Strategies for Optimizing the Supply of N95 Filtering
Facepiece Respirators During the Coronavirus Disease
2019 (COVID-19) Pandemic
Marie A. de Perio, MD ; Chad H. Dowell, MS, CIH; Lisa J. Delaney, MS, CIH;
Lewis J. Radonovich II, MD; David T. Kuhar, MD; Neil Gupta, MD, MPH;
Anita Patel, PharmD, MS; Satish K. Pillai, MD; Maryann D’Alessandro, PhD
ABSTRACT
N95 respirators are personal protective equipment most often used to control exposures to infections
transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics
or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of
N95 respirators in health care settings while maximizing the level of protection offered to health care
personnel when there is limited supply in the United States during the 2019 coronavirus disease
pandemic. The strategies are intended for use by professionals who manage respiratory protection
programs, occupational health services, and infection prevention programs in health care facilities
to protect health care personnel from job-related risks of exposure to infectious respiratory illnesses.
Consultation with federal, state, and local public health officials is also important. We use the framework of surge capacity and the occupational health and safety hierarchy of controls approach to discuss
specific engineering control, administrative control, and personal protective equipment measures that
may help in optimizing N95 respirator supplies.
Key Words: emergency preparedness, infection control, occupational health, pandemics, surge capacity
N
95 filtering facepiece respirators (commonly
called N95 respirators) are disposable, tightfitting air purifying respirators that have a
filter efficiency of 95% or greater for a standard test
aerosol.1 N95 respirators are integral to the personal
protective equipment (PPE) most often used to control
exposures to infections transmitted via the airborne
route in health care settings. Supplies of N95 respirators can become depleted during pandemics or when
otherwise in high demand.2-7
A number of federal agencies, including the
Centers for Disease Control and Prevention
(CDC), National Institute for Occupational Safety
and Health (NIOSH), Occupational Safety and
Health Administration (OSHA), and Food and
Drug Administration (FDA), provide standards,
guidance, and recommendations for the use of
respiratory protection in health care. NIOSH certifies
respirators, and the CDC (including NIOSH) develops recommendations on the use of respiratory
protection to reduce the transmission of disease in
health care settings. OSHA develops and enforces
workplace regulations on respiratory protection.
The FDA clears the sale of certain types of respirators
as medical devices.
658
Disaster Medicine and Public Health Preparedness
The CDC guidance recommends that health care
personnel (HCP) follow standard and transmissionbased precautions and use N95 or higher level respirators, along with gowns, eye protection (ie, goggles or
face shield), and gloves, when entering the room of
a patient with confirmed or suspected coronavirus
disease 2019 (COVID-19).8 In this paper, we offer
strategies for optimizing supplies of N95 respirators in
health care settings while maximizing the level of
protection offered to HCP when there is limited supply
in the United States during the COVID-19 pandemic.
The strategies are intended for use by professionals who
manage respiratory protection programs, occupational
health services, and infection prevention programs in
health care facilities. Consultation with federal, state,
and local public health officials is also important. An
accompanying summary list in an easy-to-reference
format can be used by health care facilities.9
Controlling exposures to occupational hazards is a
fundamental way to protect personnel. Traditionally,
a hierarchy approach has been used to achieve feasible
and optimal control.10 Some control measures may fall
into multiple categories; multiple strategies can be
implemented concurrently and/or sequentially. This
hierarchy can be represented as follows:
VOL. 14/NO. 5
Copyright © 2020 Society for Disaster Medicine and Public Health, Inc. This is an Open Access article, distributed under the terms of the Creative
Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in
any medium, provided the original work is properly cited. DOI: 10.1017/dmp.2020.160
https://doi.org/10.1017/dmp.2020.160 Published online by Cambridge University Press
�Optimizing the Supply of N95 Respirators
1.
2.
3.
4.
5.
Elimination
Substitution
Engineering controls
Administrative controls
PPE
To prevent infectious disease transmission, elimination
(physically removing the hazard) and substitution (replacing
the hazard) are not typically options for health care settings.
However, exposures to transmissible respiratory pathogens in
health care facilities can often be reduced or possibly avoided
through engineering and administrative controls, which
include safe work practices, and PPE.11,12
The optimal way to prevent airborne transmission is to use a
combination of interventions from across the hierarchy
of controls, not just PPE alone. Many of these strategies have
been used in experiences with pandemic influenza, measles,
tuberculosis, and severe acute respiratory syndrome
(SARS).12-15 Respirators, when required to protect HCP
from airborne contaminants, such as some infectious agents,
must be used in the context of a respiratory protection program
that meets the requirements of the OSHA Respiratory
Protection Standard.16 The program must include medical
evaluations, training, and fit testing. The program should also
include provisions for the cleaning, disinfecting, inspection,
repair, and storage of respirators used by HCP on the job
according to manufacturer’s instructions.16 Proper storage
conditions can maximize the shelf life of respirators.
Surge capacity refers to the ability to manage a sudden, unexpected increase in patient volume that would otherwise
severely challenge or exceed the present capacity of a facility.17
While there are no commonly accepted measurements or
triggers to distinguish surge capacity from daily patient care
capacity, surge capacity is a useful framework to approach a
decreased supply of N95 respirators during the COVID-19
pandemic.
Three general strata have been used to describe surge
capacity and can be used to prioritize measures to conserve
N95 respirator supplies along the continuum of care.17
• Conventional capacity: measures consist of providing patient
care without any change in daily contemporary practices.
This set of measures should already be implemented in general
infection prevention and control plans in health care settings.
• Contingency capacity: measures may change daily standard
practices but may not have any significant impact on the
care delivered to the patient or the safety of HCP. These
practices may be used temporarily during periods of expected
N95 respirator shortages.
• Crisis capacity: measures that are not commensurate with
contemporary US standards of care. These measures may need
to be considered during periods of known N95 respirator
shortages.
CONVENTIONAL CAPACITY STRATEGIES
Engineering Controls
Engineering controls reduce exposures for HCP by placing a
barrier between the hazard and HCP.10 Engineering controls
can be very effective as part of a suite of strategies to protect
HCP without placing primary responsibility of implementation on HCP (ie, they function without HCP having to take
an action).
Selective Use of Airborne Infection Isolation Rooms
Aerosol-generating procedures performed on patients with
confirmed or suspected COVID-19 should take place in an
airborne infection isolation room (AIIR). The AIIR should
be constructed and maintained in accordance with current
guidelines, as recommended in the CDC COVID-19 interim
prevention and control recommendations in health care
settings.8 Air from these rooms should be exhausted directly
to the outside or be filtered through a high-efficiency particulate arrestance (HEPA) filter directly before recirculation.8,18
Re-circulated air should not be emptied into areas where HCP,
visitors, or other people congregate or pass through, such as
break areas or thoroughfares.
Use of Physical Barriers
Barriers, such as glass or plastic windows, can be an effective solution for reducing exposures among HCP to
potentially infectious patients. This approach can be effective
in reception areas, such as the desk at the emergency
department, triage station, information booth, or pharmacy
drop-off/pick-up windows where patients may first report
upon arrival to a health care facility. Other examples include
the use of curtains between patients in shared areas and closed
suctioning systems for airway suctioning for intubated
patients.
Properly Maintained Ventilation Systems
Another cornerstone of engineering controls is ventilation
systems that provide air movement from a clean (HCP workstation or area) to contaminated (sick patient) flow direction
(along with appropriate filtration, exchange rate) that are
installed and properly maintained.13
Administrative Controls
The term administrative controls refers to employer-dictated
work practices and policies that reduce or prevent hazardous
exposures.10 Their effectiveness depends on employer
commitment and HCP acceptance and consistent use of the
strategies. Regular training, monitoring, and reinforcement are necessary to ensure that policies and procedures
are followed consistently.
Disaster Medicine and Public Health Preparedness
https://doi.org/10.1017/dmp.2020.160 Published online by Cambridge University Press
659
�Optimizing the Supply of N95 Respirators
Limit the Number of Patients Going to a Hospital or
Outpatient Settings and/or Implement Telemedicine
Exclude Visitors to Patients With Confirmed or
Suspected COVID-19
Health care facilities should consider developing mechanisms
to screen patients for acute respiratory illness prior to their
health care visits, such as through the appointment reminder
system. Postpone and reschedule those with signs and symptoms presenting for non-acute visits. This measure has been
helpful during seasonal influenza seasons and during the
SARS experience.19,20 Nurse advice lines and telemedicine
can screen and manage patients with confirmed or suspected
COVID-19 without the need for HCP to use N95 respirators.
Promoting the use of these technologies and referral networks
can help triage persons to the appropriate level of care,
potentially reducing the influx of patients to health care
facilities seeking evaluation and reserving PPE for when it is
needed.
Restricting visitors from entering the room of a patient with
confirmed or suspected COVID-19 is recommended in the
CDC COVID-19 interim infection prevention and control
recommendations in health care settings.8 Alternative mechanisms for patient and visitor interactions, such as video-call
applications on cell phones or tablets, should be explored.22
Facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient’s emotional
well-being and care. If visitors must enter the room of a known
or suspected COVID-19 patient, facilities should provide
instruction (before visitors enter patients’ rooms) on the use
of PPE according to current facility policy while in the
patient’s room.
Cohorting Patients
Source Control
Health care facilities should identify and assess patients who
may be ill with or who may have been exposed to a patient
with known COVID-19.8 Patients with symptoms of
COVID-19 or other respiratory infections, such as fever or
cough, presenting for care should use face masks for source
control until they can be placed in an AIIR or a private
room.21 Instructions should include how to use face masks.
Patients with these symptoms should not use N95 respirators.
If these patients need to leave their room for services in other
areas of the hospital (eg, radiology), they should also wear
face masks.
Exclude HCP Not Directly Involved in Patient Care
Infection prevention and control plans should limit the
number of HCP who enter the patient’s room to only those
providing direct patient care. Implementation of staffing policies to minimize the number of HCP who enter the room and
considerations to exclude staff, such as dietary and housekeeping employees, may extend the supply of N95 respirators.20
Exclusion of non-clinical HCP was used by health care facilities caring for patients with Ebola virus disease in the United
States.22 Similarly, efforts should be made to minimize the
number of HCP who are present during an aerosol-generating
procedure.
Limit Face-to-Face HCP Encounters With Patients
With Confirmed or Suspected COVID-19
Measures can be explored to limit face-to-face encounters
between HCP and patients with confirmed or suspected
COVID-19. HCP may consider bundling care activities to
minimize room entries, and bundling may occur across HCP
types, such as delivering food trays by HCP when performing
other care. Alternative mechanisms for HCP and patient
interactions include telephones, video monitoring, and
video-call applications on cell phones or tablets.20,22
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Cohorting is the practice of grouping together patients who are
infected with the same organism to confine their care to 1 area
and prevent contact with other patients. Cohorts are created
based on clinical diagnosis, microbiologic confirmation when
available, epidemiology, and mode of transmission of the
infectious agent.23 Cohorting has been used extensively for
managing outbreaks of multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), multidrug resistant,
extended spectrum β-lactamase (ESBL)-producing organisms,
Pseudomonas aeruginosa; methicillin-susceptible S. aureus, respiratory syncytial virus (RSV), adenovirus keratoconjunctivitis, rotavirus, and SARS.23-25 When single-patient rooms are
not available, patients with confirmed COVID-19 may be
placed in the same room. Cohorting patients could minimize
respirator use when extended use of N95 respirators is
implemented.
Cohorting HCP
Assigning designated teams of HCP to provide care for all
patients with suspected or confirmed COVID-19 could
minimize respirator use when extended use is implemented.
This strategy, which has been used for tuberculosis, can
also limit the number of HCP exposed to patients with
COVID-19 and limit the number of HCP who need to be
fit tested.13
Training on Use of N95 Respirators
The OSHA Respiratory Protection Standard requires
employers to provide respirator training prior to requiring an
employee to use a respirator in the workplace.16 Training
employees on the proper use of respirators they are expecting
to use at work, including putting on and removing them,
limitations on their use, and maintenance, is essential for
effective use of respiratory protection. Following these
measures may help minimize waste of N95 respirators. It is also
important that HCP be educated on the use of N95 respirators
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when caring for patients managed with airborne precautions
and other instances for respirator use, such as the performance
of aerosol-generating procedures.16
more accurate.29,30 Any switch in methods should be assessed
to ensure proficiency of the fit testers in carrying out the test.
Personal Protective Equipment: Respiratory Protection
Just-in-Time Fit Testing
Just-in-time fit testing refers to the capacity of health care
facilities to do larger scale evaluation, training, and fit testing
of employees when necessary during a pandemic. Facilities may
adopt a plan to use the just-in-time method, which has been
incorporated into pandemic plans for many facilities.26 For
large facilities, it may not be feasible to fit test all employees,
especially if their job does not typically place them at risk for
exposure to airborne infectious diseases, such as tuberculosis.
Just-in-time fit testing allows for estimating and optimizing
the size of the respiratory protection program and the number
of HCP, which can conserve N95 respirators used in training
and fit testing.27 If health care facilities are expecting to receive
COVID-19 patients, they should begin training and start to
plan for fit testing prior to receiving patients.
Limiting Respirators During Training
The steps of training and fit testing of HCP may be combined
into 1 step. If training and fit testing are conducted during
2 separate steps, it may be possible to allow limited reuse of
N95 respirators used by individual HCP during fit testing
and then training. The respirator might also be saved and then
used for patient care.
While engineering and administrative controls should be
considered first when selecting controls, the use of PPE should
also be part of a suite of strategies used to protect HCP.
Surgical N95 Respirators
N95 respirators include standard and surgical N95 respirators.
In the United States, all N95 respirators used in occupational
settings are approved by NIOSH and used in accordance
with OSHA standards. A surgical N95 respirator is a
NIOSH-approved N95 filtering facepiece respirator that has
also been cleared by the FDA as a surgical mask. Surgical
N95 respirators are recommended only for use by HCP
who need protection from both airborne and fluid hazards
(eg, splashes, sprays). These respirators are not used or needed
outside of health care settings. In times of shortages, only HCP
who are working in a sterile field or who may be exposed to
high velocity splashes, sprays, or splatters of blood or body
fluids should be provided these respirators. Other HCP can
use standard N95 respirators. If surgical N95 respirators are
not available, and there is a risk that the worker may be
exposed to high-velocity splashes, sprays, or splatters of
blood or body fluids, then a face shield should be worn over
the standard N95 respirator.
Use of Alternatives to N95 Respirators
Qualitative Fit Testing
Respirator fit test methods are classified as either qualitative or
quantitative, and there are multiple protocols of each
classification that are NIOSH-recommended or meet the
requirements of the OSHA Respiratory Protection
Standard.16 A qualitative fit test is a pass/fail test to assess
the adequacy of respirator fit that relies on the individual’s
sensory detection of a test agent. A quantitative fit test numerically measures the effectiveness of the respirator to seal with
the wearer’s face, without relying on the wearer’s voluntary
or involuntary response to a test agent. Quantitative fit tests
involve adaptation of the respirator to the fit testing equipment, which can involve making holes in the respirator.
Many health care systems already use qualitative fit test methods for fit testing HCP. For those using quantitative fit test
methods, considerations can be made to use qualitative fit test
methods to minimize the destruction of an N95 respirator used
in fit testing and allow for the reuse of the same N95 respirator
by HCP. In March 2020, OSHA recommended that health
care employers consider changing from a quantitative fit testing method to a qualitative fit testing method.28 Qualitative fit
testing methods may also allow for rapid fit testing of larger
numbers of HCP. While both types of fit tests are considered
adequate, there is evidence that quantitative fit tests may be
Only NIOSH-certified respirators are acceptable to
provide appropriate respiratory protection under the OSHA
Respiratory Protection Standard, in protecting workers,
including HCP from the transmission of airborne infectious
disease.16 Health care facilities can consider use of
NIOSH-approved alternatives to N95 respirators that provide
equivalent or higher respiratory protection where feasible.7
NIOSH approves other disposable filtering facepiece respirators that are at least as protective as the N95. These include
N99, N100, P95, P99, P100, R95, R99, and R100.31,32 The
N, R, and P designations refer to the filter’s oil resistance.
Many filtering facepiece respirators have exhalation valves
and should not be used in surgical settings, as unfiltered
exhaled breath could compromise the sterile field. On
March 2, 2020, the FDA issued an Emergency Use
Authorization (EUA) authorizing the use of some NIOSHapproved respirator models in health care settings, including
NIOSH-approved filtering facepiece respirators that are not
classified as medical devices.33
Elastomeric respirators are half-facepiece, tight-fitting
respirators that are made of synthetic or rubber material
permitting them to be repeatedly disinfected, cleaned, and
reused.27,33,34 They are equipped with replaceable filter cartridges. Similar to N95 respirators, elastomeric respirators
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require annual fit-testing but they are not destroyed during
testing. Similar to filtering facepiece respirators with exhalation valves, elastomeric respirators should not be used in surgical settings due to concerns that exhaled breath of the wearer
is not filtered when coming out of the exhalation valve and
may contaminate the sterile field.
Powered air purifying respirators (PAPRs) are reusable respirators that are typically loose-fitting hoods or helmets but can
also be tight-fitting. These respirators are battery-powered with
a blower that pulls air through attached filters or cartridges.
There are 3 PAPR filter classes. These include high efficiency
(HE) filters, PAPR 100-N filters, and PAPR 100-P filters.31
Loose-fitting PAPRs do not require fit-testing and can be used
with facial hair, unlike tight-fitting respirators. However,
PAPRs should not be used in surgical settings due to concerns
that the blower exhaust and exhaled air may contaminate the
sterile field. Facilities using elastomeric respirators and PAPRs
should have up-to-date cleaning/disinfection procedures.35
On March 28, 2020, the FDA issued an update to address
NIOSH-approved air purifying respirators for use in health
care settings during response to the COVID-19 public health
emergency.33
CONTINGENCY CAPACITY STRATEGIES
These contingency capacity strategies accompany and build on
the conventional capacity strategies.17
Decisions to implement contingency and crisis strategies17 are
based upon these assumptions:
1.
2.
3.
4.
5.
Facilities understand their current N95 respirator inventory
and supply chain.
Facilities understand their N95 respirator utilization rate.
Facilities are in communication with local health care
coalitions, federal, state, and local public health partners
(eg, public health emergency preparedness and response
staff) regarding identification of additional supplies.
Facilities have already implemented all or many conventional capacity measures.
Facilities have provided HCP with required education and
training, including having them demonstrate competency
with donning and doffing with any PPE ensemble that is used
to perform job responsibilities, such as provision of
patient care.
Administrative Controls
Decrease Length of Hospital Stay for Medically
Stable Patients With COVID-19
The CDC recommends discharging patients with confirmed
COVID-19 when they are medically stable and have an
appropriate home environment to which to return.36 If
patients cannot be discharged to home for social rather than
medical reasons, public health officials might need to identify
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alternative, non-hospital housing where those patients can
convalesce.
Temporarily Suspend Annual Fit Testing
In March 2020, OSHA issued new temporary guidance regarding the enforcement of the OSHA Respiratory Protection
Standard.16,28 The guidance gave OSHA field offices enforcement discretion concerning the annual fit testing requirement
as long as HCP have undergone an initial fit test with the same
model, style, and size. Other conditions included that employers have made a good-faith effort to comply with the standard
and that only NIOSH-certified respirators are used. The guidance emphasized the need to explain to HCP the importance
of conducting a seal check each time the respirator is put on
and conducting a fit test if there are visual changes to the
employee’s physical condition.16,28
Personal Protective Equipment: Respiratory Protection
Use of N95 Respirators Beyond the ManufacturerDesignated Shelf Life for Training and Fit Testing
In times of shortage, consideration can be made to use N95
respirators beyond the manufacturer-designated shelf life.
However, these respirators might not perform to the requirements for which they were certified. Over time, components
such as the strap and filter material may degrade, which can
affect tension and the quality of the fit and seal.37 Because
of this, use of expired respirators could be prioritized for situations where HCP are NOT exposed to pathogens, such as
during training and fit testing. As expired respirators can still
serve an important purpose, health care facilities should retain
all N95 respirators during the outbreak.
Extended Use of N95 Respirators
Extended use refers to the practice of wearing the same N95
respirator for repeated close contact encounters with several
different patients, without removing the respirator between
patient encounters.38,39 The decision to implement policies
that permit extended use of N95 respirators should be made
by the professionals who manage the institution’s respiratory
protection program, in consultation with their occupational
health and infection control departments with input from
the state/local public health departments. The CDC has recommended guidance on implementation of extended use of
N95 respirators in health care settings.38,39 Extended use has
been recommended and used as an option for conserving respirators during previous respiratory pathogen outbreaks and
pandemics.38,39
Extended use is well suited to situations wherein multiple
patients with the same infectious disease diagnosis, whose care
requires use of a respirator, are cohorted (eg, housed on the
same hospital unit).38 It can also be considered to be used
for care of patients with tuberculosis, varicella, and measles,
other infectious diseases where use of an N95 respirator or
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higher is recommended. When practicing extended use of
N95 respirators, the maximum recommended extended use
period is 8–12 hours.38 Respirators should not be worn
for multiple work shifts and should not be reused after
extended use. N95 respirators should be removed (doffed)
and discarded before activities, such as meals and restroom
breaks. N95 respirators should also be removed and discarded
if soiled, damaged, or hard to breathe through.
CRISIS CAPACITY STRATEGIES
These crisis capacity strategies accompany and build on the
conventional and contingency capacity strategies.17
When N95 Supplies Are Running Low: Personal
Protective Equipment – Respiratory Protection and
Face Masks
Use of Respirators Beyond the ManufacturerDesignated Shelf Life for Health Care Delivery
Consideration can be made to use N95 respirators beyond the
manufacturer-designated shelf life for care of patients with
COVID-19, tuberculosis, measles, and varicella. As discussed
previously, respirators beyond the manufacturer-designated
shelf life may not perform to the requirements for which they
were certified. A recent study of filtering facepiece respirators
beyond their manufacturer-designated shelf life that were
stockpiled throughout the country found that 98% of the models evaluated continued to perform in accordance with
NIOSH standards.40 Some models continued to meet the
requirements of the approval and should perform as expected,
provided a visual inspection shows that characteristics, such as
the strap and nose bridge material, have not degraded. The
CDC/NIOSH issued guidance to provide stockpile managers
information needed to make decisions regarding the release
of stockpiled respirators to support the COVID-19 response.41
These respirators should be used in the context of a respiratory
protection program that includes medical evaluation, training,
and fit testing.16 If used in health care delivery, it is particularly
important that HCP perform the expected seal check, prior to
entering a patient care area. On March 2, 2020, the FDA
issued an EUA authorizing the use of certain NIOSHapproved respirator models in health care settings. This
EUA includes respirator units that are past their
designated shelf life.33 In April 2020, OSHA issued additional
temporary guidance giving OSHA field offices enforcement
discretion for the use of N95 respirators beyond the manufacturer’s recommended shelf life.42
Use of Respirators Approved Under Standards Used
in Other Countries or Jurisdictions That are Similar to
NIOSH-Approved N95 Respirators
Other countries approve respirators for occupational use
according to country-specific standards.43 These products are
evaluated using some methods that are similar to those used
by NIOSH. Some methods are different but are expected to
provide protection similar to NIOSH-approved filtering facepiece and elastomeric respirators. Devices supplied by current
NIOSH-approval holders producing respirators under the
standards authorized in the listed countries are expected to
provide the protection indicated, given that a proper fit is
achieved. Therefore, they are generally considered to be suitable alternatives to provide protection during the COVID-19
response when supplies are short. Within Tables 1 and 2, the
country, conformity assessment standards, standards and guidance documents, acceptable product classification, and
NIOSH classification are provided in alphabetical order. All
of these respirators have protection factors of at least 10 in
the countries listed, as outlined in the standards and guidance
documents specified.
Non-NIOSH-approved products developed by manufacturers
who are not NIOSH approval holders are expected to meet the
performance requirements if they have been issued a certificate
of approval by an authorized test laboratory indicating they
conform to the standards identified in Tables 1 and 2. On
March 28, 2020, the FDA issued an EUA regarding nonNIOSH-approved disposable filtering facepiece respirators
imported from Australia, Brazil, Europe, Japan, Korea, or
Mexico.44 On May 7, 2020, FDA issued an update to the
Non-NIOSH-approved respirator EUA concerning nonNIOSH-approved respirators that have been imported from
China.45 In April 2020, OSHA issued additional temporary
guidance giving OSHA field offices enforcement discretion
for the use of N95 respirators that comply with standards of
other countries.46 Non-NIOSH-approved products developed
by manufacturers who are not NIOSH approval holders (and
do not have a certificate of approval from an authorized test
laboratory from 1 of the countries identified within the
FDA EUA) should only be used in crisis situations when no
NIOSH-approved N95 respirator (or a listed device within
the FDA EUA) is available. These devices should not be used
during aerosol-generating medical procedures unless the alternative is a loose-fitting surgical mask or improvised device.
CDC guidance is available to provide users with instructive
information about counterfeit respirators, substandard respirators, and factors to consider when planning to purchase nonNIOSH-approved respirators from another country.47-49
Limited Reuse of N95 Respirators
Reuse refers to the practice of using the same N95 respirator by
1 HCP for multiple encounters with different patients but
removing it (ie, doffing) after each encounter.38,39 This practice is often referred to as limited reuse because restrictions are in
place to limit the number of times that the same respirator is
reused. It is important to consult with the respirator manufacturer regarding the maximum number of donnings or uses they
recommend for the N95 respirator model. If no manufacturer
guidance is available, data suggest limiting the number of
reuses to no more than 5 uses per device to ensure an adequate
safety margin.50 N95 and other disposable respirators should
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TABLE 1
Respirators Approved Under Standards Used in Other Countries That Are Similar to NIOSH-Approved
N95 Filtering Facepiece Respirators
Country
Performance Standard
Australia
AS/NZS 1716:2012
Brazil
ABNT/NBR 13698:2011
People’s Republic of China
Europe
GB 2626-2006
GB 2626-2019
GB 19083-2010
EN 149-2001
Japan
JMHLW-2000
Korea
Mexico
KMOEL-2017-64
NOM-116-2009
Acceptable Product
Classification
P2
P3
PFF2
PFF3
KN/KP95
KN/KP100
P2
P3
DS/DL2
DS/DL3
Special 1st
N95
R95
P95
N99
R99
P99
N100
R100
P100
May Be Used in Lieu of
NIOSH-Certified Products
Classified as:
N95
N99 or lower
N95
N99 or lower
N95
N95
N95
N99 or lower
N95
N99 or lower
N95
N95
R95 or lower
P95 or lower
N99 or lower
R99 or lower
P99 or lower
N100 or lower
R100 or lower
P100 or lower
TABLE 2
Respirator-Cartridge Units Approved Under Standards Used in Other Countries That Are Similar to
NIOSH-Approved Elastomeric Half-Facepiece Respirators
Country
Performance Standard
Australia
AS/NZS 1716:2012
Brazil
Japan
ABNT/NBR 13694:1996;
ABNT/NBR 13697:1996
GB 2626-2006;
GB 2626-2019
GB 19083-2010
EN140-1999;
EN 143-2000
JMHLW-2000
Korea
Mexico
KMOEL-2014-46
NOM-116-2009
People’s Republic of China
Europe
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Acceptable Product
Classification
P2
P3
P2
P3
KN/KP95
KN/KP100
P2
P3
RS/RL2
RS/RL3
Special 1st
N95
R95
P95
N99
R99
P99
N100
R100
P100
May Be Used in Lieu of
NIOSH-Certified Products
Classified as:
N95
N99 or lower
N95
N99 or lower
N95
N95
N95
N99 or lower
N95
N99 or lower
N95
N95
R95 or lower
P95 or lower
N99 or lower
R99 or lower
P99 or lower
N100 or lower
R100 or lower
P100 or lower
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not be shared by multiple HCP. The CDC has guidance on the
implementation of limited reuse of N95 respirators in health
care settings.38,39
For pathogens for which contact transmission is not a concern,
routine limited reuse of single-use disposable respirators has
been practiced for decades. For example, for tuberculosis
prevention, a respirator classified as disposable can be reused
by the same provider as long as the respirator maintains its
structural and functional integrity.12,51,52 If reuse must be
implemented in times of shortages, HCP could be encouraged
to reuse their N95 respirators when caring for patients with
tuberculosis disease first.
Limited reuse of N95 respirators when caring for patients
with COVID-19 might also become necessary. However, it
is unknown what the potential contribution of contact
transmission is for SARS-CoV-2 (the virus that causes
COVID-19), and caution should be used.53,54 The surfaces
of a NIOSH-approved N95 respirator will become contaminated with pathogens while filtering the inhalation air of the
wearer during exposures to pathogen laden aerosols.50,51 The
pathogens on the filter materials of the respirator may be
transferred to the wearer upon contact with the respirator
during activities, such as adjusting the respirator, improper
doffing of the respirator, or when performing a user-seal check
when redonning a previously worn respirator. Reuse has been
recommended as an option for conserving respirators during
previous respiratory pathogen outbreaks and pandemics. It
may also be necessary to reuse N95 respirators when caring
for patients with varicella or measles, although contact
transmission poses a risk to HCP who implement this
practice. Ideally, N95 respirators should not be reused by
HCP who care for patients with COVID-19 then care for
other patients with varicella, measles, and tuberculosis, and
vice versa.
Respirators grossly contaminated with blood, respiratory or
nasal secretions, or other bodily fluids from patients should
not be reused. HCP can consider using a face shield or face
mask over the respirator to reduce/prevent contamination of
the N95 respirator. HCP reusing an N95 respirator should
use a clean pair of gloves when donning or adjusting a previously worn N95 respirator. It is important to discard gloves and
perform good hand hygiene after the N95 respirator is donned
or adjusted.
One effective strategy to mitigate the contact transfer of
pathogens from the respirator to the wearer could be to issue
each HCP who may be exposed to COVID-19 patients a minimum of 5 respirators. Each respirator will be used on a particular day and stored in a breathable paper bag or cardboard
box until the next week. This will result in each worker
requiring a minimum of 5 N95 respirators if they put on, take
off, care for them, and store them properly each day. This
amount of time in between uses of each respirator should
exceed the 72-hour expected survival time for SARSCoV-2.55 HCP should still treat the respirator as though it
is still contaminated and follow the precautions outlined in
the CDC reuse recommendations.38
Respirator manufacturers may provide guidance for respirator
decontamination. At present, there are no generally approved
methods for respirator decontamination prior to reuse.
Decontamination might cause poorer fit, filtration efficiency,
and breathability of disposable filtering facepiece respirators as
a result of changes to the filtering material, straps, nose bridge
material, or strap attachments of the filtering facepiece
respirator. Based on the limited research available, ultraviolet
germicidal irradiation, vaporous hydrogen peroxide, and moist
heat have shown the most promise as potential methods to
decontaminate filtering facepiece respirators.56
Use of Additional Respirators Beyond the
Manufacturer-Designated Shelf Life for Health Care
Delivery That Have Not Been Evaluated by NIOSH
Use of additional N95 respirators beyond the manufacturerdesignated shelf life for care of patients with COVID-19, tuberculosis, measles, and varicella can be considered. Some models
found in stockpiles have been found NOT to perform in accordance with NIOSH performances standards, and other models
have not been evaluated by NIOSH.40,41 Consideration can be
given to use these N95 respirators beyond the manufacturerdesignated shelf life. These respirators should ideally be used
in the context of a respiratory protection program that includes
medical evaluation, training, and fit testing.16 It is particularly
important that HCP perform a user seal check, prior to entering a patient care area.
Prioritize the Use of N95 Respirators and Face
Masks by Activity Type
This prioritization approach to conservation (Table 3) is
intended to be used when N95 respirators are so limited that
routinely practiced standards of care for all HCP wearing N95
respirators when caring for a COVID-19 patient are no longer
possible. The use of N95s or elastomeric respirators or PAPRs
should be prioritized for HCP with the highest potential exposures, including being present in the room during aerosolgenerating procedures performed on patients with confirmed
or suspected COVID-19. When face masks must be used by
HCP entering a patient care area, source control by masking
patients and maintaining distance from the patient is particularly important to reduce the risk of transmission.8,20
When No Respirators Are Left: Administrative Controls
Exclude HCP at Higher Risk for Severe Illness From
COVID-19 From Contact With Known or Suspected
COVID-19 Patients
During severe resource limitations, consider excluding
HCP who may be at higher risk for severe illness from
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TABLE 3
Suggested Face Mask or Respirator Use, Based Upon Distance From a Patient With Suspected or Known COVID-19 and Use of
Source Control*
HCP Planned Proximity to the Case Patient During
Encounter
HCP will remain at greater than 6 feet from
symptomatic patient.
HCP will be within 6 feet of symptomatic
patient, including providing direct patient care.
HCP will be present in the room during
aerosol-generating procedures performed on
symptomatic persons.
Face Mask or Respirator Determination
Patient Masked for Entire Encounter
Unmasked Patient or Mask Needs to be Removed
(that is, with source control)
for Any Period of Time During the Patient Encounter
If HCP must enter the patient care area: no face
If HCP must enter the patient care area: no face
mask or respirator.
mask or respirator.
However, HCP should consider not entering the
However, HCP should consider not entering the
patient care area.
patient care area.
Face Mask
Any NIOSH-approved N95 respirator/
elastomeric/PAPR, based on availability or face
mask if respirator unavailable.
Any NIOSH-approved N95 respirator/
Any NIOSH-approved N95 respirator/
elastomeric/PAPR, based on availability.
elastomeric/PAPR, based on availability.
*Based on availability, organizations may require and/or individuals may voluntarily choose to use higher levels of protection. COVID-19 = 2019 novel coronavirus
disease; HCP = health care personnel; PAPR = powered air-purifying respirator.
COVID-19, such as those of older age, those with chronic
medical conditions, and/or those who may be pregnant, from
caring for patients with confirmed or suspected COVID-19
infection57.
Consider Designating Convalescent HCP for
Provision of Care to Known or Suspected COVID-19
Patients
It may be possible to designate HCP who have clinically
recovered from COVID-19 to provide care for additional
patients with COVID-19. Individuals who have recovered
from COVID-19 infection may have developed some protective immunity, but this has not yet been proven. For Middle
East respiratory syndrome, antibody persistence was found to
depend on disease severity.58 The antibody responses to
SARS-CoV-2 and implications for immunity are not yet fully
understood.59-61
Engineering Controls
Expedient Patient Isolation Rooms for Risk
Reduction
Portable fan devices with HEPA filtration that are carefully
placed can increase the effective air changes per hour of clean
air to the patient room, reducing risk to individuals entering
the room without respiratory protection. Portable HEPA
filtration systems can be used to create expedient patient
isolation rooms.62,63 This approach involves establishing a
high-ventilation-rate, negative pressure, inner isolation zone
that sits within a “clean” larger ventilated zone. In the absence
of any remaining supply of N95 respirators, it may be possible
to use this technology in conjunction with HCP wearing
face masks.
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Ventilated Headboards
NIOSH has developed the ventilated headboard that draws
exhaled air from a patient in bed into a HEPA filter, decreasing
risk of HCP exposure to patient-generated aerosol.64 This
technology consists of lightweight, sturdy, and adjustable
aluminum framing with a retractable plastic canopy. The
ventilated headboard can be deployed in combination with
HEPA fan/filter units to provide surge isolation capacity
within a variety of environments, from traditional patient
rooms to triage stations, and emergency medical shelters. In
the absence of any remaining supply of N95 respirators, it
may be possible to use this technology in conjunction with
HCP and/or patients wearing face masks.
HCP Use of Non-NIOSH-Approved Masks
In settings where neither respirators nor face masks are available, as a last resort, it may be necessary for HCP to use masks
that have never been evaluated or approved by NIOSH.
However, these masks are not considered PPE, since their
capability to protect HCP is unknown. Caution should be
exercised when considering this option.65,66 The FDA has
issued guidance on their enforcement policy for face masks.67
CONCLUSION
Many of the engineering control, administrative control, and
PPE strategies listed in the conventional capacity strategies
should already be implemented by health care facilities as part
of general infection prevention plans. These measures may
optimize supplies of N95 respirators while maximizing the level
of protection offered to HCP in health care settings. The use of
NIOSH-approved alternatives to N95 respirators, including
other classes of filtering facepiece respirators, elastomeric respirators, and PAPRs, should be considered before considering
VOL. 14/NO. 5
�Optimizing the Supply of N95 Respirators
contingency and crisis capacity strategies. As health care facilities consider implementing contingency capacity and crisis
capacity strategies due to shortages experienced during the
COVID-19 pandemic, it is important to regularly consult with
federal, state, and local public health officials for additional
guidance. The crisis capacity strategies provided in this paper
are not commensurate with contemporary US standards of care
and should be implemented with caution. As N95 respirator
availability increases, health care facilities should promptly
resume standard practices.
These strategies highlight the importance of future research to
determine the relative contributions of various modes of transmission of SARS-CoV-2 to inform recommended PPE. It will
also be useful to understand how long SARS-CoV-2 can
remain infective in the air and on surfaces of respirators and
other PPE. In addition, it is important for future research to
evaluate the effectiveness of respirators that (1) are past their
intended manufacturer’s shelf life, (2) are worn as part of
extended use, (3) comply with international standards, and
(4) are decontaminated and reused. Evaluating effectiveness
involves evaluating filtration performance and fit performance. It is critical that science continue to inform public
health planning and practice to keep HCP healthy and safe
during this pandemic.
About the Authors
Office of the Director, National Institute for Occupational Safety and Health,
Centers for Disease Control and Prevention, Cincinnati, OH (Dr de Perio);
Emergency Preparedness and Response Office, National Institute for
Occupational Safety and Health, Centers for Disease Control and Prevention,
Atlanta, GA (Mr Dowell, Ms Delaney); National Personal Protective
Technology Laboratory, National Institute for Occupational Safety and Health,
Centers for Disease Control and Prevention, Pittsburgh, PA (Drs Radonovich,
D’Alessandro); Division of Healthcare Quality Promotion, National Center for
Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and
Prevention, Atlanta, GA (Dr Kuhar); Division of Viral Hepatitis, National
Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for
Disease Control and Prevention, Atlanta, GA (Dr Gupta); Influenza
Coordination Unit, National Center for Immunization and Respiratory Diseases,
Centers for Disease Control and Prevention, Atlanta, GA (Dr Patel); and
Division of Preparedness and Emerging Infections, National Center for Emerging
and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention,
Atlanta, GA (Dr Pillai).
Correspondence and reprint requests to Marie A. de Perio, National Institute for
Occupational Safety and Health, Centers for Disease Control and Prevention,
1090 Tusculum Avenue, R-9, Cincinnati, OH 45226 (e-mail: mdeperio@cdc.gov).
Acknowledgments
The authors wish to thank Emily Norton for her communications support
and Luisa Sarmiento Rodriguez for her operational support of this work.
Conflict of Interest Statement
The authors have no conflicts of interest to declare.
Disclaimer
The findings and conclusions in this article are those of the authors and do not
necessarily represent the views of the Centers for Disease Control and
Prevention.
REFERENCES
1. Code of Federal Regulations Title. Respiratory protective devices.
1995;42(Part 84):30335-30404.
2. Murray M, Grant J, Bryce E, et al. Facial protective equipment, personnel,
and pandemics: impact of the pandemic (H1N1) 2009 virus on personnel
and use of facial protective equipment. Infect Control Hosp Epidemiol.
2010;31(10):1011-1016.
3. Beckman S, Materna B, Goldmacher S, et al. Evaluation of respiratory
protection programs and practices in California hospitals during the
2009–2010 H1N1 influenza pandemic. Am J Infect Control. 2013;41(11):
1024-1031.
4. Hines L, Rees E, Pavelchak N. Respiratory protection policies and
practices among the health care workforce exposed to influenza in New
York State: evaluating emergency preparedness for the next pandemic.
Am J Infect Control. 2014;42(3):240-245.
5. Srinivasan A, Jernigan DB, Liedtke L, et al. Hospital preparedness for
severe acute respiratory syndrome in the United States: views from a
national survey of infectious diseases consultants. Clin Infect Dis.
2004;39(2):272-274.
6. Carias C, Rainisch G, Shankar M, et al. Potential demand for respirators
and surgical masks during a hypothetical influenza pandemic in the United
States. Clin Infect Dis. 2015;60(Suppl 1):S42-51.
7. Patel A, Lee L, Pillai SK, et al. Approach to prioritizing respiratory protection when demand exceeds supplies during an influenza pandemic: a
call to action. Health Secur. 2019;17(2):152-155.
8. Centers for Disease Control and Prevention. Interim infection prevention
and control recommendations for patients with confirmed coronavirus disease 2019 (COVID-19) or persons under investigation for COVID-19 in
healthcare settings. n. d. https://www.cdc.gov/coronavirus/2019-nCoV/
hcp/infection-control.html. Accessed February 20, 2020.
9. Centers for Disease Control and Prevention. Summary for healthcare
facilities: strategies for optimizing the supply of N95 respirators during
the COVID-19 response. n. d. https://www.cdc.gov/coronavirus/2019ncov/novel-coronavirus-2019-SupplyChecklist_of-N95-Respirators_
COVID-19_4_6_20_num.pdf. Accessed May 15, 2020.
10. Raterman SM. Methods of control. In: Plog B, ed. Fundamentals of
Industrial Hygiene. Itasca: National Safety Council; 2000:585-605.
11. Su CP, de Perio MA, Cummings KJ, et al. Case investigations of infectious
diseases occurring in workplaces, United States, 2006–2015. Emerg Infect
Dis. 2019;25(3):397-405.
12. Thorne CD, Khozin S, McDiarmid MA. Using the hierarchy of control
technologies to improve healthcare facility infection control: lessons
from severe acute respiratory syndrome. J Occup Environ Med.
2004;46(7):613-622.
13. Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing
the transmission of Mycobacterium tuberculosis in health-care settings,
2005. MMWR Recomm Rep. 2005;54(RR-17):1-141.
14. Possamai MA. SARS and health worker safety: lessons for influenza pandemic planning and response. Healthc Pap. 2007;8(1):18-28.
15. Alroy KA, Vora NM, Arciuolo RJ, et al. Notes from the field:
interventions to reduce measles virus exposures in outpatient health care
facilities – New York City, 2018. MMWR Morb Mortal Wkly Rep.
2019;68(36):791-792.
16. Occupational Safety & Health Administration [OSHA]. Regulations
(Standards-29 CFR 1910.134). n. d. https://www.osha.gov/laws-regs/
regulations/standardnumber/1910/1910.134. Accessed February 20, 2020.
17. Hick JL, Barbera JA, Kelen GD. Refining surge capacity: conventional,
contingency, and crisis capacity. Disaster Med Public Health Prep.
2009;3(2 Suppl):S59-67.
Disaster Medicine and Public Health Preparedness
https://doi.org/10.1017/dmp.2020.160 Published online by Cambridge University Press
667
�Optimizing the Supply of N95 Respirators
18. Sehulster LM, Chinn RYW, Arduino MJ, et al. Guidelines for environmental
infection control in health-care facilities. Recommendations from CDC and the
Healthcare Infection Control Practices Advisory Committee (HICPAC).
Chicago, IL: American Society for Healthcare Engineering/American
Hospital Association; 2004.
19. Centers for Disease Control and Prevention. Prevention strategies for
seasonal influenza in healthcare settings. n. d. https://www.cdc.gov/flu/
professionals/infectioncontrol/healthcaresettings.htm#fundamental.
Accessed February 20, 2020.
20. Srinivasan A, McDonald LC, Jernigan D, et al. Foundations of the severe
acute respiratory syndrome preparedness and response plan for healthcare
facilities. Infect Control Hosp Epidemiol. 2004;25(12):1020-1025.
21. Mansour MM, Smaldone GC. Respiratory source control versus receiver
protection: impact of facemask fit. J Aerosol Med Pulm Drug Deliv.
2013;26(3):131-137.
22. Cummings KJ, Choi MJ, Esswein EJ, et al. Addressing infection prevention
and control in the first U.S. community hospital to care for patients with
Ebola virus disease: context for national recommendations and future strategies. Ann Intern Med. 2016;165(1):41-49.
23. Siegel JD, Rhinehart E, Jackson M, et al. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings.
Am J Infect Control. 2007;35(10 Suppl 2):S65-164.
24. Satilmis L, Vanhems P, Bénet T. Outbreaks of vancomycin-resistant
enterococci in hospital settings: a systematic review and calculation of
the basic reproductive number. Infect Control Hosp Epidemiol.
2016;37(3):289-294.
25. Khanafer N, Voirin N, Barbut F, et al. Hospital management of
Clostridium difficile infection: a review of the literature. J Hosp Infect.
2015;90(2):91-101.
26. Jones D, Stoler G, Suyama J. Effectiveness of three just-in-time
training modalities for N-95 mask fit testing. Am J Disaster Med.
2013;8(4):283-286.
27. Pompeii LA, Kraft CS, Brownsword EA, et al. Training and fit testing of
health care personnel for reusable elastomeric half-mask respirators compared with disposable N95 respirators. JAMA. 2020;epub. doi:10.1001/
jama.2020.4806.
28. Occupational Safety and Health Administration. Temporary enforcement
guidance – healthcare respiratory protection annual fit-testing for N95 filtering facepieces during the COVID-19 outbreak. Published March 14,
2020. https://www.osha.gov/memos/2020-03-14/temporary-enforcementguidance-healthcare-respiratory-protection-annual-fit. Accessed March
15, 2020.
29. Hon CY, Danyluk Q, Bryce E, et al. Comparison of qualitative and quantitative fit-testing results for three commonly used respirators in the healthcare sector. J Occup Environ Hyg. 2017;14(3):175-179.
30. Clapham SJ. Comparison of N95 disposable filtering facepiece fits using
bitrex qualitative and TSI Portacount quantitative fit testing. Int J
Occup Environ Health. 2000;6(1):50-55.
31. Code of Federal Regulations. 42 CFR Part 84 Respiratory Protective
Devices. Updated 2020. https://ecfr.io/Title-42/pt42.1.84. Accessed May
13, 2020.
32. Centers for Disease Control and Prevention. NIOSH-approved particulate
filtering facepiece respirators. Updated 2020. https://www.cdc.gov/niosh/
npptl/topics/respirators/disp_part/default.html. Accessed February 20,
2020.
33. Food and Drug Administration. NIOSH-approved air purifying respirators
for use in health care settings during response to the COVID-19 public
health emergency. Published March 28, 2020. https://www.fda.gov/
media/135763/download. Accessed May 12, 2020.
34. Centers for Disease Control and Prevention. Elastomeric respirators:
strategies during conventional and surge demand situations. n. d.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/elastomeric-respiratorsstrategy/index.html. Accessed May 12, 2020.
35. Centers for Disease Control and Prevention. Considerations for optimizing
the supply of PAPRs for healthcare practitioners. Posted April 19, 2020.
668
Disaster Medicine and Public Health Preparedness
https://doi.org/10.1017/dmp.2020.160 Published online by Cambridge University Press
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/poweredair-purifying-respirators-strategy.html. Accessed May 12, 2020.
Centers for Disease Control and Prevention. Interim guidance for
implementing home care of people not requiring hospitalization for coronavirus disease 2019 (COVID-19). Updated February 12, 2020. https://
www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-home-care.html.
Accessed March 9, 2020.
Rottach DR, Lei Z. Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot. 2017;34(2):69-80.
Fisher EM, Shaffer RE. Considerations for recommending extended use
and limited reuse of filtering facepiece respirators in health care settings.
J Occup Environ Hyg. 2014;11(8):D115-128.
Centers for Disease Control and Prevention. Recommended guidance for
extended use and limited reuse of N95 filtering facepiece respirators in
healthcare settings. n. d. https://www.cdc.gov/niosh/topics/hcwcontrols/
recommendedguidanceextuse.html. Accessed February 20, 2020.
Centers for Disease Control and Prevention. Inhalation and exhalation
resistance and filtration performance of stockpiled air-purifying respirators:
overall performance of nearly 4,000 respirators sampled from ten stockpile
facilities. Published March 25, 2020. https://www.cdc.gov/niosh/npptl/
ppecase/pdfs/PPE-CASE-Aggregated-Stockpile-Study-03252020-508.pdf.
Accessed May 12, 2020.
Centers for Disease Control and Prevention. Release of stockpiled N95
filtering facepiece respirators beyond the manufacturer-designated shelf
life: considerations for the COVID-19 response. Updated 2020. https://
www.cdc.gov/coronavirus/2019-ncov/release-stockpiled-N95.html.
Accessed March 9, 2020.
Occupational Safety and Health Administration. Enforcement guidance
for respiratory protection and the N95 shortage due to the coronavirus
disease 2019 (COVID-19) pandemic. Published April 3, 2020. https://
www.osha.gov/memos/2020-04-03/enforcement-guidance-respiratoryprotection-and-n95-shortage-due-coronavirus. Accessed April 22, 2020.
Ryan C, Breysse PN, White N, Corn M. Critical review of international
standards for respiratory protective equipment – I. Respiratory protective
equipment for particulate-laden atmospheres. Am Ind Hyg Assoc J.
1983;44(10):756-761.
Food and Drug Administration. Emergency use authorization:
imported, non-NIOSH-approved disposable filtering facepiece respirators.
Published March 28, 2020. https://www.fda.gov/media/136403/download.
Accessed May 12, 2020.
Food and Drug Administration. Emergency use authorization: nonNIOSH-approved disposable filtering facepiece respirators manufactured
in China. Published May 7, 2020. https://www.fda.gov/media/136664/
download. Accessed May 12, 2020.
Occupational Safety and Health Administration. Enforcement guidance
for use of respiratory protection equipment certified under standards of
other countries or jurisdictions during the coronavirus disease 2019
(COVID-19) pandemic. Published April 3, 2020. https://www.osha.gov/
memos/2020-04-03/enforcement-guidance-use-respiratory-protectionequipment-certified-under. Accessed April 22, 2020.
Centers for Disease Control and Prevention. Factors to consider when
planning to purchase respirators from another country: including KN95
respirators from China. n. d. https://www.cdc.gov/coronavirus/2019ncov/hcp/ppe-strategy/international-respirator-purchase.html. Accessed
May 12, 2020.
Centers for Disease Control and Prevention. Counterfeit respirators/misrepresentation of NIOSH-approval. Updated April 28, 2020. https://www.cdc.
gov/niosh/npptl/usernotices/counterfeitResp.html. Accessed May 12, 2020.
Centers for Disease Control and Prevention. NPPTL respirator
assessments to support the COVID-19 response. Updated April 30,
2020. https://www.cdc.gov/niosh/npptl/respirators/testing/default.html.
Accessed May 12, 2020.
Bergman MS, Viscusi DJ, Zhuang Z, et al. Impact of multiple consecutive
donnings on filtering facepiece respirator fit. Am J Infect Control.
2012;40(4):375-380.
VOL. 14/NO. 5
�Optimizing the Supply of N95 Respirators
51. Reponen TA, Wang Z, Willeke K, Grinshpun SA. Survival of mycobacteria on N95 personal respirators. Infect Control Hosp Epidemiol.
1999;20(4):237-241.
52. Qian Y, Willeke K, Grinshpun SA, Donnelly J. Performance of N95
respirators: reaerosolization of bacteria and solid particles. Am Ind Hyg
Assoc J. 1997;58(12):876-880.
53. Fisher EM, Richardson AW, Harpest SD, et al. Reaerosolization of MS2
bacteriophage from an N95 filtering facepiece respirator by simulated
coughing. Ann Occup Hyg. 2012;56(3):315-325.
54. Casanova L, Rutala WA, Weber DJ, Sobsey MD. Coronavirus survival on
healthcare personal protective equipment. Infect Control Hosp Epidemiol.
2010;31(5):560-561.
55. van Doremalen N, Bushmaker T, Morris DH. Aerosol and surface
stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J
Med. 2020;382(16):1564-1567.
56. Centers for Disease Control and Prevention. Decontamination and reuse
of filtering facepiece respirators. Updated 2020. https://www.cdc.gov/
coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.
html. Accessed April 6, 2020.
57. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team.
The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi.
(China CDC Weekly.) 2020;41(2):145-151.
58. Alshukairi AN, Khalid I, Ahmed WA, et al. Antibody response and
disease severity in healthcare worker MERS survivors. Emerg Infect Dis.
2016;22(6):1113-1115.
59. Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARS-CoV-2 in
patients with novel coronavirus disease 2019. Clin Infect Dis. 2020;epub.
doi:10.1093/cid/ciaa344.
60. Wölfel R, Corman VM, Guggemos W, et al. Virological assessment
of hospitalized patients with COVID-19. Nature. 2020;epub. doi:10.
1038/s41586-020-2196-x.
61. To KK, Tsang OT, Leung W, et al. Temporal profiles of viral load in
posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. Lancet Infect
Dis. 2020;epub. doi:10.1016/S1473-3099(20)30235-8.
62. Mead KR, Johnson DL. An evaluation of portable high-efficiency
particulate air filtration for expedient patient isolation in epidemic and
emergency response. Ann Emerg Med. 2004;44(6):635-645.
63. Johnson DL, Lynch RA, Mead KR. Containment effectiveness of
expedient patient isolation units. Am J Infect Control. 2009;37(2):
94-100.
64. Dungi SR, Ghia U, Mead KR, Gressel M. Effectiveness of a local ventilation/filtration intervention for health-care worker exposure reduction to
airborne infection in a hospital room. In: Proceedings of the 2015
ASHRAE Winter Conference, January 24-28, Chicago, Illinois. Atlanta,
GA: American Society of Heating, Refrigeration and Air-Conditioning
Engineers; 2015:CH-15-C017.
65. Dato VM, Hostler D, Hahn ME. Simple respiratory mask. Emerg Infect Dis.
2006;12(6):1033-1034.
66. Rengasamy S, Eimer B, Shaffer R. Simple respiratory protectionevaluation of the filtration performance of cloth masks and common fabric
materials against 20-1000 nm size particles. Ann Occup Hyg.
2010;54(7):789-798.
67. Food and Drug Administration. Enforcement policy for face masks and
respirators during the coronavirus disease (COVID-19) public health
emergency. Published April 2020. https://www.fda.gov/media/136449/
download. Accessed May 12, 2020.
Disaster Medicine and Public Health Preparedness
https://doi.org/10.1017/dmp.2020.160 Published online by Cambridge University Press
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de Perio MA, Dowell CH, Delaney LJ, Radonovich LJ, Kuhar DT, Gupta N, Patel A, Pillai SK, D'Alessandro M. Strategies for Optimizing the Supply of N95 Filtering Facepiece Respirators During the Coronavirus Disease 2019 (COVID-19) Pandemic. Disaster Med Public Health Prep. 2020 Oct;14(5):658-669. doi: 10.1017/dmp.2020.160. Epub 2020 May 19. PMID: 32423515; PMCID: PMC7303467.
Abstract
<p>N95 respirators are personal protective equipment most often used to control exposures to infections transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of N95 respirators in health care settings while maximizing the level of protection offered to health care personnel when there is limited supply in the United States during the 2019 coronavirus disease pandemic. The strategies are intended for use by professionals who manage respiratory protection programs, occupational health services, and infection prevention programs in health care facilities to protect health care personnel from job-related risks of exposure to infectious respiratory illnesses. Consultation with federal, state, and local public health officials is also important. We use the framework of surge capacity and the occupational health and safety hierarchy of controls approach to discuss specific engineering control, administrative control, and personal protective equipment measures that may help in optimizing N95 respirator supplies.</p>
<strong>Key Words: </strong>emergency preparedness, infection control, occupational health, pandemics, surge capacity
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Strategies for Optimizing the Supply of N95 Filtering Facepiece Respirators During the Coronavirus Disease 2019 (COVID-19) Pandemic
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<p>N95 respirators are personal protective equipment most often used to control exposures to infections transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of N95 respirators in health care settings while maximizing the level of protection offered to health care personnel when there is limited supply in the United States during the 2019 coronavirus disease pandemic.</p>
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Marie A de Perio, Chad H Dowell, Lisa J Delaney, Lewis J Radonovich, David T Kuhar, Neil Gupta, Anita Patel, Satish K Pillai, Maryann D'Alessandro
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Y - PPE pos 98 qualtrics 318
Y - D0.1PPE/D0.2PPE Qualtrics # 318
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2023-07-21 J. Mundy replaced "Summary for Healthcare Facilities: Strategies for Optimizing the Supply of N95 Respirators during Shortages" CDC site (archived) with this article through consultation with Brooke and Jill (PPE work group).
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2025-07-21
CDC
COVID-19
Extended wear
N95
Personal Protective Equipment (PPE)
R-PPE
Respirator
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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<p>To ensure the safety of your colleagues, you must lead, protect, and guide others through the process of safely and correctly donning and doffing PPE.</p>
<p>As a Trained Observer, you are responsible for:</p>
<ul>
<li>Monitoring compliance with PPE protocols</li>
<li>Guiding, correcting, and assisting during donning and doffing.</li>
<li>Protecting yourself through proper PPE use during doffing, and</li>
<li>Anticipating and planning for risks.</li>
</ul>
</div>
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CDC
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2014-10-29
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Y - PPE row 44 score 0
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2023-12-04 by Jill Morgan/PPE Group
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2024-12-04
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R-PPE
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https://repository.netecweb.org/files/original/dd1c77fb00da5ebafcbbee297769b0de.pdf
c2e5383d2551730b00c3fd053736179a
PDF Text
Text
Hospital
Respiratory Protection
Program Toolkit
Resources for Respirator
Program Administrators
MAY 2015
TM
U.S. Department of Labor
U.S. Department of Labor
www.osha.gov
�This document is in the public domain and may be freely copied or reprinted.
This document was adapted from a California-specific guide, Implementing Respiratory Protection
Programs in Hospitals: A Guide for Respirator Program Administrators, May 2012, which was developed by
the California Department of Public Health, Occupational Health Branch, and the Public Health Institute
under contract no. 254-2010-345-11 from the National Institute for Occupational Safety and Health,
National Personal Protective Technology Laboratory (NIOSH-NPPTL). The guide was adapted under
contract no. 254-2011-M-40839 from NIOSH-NPPTL to produce this toolkit.
Special thanks to the following organizations for assistance in the development and/or review of
these materials:
3M, Inc.
Hospital Corporation
of America
Service Employees International
Union (SEIU)
Illinois State University,
Department of Health Sciences
University of Minnesota, School
of Public Health
American Federation of
State, County, and Municipal
Employees (AFSCME)
Intermountain Healthcare
University of North Carolina,
Chapel Hill
Arizona Division of
Occupational Safety and Health
Mayo Clinic
America Federation of
Labor-Congress of Industrial
Organizations (AFL-CIO)
Children’s Healthcare of
Atlanta, Inc.
Coalition of Kaiser
Permanente Unions
Kaiser Permanente
Michigan Public Institute,
Center for Healthy Communities
New York State Department
of Health
Veterans Health
Administration, Iowa City
VA Health Care System
Veterans Health Administration,
Office of Public Health
Y. Day Designs
This guidance document is not a standard or regulation, and it creates no new legal obligations. It
contains recommendations as well as descriptions of mandatory safety and health standards. The
recommendations are advisory in nature, informational in content, and are intended to assist employers
in providing a safe and healthful workplace. The Occupational Safety and Health Act requires employers
to comply with safety and health standards and regulations promulgated by OSHA or by a state with an
OSHA-approved state plan. In addition, the Act’s General Duty Clause, Section 5(a)(1), requires employers
to provide their employees with a workplace free from recognized hazards likely to cause death or serious
physical harm.
Cover photo courtesy of 3M. ©2015
�Hospital Respiratory Protection
Program Toolkit
Resources for Respirator
Program Administrators
May 2015
TM
U.S. Department of Labor
U.S. Department of Labor
www.osha.gov
�Intentionally left blank
�Table of Contents
Abbreviations Used in the Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Introduction to This Toolkit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Why Hospitals Need a Respiratory Protection Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Respiratory Hazards in the Healthcare Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Respiratory Protection Reduces Inhalation of Aerosols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Multiple Approaches are Needed for Infection Prevention and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
The 2007 Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
More Considerations About Respirator Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
The OSHA Respiratory Protection Standard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Types of Respiratory Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Air-Purifying Respirators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Air-Supplying Respirators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Developing a Respiratory Protection Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Assigning Responsibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Performing a Hazard Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Developing Policies and Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
References, Resources, and Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Regulatory Standards and Interpretations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Healthcare Resources and Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
General Respiratory Protection Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Medical and Industrial Hygiene Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Administrative Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Training and Educational Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
�Appendix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Clinical Syndromes or Conditions Warranting Empiric
Transmission-Based Precautions Pending Confirmation of Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Appendix B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
OSHA Assigned Protection Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Appendix C . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Respiratory Protection Program
Evaluation Checklist and Instructions for Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
RPP Evaluation Checklist Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Appendix D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Respiratory Protection Program Template for Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
FIGURES
1. Examples of Methods for Controlling Exposure
to Aerosol Transmissible Disease Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2. Surgical Masks, Filtering Facepiece
Respirators, and Surgical Respirators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3. CDC and HICPAC—Diseases/Pathogens Requiring Airborne Precautions . . . . . . . . . . 9
4. CDC and HICPAC—Diseases/Pathogens
Requiring Droplet Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
5. Examples of Aerosol-Generating Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
6. Some Key Requirements of the OSHA Respiratory Protection Standard . . . . . . . . . 14
7. NIOSH Filter Classes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
8. Establish Policies Regarding Non-Employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
9. Respiratory Protection Selection Guide
for Aerosol Transmissible Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
10. Summary of Respirator Selection Considerations for
Aerosol Transmissible Disease Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
11. Summary of Fit Test Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
�Abbreviations Used in the Toolkit
AIHA
American Industrial Hygiene
Association
MERS-CoV Middle East Respiratory
Syndrome coronavirus
AII
airborne infection isolation
MRSA
AIIR
airborne infection isolation room
methicillin-resistant
Staphylococcus aureus
APF
assigned protection factor
MSSA
methicillin-susceptible
Staphylococcus aureus
APR
air-purifying respirator
NIOSH
ATD
aerosol transmissible disease
National Institute for Occupational
Safety and Health
BMBL
Biosafety in Microbiological and
Biomedical Laboratories
NPPTL
National Personal Protective
Technology Laboratory
Cal/OSHA California Department of
Industrial Relations, Division of
Occupational Safety and Health
OSHA
Occupational Safety and
Health Administration
PAPR
powered air-purifying respirator
CBRN
chemical, biological, radiological,
and nuclear
PLHCP
physician or other licensed
healthcare professional
CDC
Centers for Disease Control
and Prevention
PPE
personal protective equipment
CNC
condensation nuclei counter
RPA
respirator program administrator
FDA
Food and Drug Administration
RPP
respiratory protection program
HCP
healthcare personnel
SARS
severe acute respiratory syndrome
HE
high-efficiency
HEPA
high-efficiency particulate air
HICPAC
Healthcare Infection Control
Practices Advisory Committee
SARS-CoV SARS-associated coronavirus
SCBA
self-contained breathing apparatus
TB
tuberculosis
VHF
viral hemorrhagic fever
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
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Glossary
Aerosol-generating procedures—
Procedures that may increase potential exposure
to aerosol transmissible disease pathogens due
to the reasonably anticipated aerosolization
of pathogens. Aerosol-generating procedures
may also be known as high hazard or coughinducing procedures. See page 12 for a
detailed explanation.
Aerosol transmissible disease (ATD) or aerosol
transmissible disease pathogen—Any disease
or pathogen requiring Airborne Precautions and/
or Droplet Precautions.
Airborne infection isolation room (AIIR)—A
single-occupancy patient-care room designed
to isolate persons with suspected or confirmed
airborne infectious diseases. Environmental factors
are controlled in AIIRs to minimize the transmission
of infectious agents that can be spread from
person-to-person by the airborne route. AIIRs
should maintain negative pressure relative to
adjacent rooms and halls (so that air flows under
the door gap into the room), an air flow rate of
6–12 air changes per hour, and direct exhaust of
air from the room to the outside of the building or
recirculation of air through a HEPA filter.
Airborne Precautions—A category of
Transmission-Based Precautions that CDC
and HICPAC may recommend when Standard
Precautions alone are not sufficient to prevent
the transmission of disease. When Airborne
Precautions are required patients should be
placed in airborne infection isolation rooms and
healthcare personnel sharing patients’ airspaces
should wear respirators.
viii
Air-purifying respirator (APR)—A respirator with
an air-purifying filter, cartridge, or canister that
removes specific air contaminants by passing
ambient air through an air-purifying element. See
page 15 for a detailed explanation.
Assigned protection factor (APF)—The workplace
level of respiratory protection that a respirator
or class of respirators is expected to provide to
employees when the employer implements
a continuing, effective respiratory protection
program as specified in 29 CFR 1910.134.
Droplet Precautions—A category of
Transmission-Based Precautions that CDC
and HICPAC may recommend when Standard
Precautions alone are not sufficient to prevent
the transmission of disease. When Droplet
Precautions are required, patients should be
spatially separated, preferably in separate rooms
with closed doors. Healthcare personnel should
wear surgical masks for close contact and, if
substantial spraying of body fluids is anticipated,
gloves and gown as well as goggles (or face
shield in place of goggles). Patients should be
masked during transport.
Facemask—A loose-fitting, disposable device that
creates a physical barrier between the mouth and
nose of the wearer and potential contaminants
in the immediate environment. Facemasks may
be labeled as surgical, laser, isolation, dental, or
medical procedure masks and are cleared by
the FDA for marketing. They may come with or
without a face shield. Facemasks do not seal
tightly to the wearer’s face, do not provide the
wearer with a reliable level of protection from
inhaling smaller airborne particles, and are not
considered respiratory protection.
�Facepiece—The part of a respirator that covers
the nose and mouth of the wearer. Respirators
may have half facepieces covering just the nose
and mouth, or they may have full facepieces
covering the nose, mouth, and eyes. They are
designed to form a seal with the face.
Filtering facepiece respirator—A type of
disposable (single-use), negative-pressure, airpurifying respirator where an integral part of
the facepiece or the entire facepiece is made of
filtering material.
Fit factor—A quantitative estimate of the fit of
a particular respirator to a specific individual;
typically estimates the ratio of the concentration
of a substance in ambient air to its concentration
inside the respirator when worn.
Fit test—The use of a protocol to qualitatively or
quantitatively evaluate the fit of a respirator on
an individual.
Food and Drug Administration (FDA)—An
agency within the U.S. Department of Health
and Human Services. The FDA is responsible for,
among other things, protecting the public health
by assuring drugs, vaccines, and other biological
products and medical devices intended for
human use are safe and effective.
Healthcare Infection Control Practices Advisory
Committee (HICPAC)—A federal advisory
committee assembled to provide advice and
guidance to the CDC and the U.S. Department
of Health and Human Services regarding the
practice of infection control and strategies for
surveillance, prevention, and control of healthcareassociated infections and antimicrobial resistance
in United States healthcare settings. CDC and
HICPAC authored the 2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious
Agents in Healthcare Settings, which describes
Standard and Transmission-Based Precautions
used for infection control.
Healthcare personnel (HCP)—Paid and unpaid
persons who provide patient care in a healthcare
setting or support the delivery of healthcare
by providing clerical, dietary, housekeeping,
engineering, security, or maintenance services.
High-efficiency (HE) or high-efficiency particulate
air (HEPA) filter—The NIOSH classification for a
filter that is at least 99.97% efficient in removing
particles and is used in powered air-purifying
respirators (PAPRs). When high-efficiency filters are
required for non-powered respirators, N100, R100,
or P100 filters may be used.
Hood—The portion of a respirator that
completely covers the head and neck, and may
also cover portions of the shoulders and torso,
and through which clean air is distributed to the
breathing zone.
Loose-fitting facepiece—The portion of a
respirator that forms a partial seal with the
face but leaves the back of the neck exposed,
is designed to form a partial seal with the face,
and through which clean air is distributed to the
breathing zone.
N95 filter—A type of NIOSH-approved filter or
filter material, which captures at least 95% of
airborne particles and is not resistant to oil.
N95 respirator—A generally used term for a
half mask air-purifying respirator with NIOSHapproved N95 particulate filters or filter material
(i.e., includes N95 filtering facepiece respirator or
equivalent protection).
Negative-pressure respirator—A tight-fitting
respirator in which air is inhaled through an
air-purifying filter, cartridge, or canister during
inhalational efforts, generating negative pressure
inside the facepiece relative to ambient air
pressure outside the respirator.
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
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Personal protective equipment (PPE)—
Specialized clothing or equipment worn by an
employee to protect the respiratory tract, mucous
membranes, skin, and clothing from infectious
agents or other hazards. Examples of PPE include
gloves, respirators, goggles, facemasks, surgical
masks, faceshields, footwear, and gowns.
Physician or other licensed healthcare
professional (PLHCP)—An individual whose
legally permitted scope of practice (i.e., license,
registration, or certification), as defined by the
state where he or she practices, allows him or
her to independently provide, or be delegated
the responsibility to provide, some or all of the
healthcare services required to provide a medical
evaluation as described in OSHA’s Respiratory
Protection standard.
Powered air-purifying respirator (PAPR)—An
air-purifying respirator that uses a blower to
force air through filters or cartridges and into
the breathing zone of the wearer. This creates a
positive pressure inside the facepiece or hood,
providing more protection than a non-powered
or negative-pressure half mask APR.
Qualitative fit testing (QLFT)—A pass/fail fit test
to assess the adequacy of respirator fit that relies
on the individual’s response to the test agent.
Quantitative fit testing (QNFT)—
An assessment of the adequacy of respirator fit
by numerically measuring the amount of leakage
into the respirator.
Respirator—A device worn over the nose and
mouth to protect the wearer from hazardous
materials in the breathing zone. Respirators must
be certified by NIOSH for the purpose for which
they are used.
x
Respirator program administrator (RPA)—
Individual designated to oversee a facility’s
respiratory protection program (RPP).
Respiratory protection program (RPP)—
Program required by OSHA under the Respiratory
Protection standard that includes development
and implementation of detailed policies and
worksite-specific procedures for respirator use for
control of respiratory hazards.
Surgical mask—A loose-fitting, disposable
type of facemask that creates a physical barrier
between the mouth and nose of the wearer
and potential contaminants in the immediate
environment. Surgical masks are fluid resistant
and provide protection from splashes, sprays,
and splatter. Surgical masks do not seal tightly
to the wearer’s face, do not provide the wearer
with a reliable level of protection from inhaling
smaller airborne particles, and are not considered
respiratory protection.
Surgical respirator—A filtering facepiece
respirator with spray- or splash-resistant
facemask material on the outside to protect the
wearer from splashes. Also known as a surgical
N95 respirator.
User seal check—An action conducted by the
respirator user to determine if the respirator is
properly seated to the face. For all tight-fitting
respirators, the employer shall ensure that
employees perform a user seal check each time
they put on the respirator using the procedures
in Appendix B-1 of OSHA’s Respiratory Protection
standard or equally effective procedures
recommended by the respirator manufacturer.
User seal checks are not substitutes for
qualitative or quantitative fit tests.
�Introduction to This Toolkit
This toolkit was developed to assist hospitals in developing and
implementing effective respiratory protection programs, with an
emphasis on preventing the transmission of aerosol transmissible
diseases (ATDs) to healthcare personnel.
Photo: Haylard Health, Inc.
Hospitals are unique work environments
with challenging occupational health and
safety issues. Some hospitals have health and
safety personnel who are highly qualified
to develop and implement appropriate
policies and procedures to control workplace
exposures. However, in many facilities with
more limited resources, the role of the health
and safety professional might be taken on as
an added responsibility by someone in the
nursing, employee health, or infection control
department. This toolkit is written as a practical
manual that can be used by anyone charged with
setting up and maintaining a hospital respiratory
protection program. A respirator is a device worn
over the nose and mouth to protect the wearer
from hazardous materials in the breathing zone.
Photo: 3M
Healthcare personnel are paid and unpaid
persons who provide patient care in a healthcare
setting or support the delivery of healthcare
by providing clerical, dietary, housekeeping,
engineering, security, or maintenance services.
Healthcare personnel may potentially be
exposed to ATD pathogens. Aerosols are particles
or droplets suspended in air. ATDs are diseases
transmitted when infectious agents, which are
suspended or present in particles or droplets,
contact the mucous membranes or are inhaled.
Filtering facepiece respirators being used in
healthcare workplaces.
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
In healthcare, the term respirator is also used
to describe a mechanical ventilator that helps
patients who are having difficulty breathing;
this document does not address this type of
medical equipment.
The body and appendices of the toolkit include
links to references, educational resources, and
electronic tools such as templates, sample forms,
and educational materials. Some of the tools
and resources were developed by the authors of
2
this document, but we have also collected many
more that were produced by other organizations
and are available on the Internet.
This toolkit identifies existing public health
guidance where available on the use of
respiratory protection. Scientific evidence is
continuously evolving, particularly with regard
to disease transmission. Precautionary use of
respiratory protection may be prudent where
scientific uncertainty exists.
�Why Hospitals Need a Respiratory
Protection Program
The hospital environment contains hazards
such as bacteria, viruses, and chemicals that
may be inhaled by personnel and cause injury
or illness. The approach for reducing exposure
required by the Occupational Safety and Health
Administration (OSHA) and accepted by health
and safety professionals is to use a “hierarchy
of controls.” This means we start with the most
effective controls—the elimination of hazards
or substitution of less hazardous processes,
chemicals, or products. Next in the hierarchy
are engineering controls, which involve
isolating the hazard and/or using specialized
ventilation (e.g., isolation rooms or laboratory
hoods). Where these controls are not feasible or
adequate, administrative controls (e.g., providing
vaccinations or triaging chemical emergency
patients) and work practices (e.g., following
respiratory hygiene/cough etiquette strategies
or keeping chemical containers capped) are used
to reduce risk, most often by minimizing the
extent or duration of the exposure, or reducing
the number of employees exposed. Respirators
and other personal protective equipment (PPE)
are used as a last line of defense when exposures
cannot be reduced to an acceptable level
using these other methods. Each facility should
develop policies and procedures which address
the control methods used at their institution.
The hazards associated with ATDs (e.g., infectious
patients with a transmissible disease or, in rare
situations, environmental sources of anthrax or
fungi) cannot be eliminated from or substituted
out of the hospital setting. ATD pathogen
exposures cannot routinely be measured in
the air, and have no established occupational
exposure limits. In addition, ATD pathogens vary
in infectivity and severity of outcome. In order
to protect employees from ATDs, healthcare
facilities must implement comprehensive
infection control plans utilizing a combination of
engineering, administrative (including training
and vaccination), and work practice controls, and
provide for the use of respirators and other PPE.
Healthcare personnel who care for patients with
ATDs must work in close proximity to the source
of the hazard; even with controls in place, they are
likely to have a higher risk of inhaling infectious
aerosols (droplets and particles) than the general
public. These personnel, and others with a
higher risk of exposure related to the tasks they
perform (e.g., lab or autopsy workers), must often
be protected further through the proper use of
Photo: Centers for Disease Control and Prevention
Respiratory Hazards in the
Healthcare Setting
Airborne droplets visible during sneezing
(photo enhanced).
3
�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
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FIGURE 1: EXAMPLES OF METHODS FOR CONTROLLING EXPOSURE
TO AEROSOL TRANSMISSIBLE DISEASE PATHOGENS
Minimize the number of
employees exposed
Minimize the amount of
infectious aerosol in the air
Protect employees who
must be exposed
• Isolate patients suspected or
confirmed with tuberculosis
in negative pressure rooms,
to separate the source from
all employees not providing
direct patient care.
• Place a surgical mask on
patients with a suspected or
confirmed ATD.
• Provide vaccinations.
• Use closed suctioning
systems to minimize the
dispersion of aerosol.
• Use personal protective
equipment (PPE) including
respirators when caring
for patients with measles
(rubeola).
• Use partitions, barriers, or
ventilated enclosures to
separate employees from
the source of the hazard.
respirators. See Figure 1 above for some examples
of methods used for controlling exposures to ATD
pathogens in the healthcare setting.
Respiratory Protection
Reduces Inhalation of Aerosols
In order to understand how respirators can
be used to protect healthcare personnel, it is
important to understand what a respirator is
and what it is not. One important distinction
that must be made when discussing respirator
use in healthcare settings is the difference
between respirators and facemasks. Facemasks
include surgical masks, which are fluid resistant,
and procedure or isolation masks which are
not fluid resistant. While some people may call
both respirators and facemasks “masks,” this is
incorrect as they are very different in their design,
performance and purpose.
4
The purpose of a facemask, when worn by
healthcare personnel, is twofold. As part of
“Droplet Precautions” (explained in more detail
later in this document), the surgical mask is worn to
protect the wearer from large droplets or sprays of
infectious body fluids from patients that otherwise
could be directly transmitted to the mucous
membranes in the wearer’s nose or mouth. In
other instances, a facemask is worn by healthcare
personnel to protect patients by reducing the
amount of large droplets with infectious agents
the wearer could introduce into the room by
talking, sneezing, or coughing; this protection is
especially important where sterile fields must be
maintained, such as operating rooms.
The purpose of a facemask, when worn by a
patient suspected or confirmed with an illness
such as influenza or tuberculosis, is to reduce the
amount of large infectious particles released as
�the patient talks, sneezes, or coughs; this limits
their concentration in the room air and reduces
the infection risk to others who are present.
However, facemasks by design do not seal
tightly to the wearer’s face. Therefore, they allow
unfiltered air to easily flow around the sides of the
facemask into the breathing zone and respiratory
tract of the wearer. In addition, the materials used
for facemasks are not regulated for their ability
to filter particles and are known to vary greatly
between models. This makes it possible for small
particles to pass through or around the facemask
and be inhaled by the wearer. This is why they
are not considered respiratory protection—
facemasks do NOT provide the wearer with a
reliable level of protection from inhaling smaller
particles, including those emitted into the room
air by a patient who is exhaling or coughing, or
generated during certain medical procedures.
Respirators are designed and regulated to
provide a known level of protection when
used within the context of a comprehensive
and effective respiratory protection program
(see the “Types of Respiratory Protection” section
on page 15). For example, filtering facepiece
respirators are designed to seal tightly to the
face when the proper model and size is selected
for the individual by using a fit test procedure.
The wearer can then be assured that inhaled air
is forced through the filtering material, which
allows contaminants to be captured and reduces
exposure to both large droplets and small
infectious particles.
Healthcare personnel
wearing a surgical mask.
Photo: California Dept. of Public Health
Photo: California Dept. of Public Health
The purpose of a respirator when worn by
healthcare personnel, for example a N95
filtering facepiece respirator, is typically to
protect the wearer by reducing the concentration
of infectious particles in the air inhaled by the
wearer. These particles may come from infectious
patients who are exhaling, talking, sneezing,
or coughing in the rooms in which healthcare
personnel are working; from medical procedures
performed on infectious patients (e.g., using
bone saws or performing bronchoscopies); or
from laboratory procedures (e.g., operating
centrifuges, blenders, or aspiration equipment)
that may aerosolize pathogens.
Healthcare personnel wearing a filtering
facepiece respirator.
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Also available, and widely used in healthcare,
is the surgical respirator—a filtering facepiece
respirator with spray- or splash-resistant facemask
material on the outside to protect the wearer
from splashes (sometimes referred to as “surgical
N95 respirators”). See Figure 2 below for further
comparison of surgical masks, filtering facepiece
respirators, and surgical respirators.
FIGURE 2: SURGICAL MASKS, FILTERING FACEPIECE
RESPIRATORS, AND SURGICAL RESPIRATORS
Surgical Masks
Intended
use when:
Worn by
HCP1
Do not protect against
small airborne particles
(aerosols)
Protect the patient and
sterile field by reducing
the number of particles
introduced into the
room as HCP talk,
sneeze, or cough
Filtering Facepiece
Respirators
Surgical Respirators
Reduce HCP inhalation
of both large droplets
and small airborne
particles (aerosols)
Reduce HCP inhalation
of both large droplets
and small airborne
particles (aerosols)
Protect the patient by
reducing the number of
particles introduced into
the room as HCP talk,
sneeze, or cough
Protect the patient and
sterile field by reducing
the number of particles
introduced into the
room as HCP talk,
sneeze, or cough
Protect the wearer’s
nose/mouth from
splashes or sprays of
large droplets of body
fluids
Worn by
patient
Protect the wearer’s
nose/mouth from
splashes or sprays of
large droplets of body
fluids
Protect HCP by reducing
the number of particles
introduced into the
room as a patient talks,
sneezes, or coughs
Not typically worn
by patients
Not typically worn
by patients
Fit testing
required?
No, not designed to seal
to the face
Yes, to ensure adequate
seal to the face
Yes, to ensure adequate
seal to the face
Government
oversight
FDA2 clears for
marketing
NIOSH3 provides
certification
NIOSH provides
certification and FDA
clears for marketing
HCP = healthcare personnel
FDA = United States Food and Drug Administration
3
NIOSH = National Institute for Occupational Safety and Health
1
2
6
�A two-page factsheet and a short video, in
English and Spanish, on the differences between
respirators and surgical masks are available from
OSHA as training resources.
Multiple Approaches
are Needed for Infection
Prevention and Control
Infection prevention and control measures
are intended to reduce the spread of disease
between patients, healthcare personnel, and
visitors. Examples of infection control measures
include employee vaccination; hand hygiene;
and replacement or cleaning, disinfection, and
sterilization of surgical instruments, patient-care
devices, uniforms, and PPE. Multiple approaches
are often required since many controls reduce
hazards without eliminating them and many
controls are subject to failure.
An effective infection prevention and control
program must provide for early hazard
identification (i.e., which patients have ATDs?),
assessment (i.e., are the diseases high-risk or is
there an increased likelihood of infection?), and
control (i.e., which controls and PPE are necessary?).
A coordinated approach to implementing
multiple preventive controls is provided by the
Centers for Disease Control and Prevention
(CDC) Healthcare Infection Control Practices
Advisory Committee’s (HICPAC) 2007 Guideline
for Isolation Precautions: Preventing Transmission
of Infectious Agents in Healthcare Settings, which
should be reviewed in its entirety by those
responsible for infection control. The guideline
describes Standard and Transmission-Based
Precautions (discussed in more detail in the
following section).
CDC and HICPAC state that transmission of an
infectious disease requires three elements: a
source of infectious agent, a susceptible host
with a route of entry, and a mode of transmission.
Standard Precautions are the foundation of
infection control and represent the minimum
infection prevention measures that apply to all
patient care. They include practices such as hand
hygiene, use of personal protective equipment
(e.g., gloves, gowns, facemasks) depending
on the anticipated exposure, cough etiquette,
safe injection practices, and safe handling of
potentially contaminated equipment or surfaces
in the patient environment. Standard Precautions
apply to all patients, clients, and staff, regardless
of the presence of infectious agents, and are
intended to reduce the risk of transmitting
infections from known and unknown sources.
When a patient is known or suspected to
be infected and Standard Precautions are
insufficient, CDC and HICPAC have prescribed
one or more of three categories of TransmissionBased Precautions to eliminate or reduce the
mode of transmission: Contact Precautions,
Droplet Precautions, and Airborne Precautions.
Contact Precautions include the use of gloves
and gowns to prevent the direct or indirect
transmission of disease between patients and
healthcare personnel. Droplet Precautions
include the use of facemasks to prevent large
droplets from travelling from the respiratory
tract of a patient to the mucosal surfaces (i.e.,
nasal mucosa, conjunctivae, and, less frequently,
the mouth) of the healthcare personnel and
also include use of gloves, gowns, and eye
protection if substantial spraying of body fluids is
anticipated. Airborne Precautions reduce the risk
of healthcare personnel inhaling small infectious
airborne particles. Airborne Precautions require
the use of respiratory protection.
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The 2007 Guideline for
Isolation Precautions:
Preventing Transmission
of Infectious Agents in
Healthcare Settings
The 2007 CDC and HICPAC Guideline for Isolation
Precautions: Preventing Transmission of Infectious
Agents in Healthcare Settings applies to healthcare
workplaces, including hospitals, long-term
care facilities, ambulatory care, home care and
hospice, which have the potential to expose
employees to ATD pathogens. This guidance
recommends that respiratory protection be
used to protect certain workers performing
specific tasks and that the use of respirators
comply with the OSHA Respiratory Protection
standard (29 CFR 1910.134; discussed in more
detail on pages 13-14). The 2007 CDC and
HICPAC Guideline serves as a primary resource
supporting respirator use policies in healthcare,
supplemented by newer guidance issued by
CDC, OSHA, public health departments, as well as
by relevant scientific literature.
CDC and HICPAC have categorized each ATD by
its mode of transmission (droplet or airborne)
and specified the applicable TransmissionBased Precautions for that agent (i.e., Droplet or
Airborne Precautions); see Figure 3 and Figure 4
on pages 9 and 11 for complete listings.
8
Photo: Haylard Health, Inc.
Vaccination of healthcare personnel is another
key component in preventing the transmission
of diseases requiring Airborne and Droplet
Precautions in hospitals. The CDC and some state
and local health departments consider healthcare
personnel to be at considerable risk for acquiring
or transmitting ATDs including influenza, measles,
mumps, rubella, pertussis, and varicella, and
therefore recommend vaccination.
Healthcare personnel wearing a filtering
facepiece respirator while checking a patient’s vitals.
In developing its guidance, CDC and HICPAC
considered epidemiological studies of disease
outbreaks, experimental studies, and information
on aerosol behavior, and the Guideline reflects
the professional opinion at that time. However, in
most cases the relative contribution of each mode
of transmission is not fully understood. CDC and
HICPAC and other public health guidance should
be regularly reviewed as the science develops so
that the most up-to-date information is used to
select respiratory protection.
CDC and HICPAC describe the distinction between
droplet transmission and airborne transmission
based on particle size and the distance and time
over which the pathogens remain infectious. CDC
and HICPAC indicate that droplets responsible
for droplet transmission have traditionally been
defined as being greater than 5 micrometers in
diameter, while the particles or “droplet nuclei”
responsible for airborne transmission are less than
5 micrometers in diameter and remain airborne
and infectious long enough to travel substantial
distances (e.g., through a ventilation system).
Although a distance of 3 feet had historically been
used to define the area of risk when working with
�patients suspected or known to have diseases
requiring Droplet Precautions, CDC and HICPAC
report that infection has occurred at distances
greater than 3 feet. Thus, CDC and HICPAC state
that observing Droplet Precautions at a distance
up to 6 or 10 feet or upon entry into the patient’s
room may be prudent.
The other factor affecting risk of infection is
how long a specific pathogen can remain viable
and infectious while suspended in air. We know
that certain pathogens, such as M. tuberculosis,
are able to remain infectious for a long time in
the air. It is likely that this feature plays a critical
role in determining if a pathogen is transmitted
When Droplet Precautions are recommended,
surgical masks function to reduce the
transmission of large infectious droplets between
the source (patient) and the mucosal surfaces
of a susceptible host (healthcare personnel).
When Airborne Precautions are recommended,
respirators and other control measures, such
as patient isolation in an airborne infection
isolation room (AIIR) with specialized ventilation,
are used to protect healthcare personnel from
inhaling infectious particles that are of small
diameter, likely to remain infectious over long
time or distance, or both.
• Aerosolizable spore-containing powders
such as Anthrax/Bacillus anthracis
Airborne Transmission of Diseases:
Factors that Affect Risk
• Measles (rubeola)/Measles virus
Experimental studies as well as epidemiological
evidence continue to inform our knowledge on
how various diseases are transmitted. Aerosol
studies show that infectious particles are
released from a patient’s respiratory tract in a
wide range of sizes, and the size of a droplet or
particle quickly decreases as water evaporates
from it. Particles up to 100 micrometers in
diameter are known to be inhalable into the nose
or mouth. Smaller particles stay airborne longer
than larger particles, which increases exposure
time and the distance the particles might travel.
Particles of various sizes can remain suspended
in air for hours, especially with high rates of air
movement in the room. Small particles can travel
on air currents and potentially be carried long
distances from the source of generation.
FIGURE 3: CDC AND HICPAC—
DISEASES/PATHOGENS REQUIRING
AIRBORNE PRECAUTIONS1
• Aspergillosis (if massive soft tissue
infection with copious drainage and
repeated irrigations required)
• Varicella (chickenpox) and herpes
zoster (disseminated or in an
immunocompromised host)/Varicellazoster virus
• Monkeypox/Monkeypox virus
• Severe acute respiratory syndrome
(SARS)/SARS-associated coronavirus
(SARS-CoV)
• Smallpox (variola)/Variola virus
• Tuberculosis (TB)/Mycobacterium
tuberculosis
• Novel or emerging pathogens and any
other disease for which public health
guidelines recommend airborne infection
isolation2
Some of these diseases may require additional
precautions such as contact precautions.
2
Hospitals need to look to CDC and public health
authorities for the latest guidance. Respiratory
protection may be advisable. For examples, see
CDC’s latest guidance for novel influenza A viruses
associated with severe disease and Middle East
Respiratory Syndrome Coronavirus.
1
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Photo: Haylard Health, Inc.
aerosols from patients to healthcare personnel
occur due to lapses in administrative controls
(e.g., failure to identify infected patients and
implement appropriate precautions).
Worker wearing a filtering facepiece respirator.
via the airborne route. However, for many other
pathogens, there is less information available
than for TB on how long they remain viable and
infectious while airborne.
Healthcare personnel caring for patients who
may be infected with a disease requiring Droplet
Precautions may not just be at risk of exposure
of their mucosa to sprays of large infectious
droplets and possible subsequent disease—they
may also be at risk of disease transmission from
inhaling particles that are present in the room
air and are infectious in the short-term and at
closer distances. Disease transmission can only
occur if the organism remains viable and infective
while it is airborne and enough particles to
represent an infectious dose (also not known
for many organisms) are inhaled. The extent of
this inhalation risk is not known for all diseases
currently calling for Droplet Precautions. However,
the use of respiratory protection in such instances
as a precautionary measure could help to reduce
the potential risk from inhalation exposure
wherever small particle aerosol transmission
may be possible. Nonetheless, in practice, most
identified instances of infections transmitted by
10
Respirator program administrators (RPAs) should
keep current with the scientific literature about
disease transmission and with changing public
health recommendations. As an example, in
2010 the CDC issued new infection control
guidance for seasonal influenza, a disease for
which droplet precautions are recommended,
stating that respiratory protection should be used
when higher-risk, aerosol-generating procedures
(discussed in more detail in the next section) are
performed on a patient suspected or confirmed
with influenza. In 2014, the CDC issued new
guidance for Ebola virus disease recommending
respirator use. Hospitals may always choose to
adopt respiratory protection policies that are more
protective than current public health guidance.
More Considerations About
Respirator Use
Respiratory protection for ATDs must be selected
based on the pathogen and the anticipated
risk associated with specific job tasks to be
performed by employees. For the protection of
healthcare personnel performing patient care,
both the likelihood that the patient may have
an ATD and the nature of the procedure to be
performed on the patient must be considered.
Identifying Patients with an ATD
In cases where a diagnosis has not yet been
made, or the pathogen has not been identified
and confirmed, the employer’s written respirator
policies must provide healthcare personnel
with clear direction on how to make decisions
about the use of respiratory protection. A
critical component of a respiratory protection
�FIGURE 4: CDC AND HICPAC—DISEASES/PATHOGENS
REQUIRING DROPLET PRECAUTIONS1, 2
• Diphtheria, pharyngeal
• Epiglottitis, due to Haemophilus
influenzae type b
• Haemophilus influenzae
serotype b (Hib) (see diseasespecific recommendations)
• Influenza viruses, seasonal2
• Meningitis
–– Haemophilus influenzae,
type b known or suspected
–– Neisseria meningitidis
(meningococcal) known or
suspected
• Meningococcal disease
sepsis, pneumonia (see also
meningitis)
• Mumps (infectious parotitis)/
Mumps virus
• Mycoplasma pneumonia
• Parvovirus B19 infection
(erythema infectiosum)
• Pertussis (whooping cough)
• Pharyngitis in infants and
young children
• Pneumonia
–– Adenovirus
–– Haemophilus influenzae,
serotype b, infants and
children
–– Meningococcal
–– Mycoplasma, primary atypical
–– Streptococcus, Group A
• Pneumonic plague/Yersinia
pestis
• Rhinovirus
• Rubella virus infection (German
measles)/Rubella virus
• Streptococcal disease (group A
streptococcus)
–– Skin, wound or burn, Major
–– Pharyngitis in infants and
young children
–– Pneumonia
–– Scarlet fever in infants and
young children
–– Serious invasive disease
• Viral hemorrhagic fevers due to
Lassa, Ebola, Marburg, CrimeanCongo fever viruses2
Some of these diseases may require additional precautions such as contact precautions.
CDC currently recommends respirator use during aerosol-generating procedures for patients with suspected or confirmed
seasonal influenza or viral hemorrhagic fevers. October 2014 CDC guidance for Ebola virus disease recommends at least an N95
respirator. See Figure 9 on page 24.
1
2
program is training staff on the hospital’s policies
regarding which situations should trigger
respirator use. The training must be given to
all caregivers and support staff, regardless of
experience or skill set. Signage on patient rooms
and notes in medical charts are additional ways
in which respirator use policies and decisions are
communicated between staff.
Personnel should be trained, consistent with
facility respirator use policies, on how the patient’s
signs and symptoms and clinical judgment about
potential diagnoses relate to risk-based decisions
on respirator use. For example, when a patient
presents in the emergency room with a cough,
fever, fatigue, night sweats, unexplained weight
loss, and loss of appetite, healthcare personnel
should suspect tuberculosis and appropriately
isolate the patient and wear respiratory protection
pending definitive diagnosis. Healthcare
personnel should also consider the possible
diseases and pathogens associated with the
diagnostic tests that have been ordered for the
patient and the diseases currently circulating in
the population when making decisions about
respiratory protection. See “Appendix A” on
page 41 for a table of symptoms, potential
pathogens, and recommended precautions based
on Table 2 in CDC and HICPAC’s 2007 Guideline for
Isolation Precautions: Preventing Transmission of
Infectious Agents in Healthcare Settings.
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A prudent approach is to implement the use
of respirators early on based on suspected
diagnosis, for example in the emergency
department, and discontinue it later if the patient
is subsequently diagnosed with a disease that
does not require respiratory protection. Other
locations including operating rooms, intensive
care units, and pulmonary units, may also require
more frequent use of respirators and/or use of
a higher level of respiratory protection due to
the number of aerosol-generating procedures
performed (discussed below).
Performing Higher-Risk,
Aerosol‑Generating Procedures
Aerosol-generating or cough-inducing
procedures are procedures that can generate
much higher concentrations of airborne particles
and ATD pathogens as compared to coughing,
sneezing, or speaking. The likelihood of exposure
via contact with mucosal membranes and
inhalation of aerosols is elevated when aerosolgenerating procedures are performed and the
airborne concentration of pathogens increases.
See Figure 5 to the right for some examples of
aerosol-generating procedures. Each hospital
should review all procedures to determine which
have a higher capacity for emitting infectious
particles into the room air.
CDC and HICPAC recommend the use of
respiratory protection when aerosol-generating
procedures are performed on patients suspected
or known to be infected with an illness or
pathogen requiring Airborne Precautions.
CDC also recommends respirators for aerosolgenerating procedures on patients suspected
or confirmed as having seasonal influenza,
viral hemorrhagic fever, MERS-CoV, and novel
influenza A viruses associated with severe disease.
CDC and HICPAC consider Neisseria meningitidis
a pathogen requiring Droplet Precautions, but
12
FIGURE 5: EXAMPLES OF
AEROSOL-GENERATING
PROCEDURES INCLUDE,
BUT ARE NOT LIMITED TO:
• Endotracheal intubation
• Open respiratory and airway suctioning
• Tracheostomy care
• Cardiopulmonary resuscitation
• Sputum induction
• Bronchoscopy
• Aerosolized administration of
pentamidine or other medications
• Pulmonary function testing
• Autopsy, clinical, surgical, and laboratory
procedures that may aerosolize pathogens,
such as operating bone saws, centrifuges,
blenders, and aspiration equipment.
acknowledge that aerosol-generating procedures
have been associated with disease transmission.
In the absence of definitive evidence, prudent
practice suggests respirator use may be advisable
when aerosol-generating procedures are
performed on patients suspected or known to
have diseases requiring Droplet Precautions.
Novel or Other Pathogens Requiring
Enhanced Protection
As demonstrated by the emergence of SARS
and avian influenza, there will be uncertainty
around the routes of exposure with novel
pathogens, as well as lack of immunity in the
population and unknown severity of disease
outcome. Public health authorities may
recommend the use of respiratory protection
by healthcare personnel and airborne infection
isolation, at least until airborne transmission can
�be ruled out. Federal OSHA recommends that
employers consider that the use of respiratory
protection may be necessary when they are
preparing for pandemic influenza. Specific
recommendations about the need for Droplet or
Airborne Precautions will be made at the time of
an actual pandemic and based on such factors as
transmissibility and severity of disease.
Photo: Bullard Safety
CDC and HICPAC recognize that certain infectious
agents may be considered epidemiologically
important and require enhanced protection,
including the use of respiratory protection.
Pathogens may be considered epidemiologically
important if they have a propensity for
transmission within healthcare facilities, are
resistant to first-line therapies, or have high rates
of morbidity and mortality. Pathogens may also
be considered epidemiologically important if
they are newly discovered, emerging, or reemerging, and little or no information about
their transmission, resistance, or disease rates is
available. These pathogens may not be regularly
encountered, but facilities and healthcare
personnel must be prepared to consider
and include these pathogens on differential
diagnoses when appropriate, and implement
infection control measures, including respiratory
protection, when necessary.
Healthcare personnel wearing a powered
air-purifying respirator while treating a patient.
The OSHA Respiratory
Protection Standard
Hospitals and all other employers who require
employees to use respiratory protection for
control of exposures to airborne contaminants,
including ATD pathogens, must comply with
Federal OSHA’s Respiratory Protection standard,
29 CFR 1910.134, or the equivalent state standard.
The OSHA Respiratory Protection standard
establishes legally enforceable requirements
about how respirators are to be used.
When respirator use is required, the Respiratory
Protection standard requires that all employee
use of respirators be done within the context
of a comprehensive and effective respiratory
protection program. The program must be in
writing, have a designated respirator program
administrator, and specify the employer’s
policies and procedures for the use of respiratory
protection in the facility. OSHA requires each
respiratory protection program to include several
specific elements, but leaves the specifics of
the policies and procedures used to meet these
requirements up to individual employers. See
Figure 6 on page 14 for a summary of the
key requirements of the standard (as it pertains
to the use of air-purifying respirators) and the
section of this document titled “Developing a
Respiratory Protection Program” on page 19
for more information.
The Respiratory Protection standard does not
specify the circumstances under which healthcare
personnel must use respirators for protection
against ATD pathogens. However, OSHA requires
employers to evaluate the respiratory hazards in
the workplace, and expects that hospitals develop
their respiratory protection policies based on
CDC/HICPAC and other public health guidance
from CDC, state, and local health departments. In
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the event of an OSHA compliance investigation,
an employer’s failure to implement respirator use
according to recognized and generally accepted
good infection control practices and public health
guidance could result in an OSHA citation.
The National Personal Protective Technology
Laboratory (NPPTL) within the CDC’s National
Institute for Occupational Safety and Health
(NIOSH) tests respirators, reviews test data
submitted by respirator manufacturers, and
approves respiratory protection equipment
when requested by respirator manufacturers.
OSHA only permits use of NIOSH-approved
respirators. NIOSH also conducts scientific
research and develops guidance related to
respiratory protection and other PPE. NIOSH
research findings and recommendations may be
considered by OSHA when setting or enforcing
health and safety standards.
Twenty-seven states and territories operate
Federal OSHA-approved State Occupational
Safety and Health plans. State standards must
be at least as effective as the corresponding
Federal OSHA standards. California’s state OSHA
program (Cal/OSHA) has promulgated the only
specific, comprehensive aerosol transmissible
diseases standard in the United States; any
employer with workplaces in California must
14
comply with these requirements which address
respiratory protection and other areas of
infection control.
The OSHA website provides a list of State Plans
with links to their websites and additional
information on each plan.
FIGURE 6: SOME KEY
REQUIREMENTS OF THE OSHA
RESPIRATORY PROTECTION
STANDARD
• Written respiratory protection program
with policies and procedures
• Designation of a program administrator
• Procedures for hazard evaluation and
respirator selection
• Medical evaluation of respirator wearers
• Fit testing procedures for tight-fitting
respirators (including filtering facepiece
respirators)
• Procedures for proper use, storage,
maintenance, repair, and disposal
of respirators
• Training
• Program evaluation including
consultation with employees
• Recordkeeping
�Types of Respiratory Protection
Respirators are devices worn over the nose and mouth to protect
the wearer from hazardous materials in the breathing zone.
OSHA has given each class of respirator an
assigned protection factor (APF) to indicate
the minimum level of protection that can be
expected when the respirators are properly
selected and used in a continuing, effective
respiratory protection program. For higher-risk
exposure situations (i.e., higher concentration
of infectious particles), choosing a respirator
with a higher APF provides a higher level of
protection for the wearer. The APFs for different
types of respirators are presented in Table 1 of
the OSHA Respiratory Protection standard and in
Appendix B of this document.
All respirators used in the workplace must be
tested by the manufacturer and tested and
certified by NIOSH. The two major types of
respirators, air-purifying respirators and airsupplying respirators, are described below.
Air-Purifying Respirators
Air-purifying respirators (APRs) work by removing
gases, vapors, aerosols (droplets and solid
particles), or a combination of contaminants from
the air through the use of filters, cartridges, or
canisters. APRs with filters will remove particles
and droplets (also called aerosols) from the
inhaled air, while those with chemical cartridges
or canisters are designed to remove gases
and vapors. To help employers select the right
protection for a specific contaminant, all filters,
cartridges, and canisters must carry a label
Photo: MSA Safety, Inc.
Respirators are available in many types
(described in detail below), models, and sizes
from several manufacturers for a variety of
applications. The most common types of
respirators in healthcare are filtering facepiece
respirators and powered air-purifying respirators
(PAPRs). Different types of respirators are
designed to provide different levels of protection
and to protect against different hazards.
Professional judgment along with the type of
airborne contaminant, its concentration, its
potential to cause a health effect in exposed
personnel, and any applicable regulation
dictate the type of respirator that must be worn.
When information regarding the exposure is
limited, the decision will rely more heavily on
professional judgment and more protective
respirators may be selected for use. Each facility’s
written policies and training programs should
specify whom to contact for questions or
additional information.
Worker wearing a half mask elastomeric
air-purifying respirator.
15
�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
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approved by NIOSH. As a secondary means of
identification, cartridges and canisters must
also be color-coded as specified by NIOSH.
Air-purifying respirators do not provide clean
breathing air from a source independent of the
work area; therefore, APRs cannot be worn in an
oxygen-deficient atmosphere.
Filters come in various degrees of filtration
efficiency (see Figure 7 on page 17 for more
information on the NIOSH filter classes); however,
leakage around the facepiece of a respirator plays
a larger role than filter efficiency in determining
the protection provided. When APRs are required
to provide protection from ATD pathogens, they
must be fitted with particulate filters at least
as efficient as an N95 filter, not cartridges or
canisters for gases and vapors.
Types of Air-Purifying Respirators
and may be used in healthcare. These respirators
are described as “negative-pressure” because the
pressure inside the facepiece is negative during
inhalation compared to the pressure outside the
respirator. Filtering facepiece respirators are also
available with other classes of filters and spray- or
splash-resistant facemask material on the outside
to protect the wearer from splashes (sometimes
referred to as “surgical N95 respirators”).
Powered air-purifying respirators (PAPRs) may
be used in healthcare when aerosol-generating
procedures are performed, by hospital first
receivers, or when the respirator user is not
able to wear a tight-fitting respirator. PAPRs
have a battery-powered blower that forces
air in the room through filters (for particles)
or cartridges (for gases or vapors) to clean it
before delivering it to the breathing zone of the
wearer. High-efficiency (HE) filters are the only
“N95 respirator” is a term used in healthcare to
refer to a half mask APR with a NIOSH-approved
N95 particulate filter. An N95 respirator may
be a filtering facepiece respirator or half mask
elastomeric respirator; both have an APF of 10
16
Photo: Moldex
Non-powered, or negative-pressure, respirators
have a tight-fitting facepiece, which can be either
a half mask that covers the nose and mouth or a
full facepiece that covers the nose, mouth, and
eyes. They may be disposable (or “single-use,”
meaning the filter is not replaceable and the
respirator cannot be cleaned) filtering facepiece
respirators where the entire facepiece is made of
filtering material, or elastomeric respirators that
have replaceable filters or cartridges.
Worker wearing a filtering facepiece
air-purifying respirator.
�class of particulate filters available for powered
air-purifying respirators. PAPRs are generally
more protective than non-powered half mask
respirators because the blower creates positive
pressure inside the facepiece, reducing inward
leakage of potentially contaminated air.
FIGURE 7: NIOSH FILTER CLASSES
Filter Class
Description
A PAPR may have a tight-fitting half or full
facepiece or a loose-fitting facepiece, hood,
or helmet. A PAPR has an OSHA APF of at least
25, compared to an APF of 10 for a filtering
facepiece respirator or elastomeric half mask
respirator; this means the PAPR reduces the
aerosol concentration inhaled by the wearer to
1/25th of that in the room air, compared to a
1/10th reduction for half mask APRs. OSHA allows
employers to use an APF of 1,000 for PAPRs
with hoods when they have evidence from the
manufacturer demonstrating performance at this
level. OSHA does not require fit testing of loosefitting PAPRs.
N95
Filters at least 95% of
airborne particles. Not
resistant to oil.
N99
Filters at least 99% of
airborne particles. Not
resistant to oil.
N100
Filters at least 99.97%
of airborne particles.
Not resistant to oil.
R95
Filters at least 95%
of airborne particles.
Resistant to oil.
Air-Supplying Respirators
P95
Filters at least 95%
of airborne particles.
Oil proof (strongly
resistant to oil).
P99
Filters at least 99%
of airborne particles.
Oil proof (strongly
resistant to oil).
P100
Filters at least 99.97%
of airborne particles.
Oil proof (strongly
resistant to oil).
HE (highefficiency)
Filters at least 99.97%
of airborne particles.
For use on PAPRs only.
Air-supplying respirators (also known as
atmosphere-supplying respirators) include
supplied-air respirators and self-contained
breathing apparatus (SCBAs). Air-supplying
respirators work by providing clean breathing
air from a source independent of the work area.
Supplied-air respirators typically have higher APFs
than APRs; the APF can be up to 1,000. These
respirators obtain breathing air from a compressor
or a large pressurized cylinder that is not carried
by the user. SCBAs can have APFs of up to 10,000.
They are usually equipped with a full facepiece
and contain their own breathing air supply in a
pressurized cylinder that is carried by the user.
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Air-supplying respirators may have a tight-fitting
facepiece, which can be a half mask or a full
facepiece, or a loose-fitting facepiece, hood, or
helmet. They do not require filters or cartridges
and will protect the wearer from all types of
contaminants (particles, gases, and vapors) and,
in certain cases, oxygen-deficient atmospheres.
These respirators are less likely to be used in a
hospital setting except, perhaps, by emergency
responders or construction contractors.
Photo: MSA Safety, Inc.
See the “References, Resources, and Tools”
section on page 36 for additional sources of
information on respiratory protection.
Worker wearing a self-contained breathing
apparatus respirator.
18
�Developing a Respiratory
Protection Program
Assigning Responsibility
A key component of a successful respiratory
protection program (RPP) is the assignment
of responsibilities for the implementation and
administration of the program. OSHA requires
that “the program be administered by a suitably
trained program administrator.” Although the
respirator program administrator (RPA) does not
have to be a health and safety professional, he
or she must have knowledge of the principles
of respiratory protection and the authority to
implement the program. While the RPA must
oversee the program, he or she can assign
others to help manage and implement medical
evaluations, training, fit testing, and other
aspects of the program. See the “References,
Resources, and Tools” section (pages 36-40)
for training resources for RPAs.
Hospitals must decide how best to manage RPPs
that cover personnel who must use respirators
to reduce their exposure to specific chemicals
only, ATD pathogens only, or both chemicals and
ATD pathogens. These employee groups may
work in very different departments with different
supervisors and/or have different types of jobs.
A single RPP with one program administrator
is preferred to ensure consistency and
accountability. However, if two separate RPPs and
program administrators exist to cover respirator
responsibilities for chemical versus infectious
exposures, the employer must ensure that overall
policies are coordinated, adequate technical
expertise is available for each program, and
that all aspects of both programs are effectively
implemented.
Performing a Hazard
Evaluation
The purpose of the hazard evaluation is to
identify and evaluate potential exposures in
the workplace that might require the use of
respiratory protection. Once identified, these
exposures must be assessed to determine how
often they are expected to occur and the level
of exposure, so that they can be controlled to
the extent feasible and, if required, appropriate
respiratory protection can be selected.
A hazard evaluation must be completed for all
respiratory hazards, including chemical exposures
and exposure to infectious agents. In the case
of infectious agents, it is not generally feasible
to quantify the level of exposure, nor is it known
what level of exposure will cause infection in
a specific individual. Therefore, respirators for
infectious agents must be selected according to
anticipated exposure by task and according to
recognized and generally accepted good infection
control practices and public health guidance such
as that provided by CDC’s HICPAC, Federal and
state OSHA, and state health departments. These
organizations should be consulted for guidance
in assessing the hazards associated with novel or
emerging infectious diseases.
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When conducting a hazard evaluation in the
patient care setting, it is useful to systematically
consider all of the activities in your units.
First, think about who will be in contact with
patients who may have ATDs, such as tuberculosis
or influenza. ATDs are divided by CDC’s HICPAC
into two categories: (1) diseases requiring
Airborne Precautions; and (2) diseases requiring
Droplet Precautions. See Figure 3 and Figure 4
on pages 9 and 11 for complete lists of
these diseases. You should also review local, state,
and federal public health guidance to identify
whether there are any additional diseases that
should be considered (e.g., a novel pathogen
currently circulating in the community).
The following questions should help to guide
your thinking about who in your facility may be
reasonably anticipated to be exposed to patients
or other sources of ATD pathogens.
• Who is exposed to suspected or confirmed
cases of ATDs?
• Who will greet and triage patients?
• Who will provide care for ATD patients?
• Who will be performing aerosol-generating
procedures on patients with ATDs, on cadavers,
or in laboratories? See Figure 5 on page 12
for examples of aerosol-generating procedures.
• Who will be cleaning the ATD patient rooms?
• Do you have contractors (e.g., those who service
ventilation systems), or temporary workers in
your facility who are reasonably anticipated to
be exposed to patients or equipment that may
be a source of ATD pathogens?
• Who will be designated as a first receiver of
victims exposed to unknown radiological,
biological, or chemical agents?
20
• Do you have physicians, students, volunteers,
or others who are not hospital employees and
are reasonably anticipated to be exposed to
ATD pathogens? See Figure 8 on page 21.
Based on an assessment of the potential exposure
hazards, you will then make a determination
regarding the minimum level of respiratory
protection required for these exposures.
Consider the PPE (including type of respirator)
and other controls that you will require for
each combination of task (aerosol-generating
procedures, direct patient care, providing services
in patient rooms, etc.) and disease or hazard. This
topic will be discussed further in the section on
“Respirator Selection.”
Finally, think about other hospital employees
who may have exposure to respiratory hazards
other than ATD pathogens that cannot be
feasibly reduced by engineering, administrative,
or work practice controls. For chemical
exposures, airborne concentrations should be
measured in order to determine the level of
respiratory protection that will be needed to
reduce the exposure to acceptable levels.
• Are there housekeeping or maintenance
personnel who are exposed to chemicals used
in cleaning, repairs, or facility maintenance?
• Is anyone in central supply exposed to
hazardous chemicals used in disinfection or
sterilization?
• Are there research or clinical laboratories with
staff who will need respiratory protection?
• Is anyone exposed to anesthetic waste gases
or hazardous drugs?
If you do not have the expertise in-house to
complete a hazard assessment, an industrial
hygienist can be consulted. The American
�Industrial Hygiene Association (AIHA) provides a
list of consultants. You may also ask for help from
your workers’ compensation insurance carrier or,
if your business is small or medium-sized, from
the OSHA On-site Consultation Program.
Developing Policies and
Procedures
Once you have determined who will administer
the program and which employees will be
included, you are ready to develop the policies
and procedures that will make up your written
RPP. The RPP must have a section that addresses
each of the elements described below. A template
for a written RPP appears in Appendix D of
this document. It was specifically designed for
hospitals, and you may find that customizing it is
the easiest way to develop your written program.
If you choose to do this, it is best to use this toolkit
and the template together. The following sections
go through the process of developing each of the
required elements of your written program.
Respirator Selection
In this section of your written RPP, you should
document the results of your hazard evaluation
and determine which types of respirators will be
used by specific staff or job titles, and for specific
tasks or procedures. You may want to put all
of this information into a table or spreadsheet
either in the body of your written program,
or as an appendix. The guidelines from CDC/
HICPAC and other public health guidance include
recommendations for minimum respiratory
protection for certain tasks and infectious agents.
However, employers are always responsible for
assessing the respiratory hazards, controlling
identified hazards, and providing a workplace
free from hazards likely to cause serious harm.
The employer can always choose to select a
higher level of respiratory protection than the
minimum required.
FIGURE 8: ESTABLISH POLICIES
REGARDING NON-EMPLOYEES
You must consider what your respirator
policy will be regarding non-employees.
Although they may not be employed by
the hospital, your facility shares some
responsibility for ensuring the protection
of physicians with privileges to practice
in the facility, students, contractors,
and volunteers. All people working and
volunteering in the hospital should
be required to follow your policies on
respirator use for protection from infectious
agents as well as chemicals such as
asbestos, formaldehyde, and ethylene
oxide. A clear statement indicating who is
responsible for implementing all elements
of the respirator program for these people
should be part of your written policy. In
many cases, including non-employee
doctors, contractors, and volunteers in the
hospital’s respiratory protection program
will be the best way to ensure consistent
and effective protection.
See the following web sites for OSHA
policies and procedures for multi-employer
work sites.
• OSHA’s Multi-Employer Citation Policy
(CPL‑2-0.124)
• Interpretation of the Bloodborne
Pathogens standard at a multiemployer worksite
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Based on current recognized and generally
accepted infection control practices, employees
who perform any of the following activities that
involve a patient suspected or confirmed with a
disease requiring Airborne Precautions should
wear respiratory protection at least as protective
as an N95 respirator when:
• Entering an airborne infection isolation (AII)
room or area in use for AII;
• Present during the performance of procedures
or services;
• Repairing, replacing, or maintaining air
systems or equipment that might contain or
generate aerosolized pathogens;
• The patient has left the area and the room
air has not yet been adequately ventilated to
clear contaminants;
• Performing decontamination procedures;
• Working in a residence where the patient
is located;
• Transporting the patient within the facility
when the patient is not masked; or
• Transporting the patient in an enclosed vehicle
(e.g., van, car, ambulance, or helicopter).
Properly fitted filtering facepiece respirators (or
equivalent) are expected to reduce exposures to
one-tenth of the concentration that is in the air,
based on OSHA’s APF of 10.
Any employee performing an aerosol-generating
procedure on a patient suspected or confirmed
with a disease requiring Airborne Precautions, or
who is in the area where the procedure is being
performed, can be exposed to much higher levels
of infectious aerosols. These employees should
wear a respirator with an APF of 10 and should
consider wearing a respirator with a higher APF,
such as a PAPR with a HEPA filter, unless the
procedure is performed with the patient in a
22
ventilated enclosure. A PAPR with a loose-fitting
facepiece and a HEPA filter is expected to reduce
exposure to airborne contaminants to 1/25th of
the concentration in the room.
The CDC recommends that personnel
performing an aerosol-generating procedure on
a patient suspected or confirmed with seasonal
influenza wear at least an N95 respirator, even
though influenza has previously been considered
a disease requiring only Droplet Precautions
(ordinarily calling for a surgical mask). The
latest guidance from CDC recommends the
use of respirators for all patient-care activities
on patients who may be infected with a novel
influenza A virus associated with severe disease.
In the case of an influenza pandemic, OSHA (as
well as CDC and other public health agencies) will
make specific recommendations on a case-bycase basis after considering information available
at that time. OSHA recommends that employers
be prepared to use a NIOSH-approved N95
respirator for routine care. In some instances a
more protective respirator may be necessary.
The Respiratory Protection Selection Guide
for Aerosol Transmissible Diseases included as
Figure 9 on page 24 will be useful in making
appropriate respirator selections for specific
diseases and tasks, and for training your staff on
respirator use. The selection guide is based on
recommendations from the 2007 CDC/HICPAC
Guidelines, CDC, and OSHA.
Selecting Respiratory Protection in the
Laboratory or Autopsy Setting
Assessment of exposure risk and selection
of respirators and other control measures
for hospital laboratory and autopsy workers
exposed to ATD pathogens must be based on
consideration of different factors than those for
�workers providing patient care. In the lab, the
primary factors include the pathogen that is
likely to be present in the material being handled
(which may be unknown), and whether the
procedures to be performed by the employee are
likely to generate aerosols.
Laboratory worker protection policies should be
described in a written biosafety plan, developed
by the lab biological safety officer and other
personnel with knowledge of laboratory
procedures as well as worker protection
expertise. The primary resource for lab biosafety,
including risk assessment, recommended
practices, selection of controls, and containment
levels, is the CDC’s Biosafety in Microbiological
and Biomedical Laboratories (BMBL).
Photo: Centers for Disease Control and Prevention
Your written RPP should cover laboratory workers
and specify the level of respiratory protection
required for different pathogens or job tasks, in
accord with the biosafety plan and other written
lab operating procedures.
Laboratory worker wearing powered
air-purifying respirator.
Stay Informed as Public Health
Guidance is Updated
Keep in mind that respiratory protection
requirements to protect against infectious
diseases are based on guidance or requirements
from OSHA, CDC/NIOSH, and state or other public
health agencies. It is important to stay informed
about any changes in public health guidance and
regulations as new pathogens emerge or relevant
new scientific information becomes available.
You will then need to consider how your facility’s
policies and practices may need to change to
conform to new regulations and guidance.
The CDC now recommends the use of respiratory
protection with at least an APF of 10, such as
a filtering facepiece respirator, in addition to
airborne infection isolation where feasible, when
aerosol-generating procedures are performed on
patients with suspected or confirmed influenza.
This recommendation raises the issue of whether
respirator use during aerosol-generating
procedures should also be considered for other
infectious diseases (e.g., pertussis, meningococcal
disease) that currently call for Droplet Precautions.
For example, at least one study has demonstrated
airborne transmission of pertussis. An even
more protective approach would be to require
respiratory protection for all procedures performed
on patients with diseases requiring Droplet
Precautions, because spontaneous coughs and
sneezes can also generate infectious aerosols.
Existing guidance may continue to change with
advances in infectious disease research, in the
design of respiratory protection to address
concerns about issues such as comfort and ease
of communication, and/or as hospitals gain more
experience with their respirator programs.
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FIGURE 9: RESPIRATORY PROTECTION SELECTION GUIDE
FOR AEROSOL TRANSMISSIBLE DISEASES
The employer is responsible for selecting PPE, including but not limited to respiratory protection,
appropriate for the hazard and the environment. The employer can always choose to select a higher level
of respiratory protection than the minimum required.
Disease
(suspected or confirmed)
Job Task
Respiratory Protection
Diseases requiring Airborne
Precautions1
Routine patient care and
support operations
At least an N95 respirator
Aerosol-generating
procedures2
At least an N95 respirator3
Routine patient care and
support operations
At a minimum use a
surgical mask4, 5
Seasonal influenza and viral
hemorrhagic fever (VHF)
An N95 respirator may reduce
aerosol exposure
Aerosol-generating
procedures2
Other diseases requiring
Droplet Precautions8
Novel pathogens/pandemic
influenza
Routine patient care
and support operations,
including aerosol-generating
procedures2
At least an N95 respirator5, 6, 7
At a minimum use a
surgical mask4
An N95 respirator may reduce
aerosol exposure
Follow current public
health guidance
See list on page 9.
See definition on page 12.
3
Cal/OSHA requires at least a PAPR.
4
A surgical mask is not a respirator but can be effective in blocking large particles.
5
October 2014 CDC guidance for Ebola virus disease recommends at least an N95 respirator.
6
CDC’s Prevention Strategies for Seasonal Influenza in Healthcare Settings.
7
See page 119 of CDC and HICPAC’s 2007 Guideline for Isolation Precautions for precautions for VHF.
8
See list on page 11.
1
2
24
�PAPRs Used by First Receivers
Photo: Hospital Corporation of America
You may also have employees who have been
designated first receivers for emergency
response purposes. These employees are
expected to decontaminate or provide initial care
for victims of a biological or chemical emergency.
When their exposures may be to unknown
substances, hospital first receivers are required to
have special training and use the most protective
type of PAPR approved by NIOSH for chemical,
biological, radiological, and nuclear (CBRN)
exposures. These PAPRs have a full facepiece, or
a hood or helmet, and a combination HE filter
and chemical cartridge. They must be a type
that has an APF of 1,000, meaning that it will
reduce the exposure of the wearer to 1/1000th of
the airborne contaminant concentration. Refer
to OSHA Best Practices for Hospital-Based First
Receivers of Victims from Mass Casualty Incidents
Involving the Release of Hazardous Substances
for more information on PPE for first receivers.
Workers wearing powered air-purifying
respirators while treating a patient.
Use of Respirators and Maintaining
a Sterile Field
Yet another consideration is which respirators to
use for aerosol-generating or other procedures
conducted in operating rooms or other settings
that involve maintaining a “sterile field” free of
microorganisms. There is some concern that
exhaled air from wearers of PAPRs or APRs with
exhalation valves can flow into and potentially
contaminate the sterile field.
Local exhaust ventilation and adequate dilution
ventilation should be used where possible at the
source of aerosol generation to reduce the need
for respiratory protection. Surgical respirators
(without exhalation valves) should be selected
for use in environments where a sterile field must
be maintained. Currently, there is insufficient
evidence to support the safe use of PAPRs in
these environments.
Respirators for Chemical Gas or
Vapor Hazards
In a hospital setting, respiratory hazards may
include gases and vapors. These contaminants
may come from procedures using hazardous
drugs (including some cancer chemotherapy
drugs, antiviral drugs, hormones, and
bioengineered drugs) and chemicals (e.g.,
anesthetic waste gases or equipment
sterilization) or cleaning and maintenance
activities. It is important to note that N95 filtering
facepiece respirators, PAPRs, or other types of
APRs, when used with only particulate or HE
filters, will not protect the wearer from gas or
vapor exposures. Filters are designed to remove
particles from the air, but will not remove gases
or vapors (e.g., glutaraldehyde, formaldehyde, or
ethylene oxide) from the air.
If you need help selecting respirators for
exposures to hazards other than infectious agents,
the following resources will be helpful in making
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
your selection. The NIOSH Respirator TrustedSource Information Page provides information
on the selection and use of respirators, and both
the NIOSH Respirator Selection Logic and Federal
OSHA Respirator e-Tool (which contains OSHA’s
updated APFs) aid in the selection of respirators
and the development of a change schedule
for cartridges. See Figure 10 to the right for a
summary of respirator selection considerations for
ATD pathogens.
Respirator Use
In this section of your written RPP, describe your
facility’s policies regarding the use of respirators.
Include detailed procedures for the routine use
of respirators. For example, describe proper
procedures for inspecting and putting on
(donning) the respirators used at the hospital, and
train users to always perform a user seal check
whenever they put on a tight-fitting respirator.
Describe and demonstrate proper respiratorspecific procedures for taking the respirator
off (doffing) and explain the importance of the
sequence of removal of the respirator with other
PPE so as to avoid self-contamination (see the
CDC slide show and the figures on pages 134-135
of CDC and HICPAC’s 2007 Guideline for Isolation
Precautions). Employees should also be trained
to recognize when the respirator is not working
correctly (e.g., if employee is experiencing
symptoms from exposure to chemicals, or having
difficulty breathing).
In order to clearly state your policies for respirator
use, it might be helpful to answer the following
question. What will your policy be for employees
with facial hair or other conditions that prevent
a good seal to the face? Employees who use
tight-fitting respirators are not permitted to have
facial hair that interferes with the facepiece seal
or valve function. Hospitals may provide loosefitting PAPRs to employees who have facial hair,
26
FIGURE 10: SUMMARY OF
RESPIRATOR SELECTION
CONSIDERATIONS FOR AEROSOL
TRANSMISSIBLE DISEASE
PATHOGENS
• Determine who has potential occupational
exposure to ATD pathogens, the level of
exposure they are likely to encounter, and
how frequently they may be exposed for
each task they perform. Be sure to consider
the hierarchy of controls before resorting
to the use of respiratory protection.
• Use federal, state, and local public health
and occupational health and safety
guidelines and regulations for choosing
the appropriate level of protection for
each task that results in exposures that
cannot be prevented through other types
of controls (e.g., engineering controls
such as ventilation).
• Make sure the respirators you have
selected are NIOSH-approved and provide
the appropriate level of protection from
all types of contaminants (particles and
gases or vapors) as needed. Consult an
industrial hygienist if you have questions
about the level of protection provided.
For example, make sure the PAPRs
used by first receivers have an assigned
protection factor of 1,000. Consult your
supplier if you have questions about the
level of protection provided.
• Stay aware of the potential for counterfeit
respirators, particularly during pandemic
outbreaks. Refer to NIOSH’s Trusted
Source Page and the OSHA/NIOSH video
on counterfeit respirators for more
information.
• Make sure that the chosen respirator is
not putting the patient at risk and that
use is consistent with other infection
prevention policies.
• Stay aware of changes in respirator
selection guidance.
�List the reasons for which an employee might
leave a contaminated area to adjust or replace
his or her respirator. These should include
problems with the use of the respirator such
as difficulty breathing, loss of face seal, gross
contamination or saturation of the filter material,
etc. This list should include a policy that wearers
of respirators with chemical cartridges must leave
the contaminated area to replace the cartridges
or respirator when they detect breakthrough of
the contaminant or because the usable service life
has been reached, as indicated in the change-out
schedule provided by the program administrator.
Storage, Maintenance, Repair,
and Disposal
therapy department, the PAPRs will be stored
there. Some hospitals issue PAPR hoods to
individuals who are responsible for maintaining
them, while central supply or materials
management is responsible for decontaminating
PAPR motors and blower units and charging
batteries. Whatever you decide works best for
your facility should be described here.
Photo: Haylard Health, Inc.
or for whom other respirators available at the
facility do not provide an acceptable fit. This is
acceptable as long as employees consistently use
the loose-fitting PAPR when required, have been
trained in its use, and the PAPR provides adequate
protection for the specific hazard (i.e., is equipped
with the correct type of filter or cartridge).
Healthcare personnel in a stockroom.
This section should include, for each type of
respirator, detailed and specific procedures
for storage, maintenance, repair, and disposal.
These procedures should include a description
of where respirators are stored in each unit or
department, how they should be stored between
uses by a respirator user (if allowed), how they
will be maintained and who is responsible
for maintenance, and who is responsible for
ensuring an adequate supply.
Filtering facepiece respirators are designed
to be worn by one individual (i.e., not shared)
and disposed of after use. Users should discard
respirators when they become unsuitable
for further use due to excessive breathing
resistance (e.g., particulates clogging the filter),
unacceptable contamination/soiling, or physical
damage. Filtering facepiece respirators should be
removed with minimal handling and disposed
of properly. Hand hygiene should always be
performed after removing a respirator.
Most hospitals keep carts of N95 filtering
facepiece respirators in each unit or outside the
isolation rooms, while PAPRs are often kept in
central supply and are ordered when needed for
aerosol-generating procedures. Some hospitals
have decided that since most aerosol-generating
procedures will be done by the respiratory
From the standpoint of the wearer’s protection,
filtering facepiece respirators may be taken
off and put on again as long as they are not
damaged or soiled, or contaminated inside the
facepiece. However, a respirator used in the care
of an infectious patient should be considered
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
potentially contaminated with infectious
material on the outside and a source of contact
transmission for healthcare personnel or patients.
Therefore, the risk of contaminating the inside
of the respirator through improper handling and
the risk of infecting the patient must be weighed
when making decisions about redonning
filtering facepiece respirators. Tuberculosis is
not transmitted via contact and, therefore, reuse
by the same wearer is acceptable as long as the
filtering facepiece respirator is not damaged
or soiled.
cause an increased resistance to breathing or a
build-up of carbon dioxide inside the facepiece.
This can lead to medical complications in some
individuals for whom it may not be safe to wear
a respirator. It may also be unsafe for someone
with moderate to severe claustrophobia to
wear a respirator. Medical evaluations must be
provided by the employer during work time and
at no cost to the employee.
You should also describe procedures to follow
when users discover problems with respirators.
• To whom do they report the problem?
• Who does the repairs?
• Who decides when to discard a reusable
respirator and replace it rather than trying to
repair it?
• What are the procedures for disposal of used
or damaged filtering facepiece respirators?
NIOSH has issued guidance on extended use and
limited reuse of N95 filtering facepiece respirators
in healthcare settings.
Medical Evaluations
The OSHA Respiratory Protection standard
(29 CFR 1910.134) requires that employees be
medically evaluated and cleared for respirator
use prior to wearing a respirator or being fit
tested. The use of some types of respirators can
28
Photo: Haylard Health, Inc.
Describe your facility’s policies regarding use
and disposal of filtering facepiece respirators in
the written RPP, including policies, procedures,
and training to reduce the potential for contact
transmission. If different policies on reuse may
be implemented in the event of a respirator
shortage, the RPP should address those policies
(or be updated to document changes in policies).
Worker donning a filtering facepiece respirator.
The standard does not require medical
reevaluation on a specific schedule. The
employer must provide reevaluation when
recommended by the physician or other
licensed healthcare professional (PLHCP)
providing the evaluation, when an employee
reports a change in signs or symptoms (e.g.,
asthma, difficulty breathing) that may affect the
ability to use a respirator, or when the supervisor
or the RPA becomes aware of a change in
employee health status or in physical job
demands that may impact respirator use. Many
hospitals, however, elect to provide medical
clearance on an annual basis.
Employers must provide the healthcare
professional evaluating the employee with a
description of the type and weight of respirator
to be used, the duration and frequency of use,
�Part A of Appendix C of the OSHA Respiratory
Protection standard is a questionnaire that solicits
information that must be reviewed by a physician
or other licensed healthcare professional either
in questionnaire format, or in person during a
visit to the PLHCP. The PLHCP may be a hospital
employee, but must not be the employee’s
supervisor. If the hospital does not have internal
occupational health services, the PLHCP may be
a contracted provider. The best outside sources
for such evaluations are occupational medicine
providers or clinics (see organizations listed in the
“References, Resources, and Tools” section of this
document starting at page 36). These clinics
provide medical clearance for respirator use and
may also provide fit testing services.
Make sure that you are clear about where the
questionnaires will be sent for evaluation,
and describe these procedures in your
written RPP. The completed questionnaires
are considered personal health information,
so there must be a procedure by which they
are confidentially provided to the PLHCP.
Completed questionnaires must be maintained
as confidential medical records and may not
be accessible to the employee’s supervisor
(see “Recordkeeping” on page 33).
Based on the answers to the questionnaire, as
well as on a physical exam or any other tests the
PLHCP deems necessary, the PLHCP must make
a determination as to whether the individual
can safely wear the respirator. Information that
is useful for the medical evaluation of respirator
Photo: CDC / Amanda Mills
the expected physical work effort, additional
protective clothing and equipment to be worn,
and temperature and humidity extremes that may
be encountered. This information is critical to the
healthcare professional’s determination regarding
the employee’s ability to use a respirator.
Physician evaluating a worker for
respirator clearance.
users is provided in ANSI/AIHA Z88.6-2006, a
voluntary consensus standard. (See “American
National Standards Institute (ANSI)” on page 38.)
The PLHCP must inform the employer (RPA or
supervisor) in writing whether the individual is
cleared for respirator use, cleared with certain
conditions or restrictions (e.g., only for PAPR use,
only for limited duration, etc.), or not cleared
for respirator use, whether there is a need for a
follow-up medical evaluation, or if the individual
requires periodic medical reevaluation. The
details of any medical evaluation, including
specific medical diagnoses or test results, should
not be shared with the employer or supervisor.
Your program should include a clear policy as to
what will be done if someone is not cleared for
respirator use. Employees who are not cleared
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
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Photo: Haylard Health, Inc.
cannot be exposed to situations in which a
respirator is necessary to protect them. If the
PLHCP determines that a person designated
to use a non-powered air-purifying respirator
cannot do so without added health risks, the
employer must provide a PAPR (assuming the
PLHCP determines that the person can use one
and the RPA determines that it will provide
adequate protection).
Fit Testing
Fit testing is required for all users of respirators
with tight-fitting facepieces, including filtering
facepiece respirators. The fit test ensures that,
when donned properly, the selected brand
and size of respirator fits adequately to protect
the wearer from excessive inward leakage of
contaminant through the face seal. The fit test
must be repeated annually and whenever the
employee reports—or the employer, PLHCP,
supervisor, or program administrator makes
visual observations of—any changes in the
employee’s physical condition, such as weight
gain or loss, facial scarring, or dental changes,
that could alter fit of the facepiece.
Describe your procedures for coordinating fit
testing for your staff, as well as the specific,
detailed fit testing protocol that will be used.
30
Worker receiving qualitative fit testing.
Photo: TSI
Fit testing is one of the most important parts
of the respirator program because it is the only
recognized tool to assess the fit of a specific
respirator model and size to the face of the user.
OSHA requires employers to make available
a sufficient number of models and sizes of
respirators so that employees can be provided
with a respirator that is comfortable and fits well.
Employees are only allowed to use the make,
model, style, and size of respirator or respirators
for which they have been successfully fit tested.
Worker receiving quantitative fit testing.
The OSHA Respiratory Protection standard
Appendix A has specific protocols which must
be followed exactly in fit testing employees
for respirators, and it is acceptable to copy and
paste one or more of these into your RPP. First,
there are general requirements that pertain to
selecting an appropriately sized respirator, some
basic training on donning the respirator and
performing a user seal check, and descriptions
of the specific exercises that are to be performed
�during the fit test to verify an adequate seal
during several routine work activities. Second,
there are detailed protocols for four different
qualitative (i.e., wearer indicates fit based on
detection of a chemical) fit tests and three
quantitative (i.e., provides a numerical test result)
fit tests from which you may choose.
Qualitative Tests: There are four qualitative
fit test protocols specified in the Respiratory
Protection standard. Either the saccharin or
Bitrex® fit test protocol may be used for fit testing
APRs, including filtering facepiece respirators, for
particulate exposure. The APF for qualitative fit
tests is limited to 10, even for respirators with a
full facepiece. In these tests, the user is exposed
to a saccharin (sweet-tasting) or Bitrex® (bittertasting) aerosol. It is up to the respirator user to
let the tester know if he or she tastes the test
aerosol at any time. Because these tests rely on
the user’s subjective detection of leakage when
challenged with a test agent, the protocols
require pre-screening to determine each user’s
ability to detect the specific test agent.
Quantitative Tests: There are three approved
quantitative fit tests and all require an investment
in relatively expensive equipment. The most
common quantitative protocol used in hospitals
is the ambient aerosol condensation nuclei
counter (CNC) test. With the correct equipment,
this test protocol can be used for all types
of respirators and provides an automated
calculation of the effectiveness of fit (fit factor)
by consecutively measuring and comparing the
concentration of airborne particles inside and
outside the facepiece.
It is critical that the person conducting the fit
testing follows one of the protocols written
in the Respiratory Protection standard. Most
hospitals do qualitative fit testing using either
the saccharin or Bitrex® protocol. There are some,
however, who do quantitative fit testing.
It is the program administrator’s responsibility to
ensure that the person conducting the fit tests is
competent. There is no licensing or certification
required for someone to do fit testing; anyone
can do it as long as they understand how to
FIGURE 11: SUMMARY OF FIT TEST
REQUIREMENTS
• All employees required to wear tightfitting respirators must be fit tested after
receiving medical clearance, prior to
respirator use, and annually thereafter.
• An OSHA-accepted fit test protocol must
be followed exactly as it is written in the
standard. This may be a qualitative test
using Bitrex® or saccharin, or a quantitative
test using a condensation nuclei counter
or another appropriate instrument.
• Fit testing must be performed by an
individual knowledgeable in respiratory
protection, and qualified to follow
the protocol and train the employee
to properly put on and take off the
respirator.
• Records of fit tests must be kept on file
until the next annual test is performed,
and you must make sure that employees
use only the respirator model and size for
which they have passed a fit test.
• There is no fit test requirement for PAPRs
with loose-fitting facepieces, hoods,
or helmets. A PAPR with a tight-fitting
facepiece requires fit testing (with the
blower off ).
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
follow the protocol and are skilled at training
people on how to put on and take off a
respirator and perform a user seal check. In some
hospitals, the employee health department or
an occupational health clinic is responsible for
both medical evaluations and fit testing, and
they can be done in one visit. In other hospitals,
the infection preventionist is responsible for fit
testing the healthcare personnel with filtering
facepiece respirators. Still others train each of
the unit managers to fit test their own staff so
that one person is not charged with fit testing
hundreds of employees. Some hospitals do all
of their fit testing and training in one month.
Others spread it out so that each employee is
tested on or before the anniversary date of his
or her previous fit test. You should decide which
approaches work best for you and your facility.
Employees can only wear the respirator model
and size for which they have successfully
passed a fit test. Employers should implement a
mechanism to ensure that employees know the
manufacturer, model, and size of respirator they
can wear. Some hospitals issue wallet-sized cards
containing this information, while others place
stickers on the back of employee badges.
Fit testing is critical to ensure the safety of
the employees relying on their respirators
for the expected degree of protection. If
hospital personnel do not have the time
or skills to conduct fit testing, there are
consultants who provide fit testing services.
In addition to these consultants, some of the
respirator manufacturers will provide train-thetrainer services so you can have multiple inhouse staff with these skills. There are also some
workers’ compensation insurance companies that
provide similar assistance to their customers.
A summary of fit test requirements appears in
Figure 11 on page 31.
32
Training
Employee training is a critical component of
an effective RPP. It requires significant time
and resources and must be conducted prior
to respirator use, at least annually thereafter,
and whenever necessary due to changes in
the workplace or identified inadequacies in
the employee’s knowledge. The annual fit test
provides an opportunity for hands-on learning
and serves to reinforce some of the topics
covered in training. Some hospitals include
respirator training as part of a skills day for their
healthcare professionals and require them to
pass a competency test.
This section of your written program must
include both the mechanism for getting
everyone trained in a way that they can
understand and a description of the curriculum,
including all of the topics that are required by the
standard to be covered. These are:
• Why the respirator is necessary (including
when it must be worn);
• Why proper fit, usage, and maintenance is
crucial to its effectiveness;
• What the limitations and capabilities of the
respirator are;
• Hands-on demonstration of how to inspect,
put on, remove, use, and check the seal of the
respirator;
• What the procedures are for storage and
maintenance;
• How to recognize medical signs or symptoms
that limit or prevent the safe, effective use of
respirators;
• The general requirements of the OSHA
Respiratory Protection standard;
• How to identify and react to respirator
malfunctions; and
• How to use the respirator in emergencies (e.g.,
chemical release) if appropriate.
�There are a number of educational tools
(including slide presentations, posters, and flyers)
listed in the “References, Resources, and Tools”
section at the end of this document. You may
use these materials during your annual training
and as needed year-round to make sure that
employees are up-to-date on their knowledge
of respiratory protection and its proper use.
However, you must ensure that respirator users
are fully trained on the specific risks, programs,
and procedures at your hospital; can correctly
put on and take off their respirators; and can
recognize when their respirator needs to be
repaired or replaced.
Recordkeeping
The respirator standard requires that several
types of records be maintained. The written
RPP must be maintained in a location that is
accessible to all program participants, and it
must be made available to OSHA on request.
We recommend documenting the changes that
are made to the RPP along with any evaluation
checklists that are completed during program
evaluation (see next section). The current
program, however, can be kept online for access
by participants.
You must also keep a record of the employee
medical evaluations. The questionnaires and
any notes from physical exams are medically
confidential, so these are often maintained by
the PLHCP who does the medical clearance
evaluations. They must be maintained for 30 years
after termination of employment. The medical
clearance letters that are provided by the PLHCP
should be kept on file by the RPA as evidence that
the employee has been cleared. It makes sense to
keep these with the fit test records.
Fit test records must be kept on file until a new
fit test is completed, so there should always be
a record for each tight-fitting respirator user
indicating that he or she has passed a fit test
within the last 12 months.
The Respiratory Protection standard requires
that the following information be kept in the fit
test record:
• Name or employee ID;
• Type of fit test performed;
• Specific make, model, style, and size of
respirator tested;
• Date of test; and
• Pass/fail result from qualitative test or printout
from quantitative test.
Links to a sample fit test record form and a fit
test verification card are provided as resources.
Software to track RPP participants and provide
reminders of requirement (e.g., medical
clearance, fit testing, and training) due dates can
be developed in-house or purchased.
Program Evaluation
Regular program evaluation is required by
the standard and it is critical to successful
implementation. There should be a section in
your written program that describes how you will
evaluate the implementation and effectiveness
of your program. The standard does not require
this to be done at specific intervals (i.e., annually).
It requires that the workplace be evaluated
as necessary to ensure that the provisions of
the written program are being implemented
effectively. It also requires that the employer
regularly consult employees to assess their views
on the effectiveness of the program.
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
This means that the RPA, or whoever has been
designated to evaluate the program, should
observe respirators being put on and taken off,
availability, storage, maintenance, and other
practices in all units where respirators are
commonly used. The systems in place to manage
respirator use should be evaluated to ensure
that they support the behaviors you expect to
observe among employees. If someone is not
using a respirator when he or she is supposed
to, consider all the possibilities why this may
be happening. Some hospitals use a labormanagement health and safety committee
to tap into the knowledge and experience of
employees and obtain feedback and suggestions
for improvements, while others survey or
interview respirator users.
Any deficiencies in the implementation of
policies and procedures that are discovered as
a result of the evaluation must be corrected in a
timely manner. In some cases, this might mean
revising the written program to conform to actual
practices as long as the procedures being followed
comply with the standard. In other cases, it might
34
Photo: iStockphoto
Resources for Respirator Program Administrators
Healthcare personnel evaluating their RPP.
mean retraining personnel on some aspect of
the program, or assigning a loose-fitting PAPR to
someone who had been using a filtering facepiece
respirator, but has since grown a beard.
An evaluation checklist, with instructions on
how to use it, is provided in Appendix C of this
document. It will make the process of evaluation
a bit easier as well as more standardized and
comprehensive. You are not required to use a
checklist, but it is one way to make sure that you
do the evaluations and track any improvements
you make.
�Summary
Healthcare personnel are at increased risk for exposure to
ATD pathogens and, when other controls have been considered
and implemented as appropriate, may be required to use
respiratory protection.
obtaining input from all respirator users and
persons involved in implementing the program.
Public health guidance and regulations must be
regularly reviewed for changes and utilized to
identify tasks and pathogens requiring the use of
respiratory protection.
Photo: Fotolia and Microsoft
In order for respirators to provide effective
protection they must be properly selected, used,
and maintained as part of a written program,
which describes how employers will provide
employees adequate medical evaluations,
training, and fit testing. The program must be
evaluated regularly through observation and
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
References, Resources, and Tools
Regulatory Standards and Interpretations
Occupational Safety and Health Administration (OSHA)
Respiratory Protection Standard (29 CFR 1910.134)
Interpretations of the OSHA Respiratory Protection Standard, Appendix A—Fit Testing Procedures
and Appendix C—Medical Evaluation
OSHA’s Multi-Employer Citation Policy (CPL 2-0.124)
Interpretation of the Bloodborne Pathogens Standard at a Multi-Employer Worksite
State Occupational Safety and Health Plans
California Division of Occupational Safety and Health (Cal/OSHA)
Cal/OSHA Aerosol Transmissible Diseases (ATD) Standard (Title 8 CCR; Section 5199)
Healthcare Resources and Guidelines
Occupational Safety and Health Administration (OSHA)
Safety and Health Topics: Healthcare—Infectious Diseases
Safety and Health Topics: Ebola
Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare
Employers, 2007
Guidance on Preparing Workplaces for an Influenza Pandemic, 2009 (PDF)
Precautions for Healthcare Workers during Flu Season
Safety and Health Management Systems and Joint Commission Standards (PDF)
Hospital eTool
Centers for Disease Control and Prevention (CDC)
Healthcare Infection Control Practices Advisory Committee (HICPAC)—2007 Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition
Prevention Strategies for Seasonal Influenza in Healthcare Settings
Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed
Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses
Associated with Severe Disease
36
�Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle
East Respiratory Syndrome Coronavirus (MERS-CoV)
Ebola (Ebola virus disease)
Infection Prevention and Control Recommendations for Hospitalized Patients with Known or
Suspected Ebola Hemorrhagic Fever in U.S. Hospitals
Guidance on Personal Protective Equipment To Be Used by Healthcare Workers During Management
of Patients with Ebola Virus Disease in U.S. Hospitals, Including Procedures for Putting On (Donning)
and Removing (Doffing)
CDC (Centers for Disease Control and Prevention). 2011. Immunization of Health-Care Personnel:
Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and
Mortality Weekly Report 60(RR07); 1-45.
National Institute for Occupational Safety and Health (NIOSH)
Workplace Safety and Health Topics Page—Healthcare Workers
Workplace Safety and Health Topics Page—Ebola
Workplace Safety and Health Topics Page—Emerging Infectious Diseases
Workplace Safety and Health Topics Page—Hazardous Drug Exposures in Health Care
Workplace Safety and Health Topics Page—Seasonal Influenza (flu) in the Workplace
Workplace Safety and Health Topics Page—Severe Acute Respiratory Syndrome (SARS)
Workplace Safety and Health Topics Page—Tuberculosis
TB Respiratory Protection Program in Healthcare Facilities—Administrator’s Guide, 1999
Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators
in Healthcare Workers
Revised, Updated Resources Are Announced to Help Prevent Exposures of Emergency Response
Employees to Infectious Diseases During Duty
Institute of Medicine (IOM)
Use and Effectiveness of Powered Air Purifying Respirators in Health Care
IOM Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal
Protective Equipment for Healthcare Personnel Update 2010
World Health Organization (WHO)
Epidemic- and Pandemic-prone Acute Respiratory Diseases—Infection Prevention and Control in
Health Care. Infection Control Aide-Memoire, World Health Organization, 2008
Epidemic- and Pandemic-prone Acute Respiratory Diseases—Infection Prevention and Control in
Health Care. Summary Guidance, World Health Organization, 2007
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
The Joint Commission
Implementing Hospital Respiratory Protection Programs: Strategies from the Field
California Department of Public Health
Respirator Use in Health Care Workplaces—a Toolkit for Respirator Program Administrators
Guide and tools developed for use in California
Association of periOperative Registered Nurses
Guidelines for Perioperative Practice, 2015
General Respiratory Protection Resources
National Institute for Occupational Safety and Health (NIOSH)
Workplace Safety and Health Topics—Respirators
National Personal Protective Technology Laboratory
Respirator Trusted-Source Information Page
Respirator Selection Logic, 2004
Certified Equipment List Search—search for NIOSH-approved respirators by facepiece type,
manufacturer and hazard
Getting optimal performance from a powered air-purifying respirator (PAPR) depends on the
condition of its battery!
Occupational Safety and Health Administration (OSHA)
Safety and Health Topics: Respiratory Protection
Assigned Protection Factors for the Revised Respiratory Protection Standard, 2009 (PDF)
Respirator eTool—Learn how to select appropriate respirators and develop a change schedule
for cartridges.
Small Entity Compliance Guide for the Respiratory Protection Standard, 2011 (PDF, 6MB)
Questions and Answers on the Respiratory Protection Standard, OSHA memorandum, 1998 (PDF)
American National Standards Institute (ANSI)
(Standards must be purchased to access online.)
ANSI/AIHA Z88.6-2006 Respiratory Protection—Respirator Use—Physical Qualifications for Personnel
ANSI/AIHA Z88.7-2010 Color Coding of Air-Purifying Respirator Canisters, Cartridges, and Filters
ANSI/AIHA Z88.10-2010 Respirator Fit Testing Methods
ANSI/ASSE Z88.2 Practices for Respiratory Protection
38
�Medical and Industrial Hygiene Services
American Industrial Hygiene Association (AIHA) Consultants List—search by specialty for help with
respiratory protection programs and fit testing.
OSHA On-site Consultation Program—offers free and confidential advice to small and mediumsized businesses in all states across the country, with priority given to high-hazard worksites.
The Association of Occupational and Environmental Clinics directory of member clinics—These
clinics provide medical clearance for respirator use, may provide fit testing services, and meet
certain criteria for quality patient care.
Administrative Resources
Respiratory Protection Program Evaluation Checklist & Instructions for Use (Appendix C)
Written Respiratory Protection Program Template (Appendix D)
Sample Respirator Fit Test and Training Verification Card (PDF)—developed by the Association of
Occupational Health Professionals in Healthcare
Sample Respirator Fit Test Record (Word)—customizable for your respirator program (developed by
the California Department of Public Health)
Training and Educational Resources
Occupational Safety and Health Administration (OSHA)
OSHA Training Institute (OTI)—searchable schedule of courses offered by the OTI Education Centers
Fact Sheet: Respiratory Infection Control: Respirators Versus Surgical Masks (PDF)—two-page
explanation of when to use respirators and surgical masks
Respiratory Protection Videos (MPEG4 or YouTube)—website with 13 videos in English and Spanish
The Difference Between Respirators and Surgical Masks—English and Spanish videos
Respiratory Protection for Health Care Workers—download video or watch on YouTube
Respirator Safety: Donning and Doffing (WMV, 21MB)—English and Spanish videos
QuickCard on types of respirators (PDF)—one page reference on the different types of respirators
OSHA Best Practices for Hospital-Based First Receivers of Victims from Mass Casualty Incidents
Involving the Release of Hazardous Substances, 2005
Susan Harwood Grantee Produced Training Materials
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�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
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National Institute for Occupational Safety and Health (NIOSH)
NIOSH Science Blog: N95 Respirators and Surgical Masks—discussion of respirator and surgical mask
history, fit and filter performance
NIOSH Science Blog: Do We Need to Challenge Respirator Filters With Biological Aerosols?—
discussion of particle filtration as it relates to viruses and bacteria
Debunking the Myths Regarding N95 Respirator Use—N95 Day Webinar
Respirator Awareness: Your Health May Depend On It—Personal Protective Equipment for
Healthcare Workers (PDF, 2.5 MB)
Listing of Approved Surgical N95 Filtering Facepiece Respirators with Donning/Doffing Instructions
How to Properly Put on and Take off a Disposable Respirator (PDF)—NIOSH factsheet in English
and Spanish
Educational Resource Centers for Occupational Safety and Health—courses, seminars, and
workshops for occupational health and safety professionals
Centers for Disease Control and Prevention (CDC)
CDC Tools for Protecting Healthcare Personnel—guidelines, slideshow, and resources on selecting
and using personal protective equipment
Guidance for the Selection and Use of PPE (PPT, 1.5MB)
Sequence for Donning and Removing Personal Protective Equipment poster (PDF)—English
and Spanish
AAOHN Respiratory Protection Education & Resources Webkit—a 10-module Respiratory Protection
Course and accompanying resources
University of Wisconsin PAPR Training Workshop Presentation (PDF)—training on powered airpurifying respirators (PAPRs)
APIC-MDH PAPR Donning and Doffing Poster (PDF)—produced by the Association for Professionals
in Infection Control and Epidemiology and the Minnesota Department of Health
Washington State Department of Labor and Industries Respirator Training Kit—training
presentations for filtering facepiece, cartridge, and supplied-air respirators
40
�Appendix A
Clinical Syndromes or Conditions Warranting Empiric
Transmission-Based Precautions Pending Confirmation
of Diagnosis1, 2
Clinical Syndrome or
Condition3
Potential Pathogens4
Precautions, in Addition to
Standard Precautions
Meningitis
M. tuberculosis
Airborne Precautions if pulmonary infiltrate
Airborne Precautions plus Contact
Precautions if potentially infectious draining
body fluid present
Rash or Exanthems, Generalized, Etiology Unknown
If positive history of travel
to an area with an ongoing
outbreak of viral hemorrhagic
fever in the 10 days before
onset of fever
Ebola, Lassa, Marburg viruses
Droplet Precautions plus Contact
Precautions, with face/eye protection,
emphasizing safety sharps and barrier
precautions when blood exposure likely. Use
N95 or higher respiratory protection when
aerosol-generating procedure performed
Vesicular
Varicella-zoster, herpes
simplex, variola (smallpox),
vaccinia viruses
Airborne plus Contact Precautions
Maculopapular with cough,
coryza and fever
Rubeola (measles) virus
Airborne Precautions
M. tuberculosis, Respiratory
viruses, S. pneumoniae,
S. aureus (MSSA or MRSA)
Airborne Precautions plus Contact
Precautions
Respiratory Infections
Cough/fever/upper lobe
pulmonary infiltrate in an HIVnegative patient or a patient
at low risk for HIV infection
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Clinical Syndrome or
Condition3
Cough/fever/pulmonary
infiltrate in any lung location
in an HIV-infected patient or
a patient at high risk for HIV
infection
Potential Pathogens4
M. tuberculosis, Respiratory
viruses, S. pneumoniae,
S. aureus (MSSA or MRSA)
Precautions, in Addition to
Standard Precautions
Airborne Precautions plus Contact
Precautions
Use eye/face protection if aerosolgenerating procedure performed or contact
with respiratory secretions anticipated.
If tuberculosis is unlikely and there are
no AIIRs and/or respirators available, use
Droplet Precautions instead of Airborne
Precautions.
Tuberculosis more likely in HIV-infected
individual than in HIV negative individual.
Cough/fever/pulmonary
infiltrate in any lung location
in a patient with a history
of recent travel (10-21 days)
to countries with active
outbreaks of SARS or avian
influenza
M. tuberculosis, severe acute
respiratory syndrome virus
(SARS-CoV), avian influenza
Airborne plus Contact Precautions plus eye
protection.
If SARS and tuberculosis unlikely, use
Droplet Precautions instead of Airborne
Precautions.
Abbreviated and based on Table 2: Clinical Syndromes Or Conditions Warranting Empiric Transmission-Based Precautions In Addition To Standard
Precautions Pending Confirmation Of Diagnosis from Appendix A of CDC and HICPAC’s 2007 Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings. This table is not up-to-date on current pathogens of concern; therefore, public health
guidance must be regularly reviewed to understand the potential pathogens and recommended precautions. For examples, see CDC’s latest
guidance for novel influenza A viruses associated with severe disease, Middle East Respiratory Syndrome Coronavirus, and Ebola virus disease.
2
Infection control professionals should modify or adapt this table according to local conditions. To ensure that appropriate empiric precautions
are always implemented, hospitals must have systems in place to evaluate patients routinely according to these criteria as part of their
preadmission and admission care.
3
Patients with the syndromes or conditions listed below may present with atypical signs or symptoms. The clinician’s index of suspicion should
be guided by the prevalence of specific conditions in the community, as well as clinical judgment.
4
The organisms listed under the column “Potential Pathogens” are not intended to represent the complete, or even most likely, diagnoses, but
rather possible etiologic agents that require additional precautions beyond Standard Precautions until they can be ruled out.
1
42
�Appendix B
OSHA Assigned Protection Factors1, 2
Helmet/
hood
Loosefitting
facepiece
25/1,000
25
25/1,000
25
Half mask
Full
facepiece
10
50
50
1,000
• Demand mode
10
50
• Continuous flow mode
50
1,000
• Pressure-demand or other
positive-pressure mode
50
1,000
10
50
50
10,000
10,000
Type of respirator3, 4
Air-Purifying Respirator
Powered Air-Purifying
Respirator (PAPR)
Quarter
mask
5
5
6
Supplied-Air Respirator (SAR) or
Airline Respirator
6
Self-Contained Breathing
Apparatus (SCBA)
• Demand mode
• Pressure-demand or other
positive-pressure mode
(e.g., open/closed circuit)
These APFs do not apply to respirators used solely for escape. For escape respirators used in association with specific substances covered
by 29 CFR 1910 subpart Z, employers must refer to the appropriate substance-specific standards in that subpart. Escape respirators for other
immediately dangerous to life or health atmospheres are specified in 29 CFR 1910.134 (d)(2)(ii).
2
Based on Table 1. Assigned Protection Factors in OSHA’s Respiratory Protection standard.
3
Employers may select respirators assigned for use in higher workplace concentrations of a hazardous substance for use at lower concentrations
of that substance, or when required respirator use is independent of concentration.
4
The assigned protection factors in Table 1 are only effective when the employer implements a continuing, effective respirator program as
required by this section (29 CFR 1910.134), including training, fit testing, maintenance, and use requirements.
5
This APF category includes filtering facepieces, and half masks with elastomeric facepieces.
6
The employer must have evidence provided by the respirator manufacturer that testing of these respirators demonstrates performance at a
level of protection of 1,000 or greater to receive an APF of 1,000. This level of performance can best be demonstrated by performing a Workplace
Protection Factor or Simulated Workplace Protection Factor study or equivalent testing. Absent such testing, all other PAPRs and SARs with
helmets/hoods are to be treated as loose-fitting facepiece respirators, and receive an APF of 25.
1
43
�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
Appendix C
Respiratory Protection Program
Evaluation Checklist and Instructions for Use
Yes
No
1. Is there a written policy which acknowledges employer responsibility for providing
a safe and healthful workplace?
£
£
2. Has a suitably trained individual been designated as the respirator program
administrator (RPA) with overall responsibility for development and
implementation of the respiratory protection program?
£
£
3. written designation of a program administrator;
£
£
4. an evaluation of hazards and identification of appropriate respirators for specific
job classifications and/or tasks;
£
£
5. procedures for medical evaluations of employees required to use respirators;
£
£
6. fit testing procedures for tight-fitting respirators;
£
£
7.
£
£
8. procedures and schedules for storage, inspection, cleaning, and maintenance
of respirators;
£
£
9. procedures for training employees regarding the respiratory protection program;
£
£
10. a description of the training curriculum;
£
£
11. procedures for voluntary use of respirators; and
£
£
12. procedures for regular evaluation of the program.
£
£
13. Is the written program readily available to any employee included in the program?
£
£
Does the written respiratory protection program include the following required elements?
(items 3-12)
44
procedures for proper use of respirators;
�Yes
No
14. Is there a record of medical clearance for each employee required to wear
a respirator?
£
£
15. Is there a record of a fit test or fit test screening for each respirator user within the
last year?
£
£
16. Have users been trained in the proper use, maintenance, cleaning, and inspection
of respirators?
£
£
17. Have workers been trained on the respiratory hazards to which they are potentially
exposed during routine and emergency situations?
£
£
18. Are workers prohibited from wearing respirators with a tight-fitting facepiece if
they have facial hair or other characteristics which may cause face seal leakage?
£
£
19. Are respirators stored appropriately so as to prevent them from becoming
damaged or deformed?
£
£
20. Are the users wearing the respirator for which they have passed a fit test?
£
£
21. Are N95, or more protective, respirators always worn by employees in areas
occupied by a suspected or confirmed case of airborne infectious disease?
£
£
22. Are PAPRs always worn by employees in areas where an aerosol-generating
procedure is being performed on a suspected or confirmed case of airborne
infectious disease? (An N95 respirator is the minimum level of respiratory
protection required, except in California where a PAPR is required.)
£
£
23. Are N95, or more protective, respirators always worn by employees in areas where
a high-hazard procedure is being performed on a suspected or confirmed case of
seasonal influenza?
£
£
24. Are respirators inspected by the users before each use?
£
£
25. Are respirators being put on (donned) and taken off (doffed) correctly?
£
£
26. Are respirators cleaned and disinfected as often as necessary, including before
being worn by a different individual?
£
£
27. Is there a mechanism for users to report problems with respirator use?
£
£
28. Is there a mechanism for users to provide feedback about the effectiveness of
the program?
£
£
45
�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
RPP Evaluation Checklist Instructions
This checklist should be completed and used to update any deficiencies in the program on a regular
basis. Any changes made to the program should be documented and kept on file with the written
program, which must be available to all employees. List the changes or improvements that need to be
made to the program.
1.
2.
Every employer has a legal obligation to
provide and maintain a safe and healthful
workplace for employees, according to the
Occupational Safety and Health Act of 1970.
This obligation should be stated in writing as
a reason for developing and implementing
a respiratory protection program (RPP), and
can serve as the opening paragraph of your
written RPP. If you do not have such a policy
in writing for your facility, it would be a good
idea to develop one as a preface to all of
your health and safety programs.
Asks whether management has designated
an appropriate person to be held accountable
for implementing the respiratory protection
program. The OSHA standard requires the
employer to designate a respirator program
administrator (RPA) to be “qualified by
appropriate training or experience that
is commensurate with the complexity of
the program.” The RPA should have an
understanding of the principles of respiratory
protection and of the requirements of the
OSHA Respiratory Protection standard (29 CFR
1910.134). If your RPA is not a health and safety
professional, he or she might need some
additional training to effectively carry out
their responsibilities.
The OSHA Respiratory Protection standard
(Standard) requires all employers with
employees who are required to use
respiratory protection to have a written RPP.
Items 3-12 refer to the written program.
46
Check the written RPP to be sure each of
the required elements is present and in
compliance with the Standard.
3.
One individual should be identified either
by name or job title as the RPA. If additional
people have key responsibilities for the RPP,
their names and roles may be listed as well.
4.
The employer shall select and provide
an appropriate respirator based on the
respiratory hazards to which the worker is
exposed and workplace and user factors that
affect respirator performance and reliability.
The hazard evaluation or respirator selection
section of the RPP should include a list of job
titles, tasks or both and identify the type of
respirator required for each. This should be
the general type of respirator (e.g., filtering
facepiece respirator or PAPR), not the specific
make and model.
5.
Written procedures should address how
employees are to obtain and complete
the questionnaire, who will evaluate the
questionnaire, who will do exams when
necessary, how clearance will be reported,
and how records will be kept. You may
attach or copy and paste the questionnaire
from the Standard.
6.
Written fit test procedures should address
the following questions. Who will do the fit
test? What protocol will be used? You may
copy and paste or attach the protocol from
the Standard. What will happen if someone
fails the fit test? How are records kept?
�7.
Procedures for use should include policies
for prohibition of use (e.g., facial hair),
procedures for proper use including
inspection of the respirator, seal checks,
proper technique for putting on and taking
off the respirator, etc.
8.
Procedures should address appropriate
storage, maintenance, disposal, and/or
cleaning and disinfecting of all types of
respirators used at the facility.
9.
The training section of the RPP should
include the procedures for training (e.g., who
will do it and how often).
10. The training section should also include
the training curriculum, which must
include: the hazards to which employees
are exposed; the procedures for proper use
and maintenance of respirators; and the
limitations of the respirators being used.
11. In instances when respirators are not
required by OSHA or the RPP, the Standard
allows employers to provide respirators
to employees who choose to wear them
voluntarily. When such voluntary use is
allowed, the employer must implement
written procedures to ensure that employees
are medically able to use a respirator and
that the respirator is cleaned, stored, and
maintained in such a manner that it does not
create a health hazard. These procedures are
not required for employees who only use
filtering facepiece respirators voluntarily. The
employer must also provide the voluntary
user with a copy of Appendix D, Information
for Employees Using Respirators When not
Required Under the Standard, of OSHA’s
Respiratory Protection standard.
12. Procedures for periodic evaluation of the
RPP must be in writing and must include
procedures for obtaining feedback from
employees as part of the evaluation process.
Item 13 addresses the requirement that the
written RPP must be available for review to
anyone in the program and OSHA. It may be
in a central file accessible to employees, or
it may be available in electronic format, but
users must know where to find it.
In order to answer questions 14 and 15, you
will need to pull the records on medical
evaluations and fit tests and make sure
that they are comprehensive. If records
are missing for any employees wearing
respirators, you must determine immediately
whether the records are simply missing, or
if the person has really not been evaluated
or fit tested. Any time you discover missing
records, you should rectify this immediately.
Questions 16 and 17 may also be answered
by reviewing records or observing respirator
use. You should consider either tracking
training electronically or by keeping a
physical training roster in a file so that you
can easily determine who has and has not
been trained and when training is due. If
there is anyone wearing a respirator who
has not been trained, this should also be
rectified immediately.
In order to answer questions 18-26, you
will need to go to the units and observe
the program in action. Watch carefully to
ascertain whether or not the procedures
in the written program are being followed.
If they are not, you will need to determine
whether additional training is needed or
whether your procedures should be revised.
47
�HOSPITAL RESPIRATORY PROTECTION PROGRAM TOOLKIT
Resources for Respirator Program Administrators
Items 27 and 28 address procedures for
communication and feedback that should be
in place for employees covered by the RPP.
27. Addresses whether or not there is a way for
users to report any specific problems they
are having on a day-to-day basis. Is their
model and size of respirator unavailable?
Are the straps of their filtering facepiece
respirator breaking during donning? Are
they experiencing discomfort or difficulty
breathing when wearing respirators for
48
required time periods? Are they unable to
get a good seal when they perform a seal
check? Do they know who to report these
problems to?
28. Addresses whether or not employees
are involved in the periodic evaluation of
the program. Is there a way for them to
communicate general problems or ideas for
improvement to the RPA so that appropriate
changes to the program will be considered
when the program is evaluated?
�Appendix D
Respiratory Protection Program Template for Hospitals
Use of this template does not guarantee compliance with OSHA standards, but it is meant to help hospitals fulfill
the requirement for a written respiratory protection program as one component of a comprehensive
program to protect their employees. It is important that you reference 29 CFR 1910.134, the Federal
OSHA Respiratory Protection standard, (or the equivalent state OSHA standard) for details on specific OSHA
requirements. This template is provided for public use and is not protected by copyright. You have permission to
edit and use this template as a resource in developing a written respiratory protection program for your facility.
49
�Intentionally left blank
�Instructions
This template is designed for use by personnel who have been suitably trained and charged with the
responsibility of developing and implementing a respiratory protection program (RPP) that addresses
exposure to aerosol transmissible disease (ATD) pathogens and other respiratory hazards in hospital
work environments. It is designed to be used in conjunction with the “Hospital Respiratory Protection
Program Toolkit: Resources for Respirator Program Administrators,” which provides detailed
instructions and tips for program development specifically in hospitals. Use of this template does not
guarantee compliance with OSHA standards, but it is meant to help hospitals fulfill the requirement for a
written RPP as one component of a comprehensive program to protect their employees. It is important
that you reference 29 CFR 1910.134, the Federal OSHA Respiratory Protection standard, (or the
equivalent state OSHA standard) for details on specific OSHA requirements.
Before considering the use of respirators, keep in mind that you must first implement, where feasible,
engineering, work practice and administrative controls as the means to prevent or reduce exposures,
and only look at respiratory protection as a last line of defense when exposures cannot be eliminated or
substantially reduced in frequency and duration by using these other methods.
As you prepare to develop your program, you must consider whether you will have one comprehensive
RPP for the entire hospital, which would cover all inhalation hazards, including infectious agents and
chemical exposures, or whether you will have an RPP for chemical exposures and a separate one for
exposure to infectious agents. Your decision may depend on the size of your facility and the number of
staff with exposure to various inhalation hazards. A single RPP with one program administrator is
preferred, to ensure consistency and accountability. However, if two separate RPPs and program
administrators exist to cover respirator responsibilities for chemical and infectious exposures, the
employer must ensure that overall policies are coordinated, adequate technical expertise is available for
each program, and that all aspects of both programs are effectively implemented. Keep in mind that a
respirator program encompassing chemical hazards will need to address additional issues beyond solely
addressing ATD pathogens.
The OSHA Respiratory Protection standard (29 CFR 1910.134) requires employers to include certain
policies and procedures in their RPP, but there is some flexibility in the content of those policies and
procedures. What might work well for one hospital may not work at all for another. For this reason, the
template is designed to be flexible and it is made available as an editable Microsoft Word document that
each hospital can customize to meet its specific needs. Your paramount goal is to develop a sitespecific RPP that can be effectively implemented.
There are places throughout the document where you will need to fill in a blank or change a generic
placeholder (such as ABC Hospital) to customize it to your facility. These placeholders and blanks are
always in {bold curly brackets}, so that you can find them easily and replace them with the appropriate
black text.
Use of this template does not guarantee compliance with OSHA standards, but it is meant to help hospitals fulfill the requirement
for a written respiratory protection program as one component of a comprehensive program to protect their employees. It is
important that you reference 29 CFR 1910.134, the Federal OSHA Respiratory Protection standard, (or the equivalent state OSHA
standard) for details on specific OSHA requirements. This template is provided for public use and is not protected by copyright. You
have permission to edit and use this template as a resource in developing a written respiratory protection program for your facility.
D-i
�You will also notice text enclosed in [bold, italic square brackets] in many places throughout the
document. This text gives you instructions, tips, or ideas for customizing sections that you might want
to change. Make sure to remove the red text in your final document.
Remember – this template is meant to be used as a helpful guideline for developing your RPP. You may
be able to use it with minimal modification, but you will need to change the wording or organization to
be specific to your facility and include your site-specific procedures and policies. Make sure that you
include each section that is in the template since these components are required by OSHA’s Respiratory
Protection standard (29 CFR.1910.134).
Use of this template does not guarantee compliance with OSHA standards, but it is meant to help hospitals fulfill the requirement
for a written respiratory protection program as one component of a comprehensive program to protect their employees. It is
important that you reference 29 CFR 1910.134, the Federal OSHA Respiratory Protection standard, (or the equivalent state OSHA
standard) for details on specific OSHA requirements. This template is provided for public use and is not protected by copyright. You
have permission to edit and use this template as a resource in developing a written respiratory protection program for your facility.
D-ii
�Respiratory Protection Program
{ABC Hospital}
Updated {Hospital Provide Date}
[We recommend updating the RPP annually or as necessary
to reflect changes in workplace conditions that affect respirator use.]
Use of this template does not guarantee compliance with OSHA standards, but it is meant to help hospitals fulfill the requirement
for a written respiratory protection program as one component of a comprehensive program to protect their employees. It is
important that you reference 29 CFR 1910.134, the Federal OSHA Respiratory Protection standard, (or the equivalent state OSHA
standard) for details on specific OSHA requirements. This template is provided for public use and is not protected by copyright. You
have permission to edit and use this template as a resource in developing a written respiratory protection program for your facility.
D-iii
�Table of Contents
1.0
Purpose and Applicability ........................................................................................................ 1
2.0
Responsibilities........................................................................................................................ 1
2.1 Respirator Program Administrator ............................................................................................ 1
2.2 Supervisors ................................................................................................................................. 2
2.3 Employees in the Program ......................................................................................................... 2
3.0
Respirator Selection ................................................................................................................ 2
3.1 Hazard Assessment .................................................................................................................... 2
3.2 NIOSH-Certified Equipment ....................................................................................................... 3
3.3 Assignment of Respirators by Task and Location ...................................................................... 4
3.4 Updating the Hazard Assessment .............................................................................................. 4
3.5 Voluntary Use of Respirators ..................................................................................................... 4
4.0
Medical Evaluation .................................................................................................................. 4
5.0
Fit Testing ................................................................................................................................ 5
6.0
Training ................................................................................................................................... 6
7.0
Respirator Use ......................................................................................................................... 7
8.0
Storage, Reuse, Maintenance and Care of Respirators ............................................................. 8
8.1 Storage and Reuse ..................................................................................................................... 8
8.2 Inspection, Maintenance and Repairs ....................................................................................... 8
8.3 Cleaning and Disinfection .......................................................................................................... 9
9.0
Program Evaluation ................................................................................................................. 9
10.0
Recordkeeping ....................................................................................................................... 10
RPP Appendix A: Respirator Assignments by Task or Location ............................................................ 11
RPP Appendix B: Information for Voluntary Users .............................................................................. 12
RPP Appendix C: Medical Clearance Questionnaires........................................................................... 13
RPP Appendix D: Selected Fit Test Protocols ...................................................................................... 20
RPP Appendix E: User Seal Check Procedures ..................................................................................... 28
RPP Appendix F: Respirator Cleaning Procedures ............................................................................... 29
D-iv
�1.0
Purpose and Applicability
It is the policy of {ABC Hospital} to protect the health and safety of its employees by (1) eliminating hazardous
exposures where feasible; (2) using engineering and administrative controls to minimize hazardous exposures
that cannot be eliminated; and (3) using respiratory protection and other personal protective equipment
when the frequency and duration of exposures cannot be substantially reduced or eliminated.
The purpose of this respiratory protection program (RPP) is to maximize the protection afforded by
respirators when they must be used. It establishes the procedures necessary to meet the regulatory
requirements described in OSHA’s Respiratory Protection standard (29 CFR 1910.134) [Note: as the
employer, you are ultimately responsible for ensuring that is indeed the case. If applicable, replace
references to the Federal OSHA standard with your state standard.]
This program applies to all employees and contractors who are required to wear respiratory protection
due to the nature of their work at {ABC Hospital}. It applies to the use of air-purifying and air-supplying
respirators, including filtering facepiece respirators. If Self-Contained Breathing Apparatus (SCBA) are to
be used, significant additions to this RPP will be necessary to achieve compliance with 29 CFR 1910.134
requirements (see note in section 3.2).
[Note: You must provide a description of how your facility has decided to handle respiratory protection for
healthcare workers who are contractors, nursing registries, and other non-employees. Are contractors held
to their own RPP and if so, how? Via contract? How will you ensure the adequacy of their RPP? Will staff
from a temporary agency or registry be included with hospital employees in all aspects of the hospital
RPP, training, fit testing, etc., or are responsibilities divided in some way? You must have a clear policy
that ensures all healthcare workers are adequately protected and describe it in writing.]
2.0
Responsibilities
[You may choose to assign responsibilities differently than below as long as someone
is responsible for each of the components of the program]
2.1 Respirator Program Administrator
[This should be an individual (either a name or a job title or both) rather than a department or group of
administrators, and affected employees need to know who that person is.] {XXXXXX,} has been designated
as the respirator program administrator (RPA). The RPA has received appropriate training and is
knowledgeable about the requirements of the OSHA Respiratory Protection standard and all elements of the
respiratory protection program that need to be implemented to be effective. Hospital administration has the
ultimate responsibility for all aspects of this program and has given {him/her} full authority to make the
necessary decisions to ensure its success. This authority includes, but is not limited to, conducting hazard
assessments for selecting appropriate respiratory protection, purchasing the necessary equipment and
supplies, and developing and implementing the policies and procedures described in the written RPP.
Specifically, the RPA or other staff in conjunction with the RPA will, in accordance with OSHA’s Respiratory
Protection standard (29 CFR 1910.134):
Conduct a hazard assessment and select the appropriate level of respiratory protection for each
task or job title with potential exposure and record this information in the “Respirator
Assignments by Task or Location” in Appendix A of this RPP.
Develop and monitor respirator maintenance procedures.
Coordinate the purchase, maintenance, repair, and replacement of respirators.
D-1
�
Routinely evaluate the effectiveness of the RPP, with employee input, and make any necessary
changes to the program.
Provide or arrange for annual training on the use and limitations of respirators.
Ensure that medical evaluations are provided.
Ensure that annual respirator fit testing is provided.
Maintain records of respirator training, medical clearance, and fit testing as required by 29 CFR
1910.134 and 29 CFR 1910.1020.
Maintain a copy of this written RPP and program evaluations, and ensure that they are readily
accessible to anyone in the program.
2.2 Supervisors
Supervisors of employees included in the RPP will:
Participate in the hazard assessment by evaluating all potential exposures to respiratory hazards,
including exposure to chemicals and aerosol transmissible disease (ATD) pathogens, and
communicating this information to the RPA.
Identify employees and/or tasks for which respirators may be required and communicate this
information to the RPA. [This will be a shared responsibility with the RPA since the supervisor
knows the day-to-day jobs/tasks their employees do, but the RPA may have more knowledge
about respiratory protection requirements.]
Be responsible for ensuring that employees in their units follow the procedures outlined in the
RPP. Schedule employees for medical evaluations, training, and fit testing and ensure that they
are allowed to attend these appointments during work hours.
2.3 Employees in the Program
Employees assigned to jobs/tasks requiring the use of a respirator will:
3.0
Complete the required questionnaire for medical clearance and participate in a medical
examination if necessary.
Adhere to hospital policies on facial hair and respirator seal protection.
Attend annual training and respirator fit testing as required in the RPP.
Use, maintain, and dispose of respirators properly in accord with training and the procedures in
the RPP.
Respirator Selection
[You may remove any mention of types of respirators that are not used at your facility.]
3.1 Hazard Assessment
The RPA will select the types of respirators to be used by hospital staff based on the hazards to which
employees may be exposed and in accord with OSHA regulations and Centers for Disease Control and
Prevention (CDC), Healthcare Infection Control Practices Advisory Committee (HICPAC), and other public
health guidelines. With input from the respirator user, the RPA and supervisor will conduct a hazard
assessment for each task, procedure, or work area with the potential for airborne contaminants. The
hazard assessment will include the following as needed:
Identification of potential exposures. The most common potential exposure for employees involved
in patient care will be pathogens associated with ATDs such as tuberculosis. Maintenance,
housekeeping, laboratory, or other staff may have the potential to be exposed to hazardous gases,
vapors, or dusts in addition to ATD pathogens.
D-2
�
A review of work processes to determine levels of potential exposure for all tasks and locations.
Quantification or objective determination of potential exposure levels, where possible. This may
not be feasible for ATD pathogens.
3.2 NIOSH-Certified Equipment
All respiratory protective equipment shall be approved by the National Institute for Occupational Safety and
Health (NIOSH) for the configuration and environment in which it is going to be used. The NIOSH Certified
Equipment List is found at the following Internet address: www.cdc.gov/niosh/npptl/topics/respirators/cel.
The following definitions apply to equipment that may be issued to employees under this program:
Air-purifying respirators (APR) are respirators with a filter, canister, or cartridge that removes
specific air contaminants from the ambient air by passing through an air-purifying element. APRs
must have been tested and approved by NIOSH for use in specific types of contaminated
atmospheres. These respirators do not supply oxygen and therefore cannot be used to enter an
atmosphere that is oxygen-deficient.
o
Filtering facepiece respirators (FFR) are disposable, negative-pressure, air purifying
respirators where an integral part of the facepiece or the entire facepiece is made of
filtering material. These respirators are designed to be used once and then properly
disposed of. However, a FFR may be reused by the same user, under some
circumstances, as long as the respirator has not been obviously soiled or damaged (See
discussion of specific conditions in which FFR reuse may be acceptable in section 8.1).
An N95 FFR has a filter efficiency of 95% and is not resistant to oil, while a P100 FFR has
a filter efficiency of 99.97% and has a strong resistance to oil. Filters with other
combinations of filtration efficiency and oil resistance, “N”, “R” or “P”, categories are
available. [You must provide clear guidance on when FFRs will be discarded. You may
allow employees to wear the same FFR while carrying out a number of tasks, requiring it
to be discarded after it is removed; or, for infection control reasons, you may want to
have employees discard FFRs between patients.]
o
Half mask elastomeric respirators are reusable air-purifying respirators that fit over the
nose and mouth. They are made of rubber or silicone with attached cartridges or filters
for removal of gases, vapors, or dusts.
o
N95 respirator is a generally used term for a half mask negative pressure air-purifying
respirator with NIOSH-approved N95 filters or filter material (i.e., includes N95 filtering
facepiece respirator or equivalent protection).
o
Full facepiece elastomeric respirators are reusable air-purifying respirators that cover
the face from the forehead to the chin. They are made of rubber or silicone with a clear
plastic lens and have attached cartridges or filters for removal of gases, vapors, or dusts.
Powered air-purifying respirators (PAPR) are air-purifying respirators that use a blower to force
ambient air through air-purifying elements and into the respirator facepiece, helmet, or hood.
Air-supplying respirators (also known as atmosphere-supplying respirators) have a source of
breathing air that is independent from the work area and supplied to the wearer’s facepiece.
These include two main types:
o Supplied-air respirators (SARs) are connected to a free-standing cylinder of breathing
air, an air compressor, or a system piping breathing air through the building.
D-3
�o
Self-contained breathing apparatus (SCBA) are usually equipped with a full facepiece
and have a tank of breathing air worn on the back of the user, and escape respirators
which have a small supply of air designed to last a short period of time to allow the user
to leave the hazardous area. Air-supplying respirators will not be used for routine
healthcare procedures, but may be used by emergency responders. [Note: If this type of
respirator is going to be used, significant additions to this RPP will be necessary to
achieve compliance with 29 CFR 1910.134 requirements relative to air source, etc.]
3.3 Assignment of Respirators by Task and Location
The RPA will use the hazard assessment to assign appropriate types of respirators for use by specific types
of personnel during specific procedures or in specific areas of the hospital. These assignments are listed in
Appendix A of this RPP.
3.4 Updating the Hazard Assessment
The RPA will revise and update the hazard assessment any time an employee or supervisor identifies or
anticipates a new exposure or changes to existing exposures. Any employee who believes that respiratory
protection is needed during a particular activity must contact his or her supervisor or the RPA. The
supervisor must contact the RPA whenever respiratory protection is requested. The RPA will assess the
potential hazard with the employee and supervisor. If it is determined that respiratory protection is needed,
all elements of this program will be in effect for those tasks and the program will be updated accordingly.
3.5 Voluntary Use of Respirators
[You may choose whether or not to allow voluntary use. If you do not allow it, you may remove this
section of the program]
When the use of a respirator is not required by a substance-specific OSHA standard, the OSH Act or
hospital policies and the RPA has determined that its use is not necessary to protect the health of the
employee, an employee may still request to use a respirator voluntarily.
Employees using respirators voluntarily will be provided with the information in Appendix D to 29 CFR
1910.134 (Appendix B of this RPP). If they are using a respirator other than a filtering facepiece respirator,
they will also be provided initial medical clearance and required to clean, store, and maintain the
respirator as per the requirements of this RPP. Employees who choose to voluntarily use respirators
should advise their supervisor of the need to be included in the applicable sections of the respirator
program. If approved, the employees using a respirator other than a filtering facepiece respirator are
required to attend annual training provided to those in the full respirator program, as 29 CFR
1910.134(k)(1)(v) requires training in the procedures for cleaning, maintenance and storage of the
respirator. If employees voluntarily using respirators are aware of a change that warrants review of
medical clearance or repeat fit testing, they should bring that to the attention of their supervisor. [You
may choose to fit test voluntary users, but this is not required. In the hospital setting, most voluntary
use is by employees who are already included in the RPP and simply choose to wear the same type of
respirator more often than is required. In this case, procedures for voluntary use are not necessary.]
4.0
Medical Evaluation
Employees whose work activities require the use of respiratory protective equipment shall receive
medical clearance prior to the use of a respirator and prior to being fit tested for a respirator.
D-4
�Medical evaluations will be performed by a physician or other licensed health care professional (PLHCP) at
{ABC Hospital Occupational Health Clinic}. [This can be the hospital’s occupational employee health service
or clinic, or another provider of your choice as long as the evaluations are kept medically confidential,
conducted by an individual licensed in your state to perform such evaluations, and are provided at no cost
to the employee. To ensure the confidentiality of medical information, the medical evaluation should not be
conducted by the employee’s immediate supervisor and others in the employee’s direct line of authority.]
Before being assigned to work in an area where respirators are required, each employee will complete the
questionnaire in Appendix C of this RPP and deliver it to {ABC Hospital Occupational Health Clinic}. [Any
other questionnaire may also be used, as long as it includes the same information as the questionnaire
provided in Appendix C of the OSHA Respiratory Protection standard.] Employees may also speak
directly with the PLHCP if they have questions. The PLHCP will be provided with a copy of the RPP,
information from the RPA about the type of respiratory protection to be used by employees, duration and
frequency of respirator use, expected physical effort, other protective equipment worn, and any expected
extremes of temperature or humidity.
The PLHCP will review completed questionnaires and make a medical determination as to whether the
employee can wear a respirator safely. The PLHCP may make this determination based on the
questionnaire alone, but may also require a physical examination of the employee and any tests,
consultations, or procedures the PLHCP deems are necessary. The PLHCP will provide a written
recommendation to the employer, which may clear the employee for all respirator use, or may specify
restrictions or limitations on use, such as the type of respirator that may be worn, the duration that it may
be worn, and the acceptable level of exertion while wearing the respirator. A copy of this written
determination shall also be provided by the PLHCP to the employee.
An additional medical evaluation is required when:
5.0
The employee reports medical signs or symptoms that are related to the ability to use a
respirator.
A PLHCP, supervisor, or the RPA requests a reevaluation.
Observations made during fit testing or program evaluation indicate a need for reevaluation
(e.g., the employee experiences claustrophobia or difficulty breathing during the fit test).
A change occurs in workplace conditions (e.g., physical work effort, protective clothing, or
temperature) that may result in a substantial increase in the physiological burden placed on an
employee wearing a respirator.
Fit Testing
Before an employee is required to use any respirator with a tight-fitting facepiece (anything except a
PAPR with loose-fitting facepiece, hood, or helmet that does not rely upon a tight-fitting facepiece-to-face
seal), she/he will be fit tested by [Insert who will be doing the fit testing. This may be your employee
health or infection control department, a unit supervisor, or an outside consultant. There is no
requirement for certification of fit testers but you must be sure that the person doing the fit testing
understands and follows the fit test protocol and understands how to train the wearer to don the
respirator properly and do a user seal check. At least 15 minutes per person will be needed to show the
employee how to put the respirator on, position it, and assess its comfort, perform the user seal check,
and complete the fit testing. Providing these instructions during fit testing is considered a review and
may not constitute the subject's formal training on respirator use.] {XXXXXX} with the same make,
model, style, and size of respirator to be used. Employees who use tight-fitting respirators are not
permitted to have facial hair that interferes with the facepiece seal or valve function.
D-5
�All employees who must wear respiratory protection shall receive medical clearance before fit testing is
performed or the respirator is worn. Fit tests will be provided at the time of initial assignment and
annually thereafter. Additional fit tests will be provided whenever the employee experiences or the
supervisor or RPA observes physical changes that could affect respirator fit. These changes include, but
are not limited to, facial scarring, dental changes, cosmetic surgery, or an obvious change in body weight.
Employees who will be using only a PAPR with loose-fitting facepiece, hood, or helmet do not need to be fit
tested. Any employee who cannot be successfully fit tested with a tight-fitting respirator may be assigned a
PAPR with a loose-fitting facepiece, hood, or helmet for all tasks requiring a respirator. [Insert your policy
here. There is flexibility here for you to formulate your own policy regarding facial hair and people who
cannot pass a fit test with any of the tight-fitting respirators you have available. Providing a PAPR may be
the simplest solution, but one that has other costs. You may require employees to be clean-shaven where
the respirator seals to the face, but you must be prepared to enforce that policy. You may also choose to
reassign employees who can’t wear tight-fitting respirators to areas without exposure.]
Employees will be offered a selection of several models and sizes of respirators from which they may
choose the one that correctly fits and is most acceptable/comfortable.
A qualitative fit test may be used for all wearers of half mask APRs, including filtering facepiece respirators
with N95 or P100 filters and elastomeric APRs. The qualitative test will follow the protocol {for saccharine
or Bitrex® solutions} [choose one and delete the other] found in Appendix A of the OSHA Respiratory
Protection standard (29 CFR 1910.134) and in Appendix D of this RPP. Another available test is the
quantitative ambient aerosol condensation nuclei counter (CNC) fit testing protocol [choose if applicable]
and can be used to replace the qualitative test [If you will be using a quantitative test, indicate the
chosen protocol from Appendix A of the OSHA standard here and in Appendix D of this RPP.]
6.0
Training
Annual respirator training will be provided for all employees covered by this program. The training will be
conducted by {XXXXXXXX} [Insert who will be doing training] and will include the following:
The general requirements of the OSHA Respiratory Protection standard.
The specific circumstances under which respirators are to be used.
Respiratory hazards to which employees are potentially exposed during routine and emergency
situations.
Why the respirator is necessary and how proper fit, usage, and maintenance can ensure the
protective effect of the respirator as well as how improper fit, usage or maintenance can
compromise the protective effect of the respirator.
The limitations and capabilities of the respirators that will be used.
How to effectively use the respirators, including emergency situations and situations in which the
respirator malfunctions.
How to inspect, put on, remove, use, and check the seals of the respirator (for tight-fitting
respirators such as N95 filtering facepiece respirators).
The procedures outlined in this program for maintenance, storage, and cleaning or disposal of
respirators. Employees who are issued PAPRs shall be instructed in procedures for charging and
maintaining the batteries, and for checking the air flow rate.
How to recognize medical signs and symptoms that may limit or prevent the effective use of
respirators.
How and when to decontaminate (or safely dispose of) a respirator that has been contaminated
with chemicals or hazardous/infectious biological materials.
D-6
�Training shall be provided at the time of initial assignment to respirator use, but before actual use, and
annually thereafter.
Additional training will be provided when there is a change in the type of respiratory protection used, or
when inadequacies in the employee's knowledge or use of the respirator indicate that he or she has not
retained the requisite understanding or skill.
The employee will also receive training during the fit testing procedure that will provide an opportunity
to handle the respirator, have it fitted properly, test its facepiece-to-face seal, wear it in normal air to
familiarize themselves with the respirator, and finally to wear it in a test atmosphere. Every respirator
wearer will receive fitting instructions, including demonstrations and practice in how the respirator should
be worn, how to adjust it, and how to perform a user seal check according to the manufacturer’s
instructions (see Appendix E of this RPP). [Generally, the hands-on training provided during fit testing
does not meet the requirements of the standard and a separate training session will be necessary.
Appendix E of this RPP currently contains mandatory Appendix B-1 of the Respiratory Protection
standard on User Seal Check Procedures. Manufacturers of filtering facepiece respirators often provide
their own recommended procedures for user seal checks. You should insert copies of the applicable
respirator manufacturers’ instructions for user seal checks in Appendix D of the RPP.]
Employees will be given the opportunity during training, annual retraining and throughout the year to
provide feedback on the effectiveness of the program and suggestions for its improvement. [The
standard requires that you get feedback from employees when evaluating your program and it makes
sense to gather the feedback at the annual training. However, you may choose some other mechanism
for obtaining feedback.]
7.0
Respirator Use
Employees will follow procedures for proper use of their respirators under conditions specified by this
program and in accord with the training they receive on the use of each particular model or type of
respirator. The appropriate types of respirators to be used and the exposure conditions are listed in the
respirator selection chart in Appendix A of this RPP.
Respirators relying on a tight facepiece-to-face seal must not be worn when conditions prevent a good
seal. Such conditions may be a beard, long moustache, sideburns, or even razor stubble as well as scars,
other facial deformities, piercings, and temple pieces on glasses. In addition, the absence of one or both
dentures can seriously affect the fit of a facepiece.
Employees and supervisors are expected to be diligent in observing practices pertaining to ensuring the safe
use of respirators. To ensure proper protection, the wearer will perform a user seal check, in accord with
manufacturer’s instructions and the training provided at the time of fit testing, each time he or she puts on a
tight-fitting respirator. Employees who wear corrective glasses or other personal protective equipment must
wear these during their fit testing to ensure that it does not interfere with the facepiece seal.
When respirators with cartridges are used, the RPA shall determine a cartridge change schedule, which
will be included in Appendix A. Odor or taste may not be used as the primary basis for determining the
useful life of a cartridge for gases or vapors. In addition to the manufacturer’s recommendations, the
NIOSH Respirator Selection Logic and Federal OSHA Respirator e-Tool can aid in the development of a
change schedule for cartridges. [If your facility only has filtering facepiece respirators then you may
leave this out.] When filtering facepiece respirators are used, respirators should be discarded after each
use or sooner if breathing becomes difficult or if the respirator is damaged, soiled, or contaminated.
D-7
�Employees must leave the respirator use area:
8.0
To adjust their respirator if the respirator is not fitting correctly or impeding their ability to work.
To wash their face if the respirator is causing discomfort or rash.
To change the respirator, filters, cartridges, or canister elements.
To inspect the respirator if it stops functioning as intended, such as detection of vapor or gas
breakthrough, changes in breathing resistance or leakage of the facepiece (e.g., fogging of
eyeglasses).
Storage, Reuse, Maintenance and Care of Respirators
8.1 Storage and Reuse
Reusable respirators will be stored in a manner to protect them from damage, contamination, dust,
sunlight, extreme temperatures, excessive moisture, and damaging chemicals.
When caring for infectious patients, disposable filtering facepiece respirators will be discarded after each
use (i.e., patient encounter). It should be noted that Tuberculosis is not transmitted via contact and,
therefore, reuse by the same wearer in the care of the same patient is acceptable as long as the filtering
facepiece respirator is not damaged or soiled. The respirator must be discarded when it is no longer in its
original working condition, whether that condition results from contamination, structural defects, or
wear. [The RPA must describe the facility policies regarding when FFRs will be used and discarded. This
includes polices pertaining to training and procedures to reduce contact transmission and when reuse of
the FFRs by employees are allowed.] Disposable filtering facepiece respirators that will be reused in
patient care areas should be stored in a breathable container such as a paper bag labeled with the user’s
name, as per your program policy {_________________________} [e.g., in the patient’s room, etc.]
Reusable elastomeric respirators that are assigned to individual users will be cleaned and
disinfected/sterilized after use and stored at room temperature in a dry area that is protected from
exposure to hazardous contaminants in {_________________________} [e.g., employee locker, nurses’
station, etc.] as per the manufacturer’s instructions. [The respirator has to be kept in a clean
environment where it will not be damaged or contaminated].
PAPRs will be cleaned and stored after use {_______________________} [e.g., in Central Supply, at the
nurses’ station, etc.] and will be provided {to employees upon request for use during aerosol-generating
procedures being conducted on patients with suspected or confirmed airborne infectious disease or} for
use by individuals who are unable to wear a respirator with a tight-fitting facepiece. PAPRs must be stored
at room temperature in a dry area that is protected from exposure to hazardous contaminants as per the
manufacturer’s instructions [Edit this section to describe when PAPRs will be provided in your facility.]
8.2 Inspection, Maintenance and Repairs
All respirators will be inspected by the user prior to each use. Inspections should include a check of:
Condition of the various parts including, but not limited to, the facepiece, head straps, valves,
and cartridges, canisters, or filters.
All rubber or plastic parts, for pliability and signs of deterioration.
PAPR connecting tubes or hoses, air flow, and batteries.
Any defective respirators shall be removed from service. Defective disposable respirators will be
discarded and replaced. Defective reusable respirators will be turned in to {XXXXXX} [specify who] for
repair, adjustment, or disposal.
D-8
�{XXXXXX} [specify who] is responsible for charging and maintaining PAPR pumps, filters, and batteries
when they are stored or not in use.
Filters on reusable particulate respirators will be changed by the wearer whenever it becomes difficult to
breathe. [Note: If you include the use of respirators with chemical cartridges in this RPP, you will need to
add language about the schedule for changing cartridges and process of removal,
cleaning/disinfection/sterilization, and storage.]
For respirators maintained for emergency use, {XXXXXXX} [specify who] must:
Keep respirators accessible to the work area.
Store respirators in such a manner as to be clearly marked for emergency use.
Store respirators in accordance with any applicable manufacturer instructions.
Inspect respirators at least monthly and in accordance with the manufacturer’s
recommendations.
Check for proper function before and after each use.
Certify the respirator with documentation of date of inspection, inspector name/signature,
findings, remedial action taken if necessary, and serial number.
Provide certification information on a tag or label kept with the respirator or included in
inspection reports stored as paper or electronic files.
8.3 Cleaning and Disinfection
Reusable respirators will be cleaned with mild soap and warm water and air dried before storing in a plastic
bag for reuse, as described in Appendix F of this RPP (which is mandatory Appendix B-2 of the Respiratory
Protection standard [Note: If the manufacturer of your PAPRs has additional instructions for
cleaning/disinfection/sterilization procedures, you should also include them here].
Reusable respirators issued for the exclusive use of an employee will be cleaned and disinfected {by the
user} [change this if your facility has a procedure for centralized respirator cleaning] as often as
necessary to maintain a sanitary condition.
Reusable respirators used in fit testing and training will be cleaned and disinfected after each use.
9.0
Program Evaluation
The RPA will conduct a periodic evaluation of the RPP to ensure that all aspects of the program meet the
requirements of the OSHA Respiratory Protection standard and that the RPP is being implemented
effectively to protect employees from respiratory hazards. This evaluation will be done
{_________________________} [How often? Some recommend at least annually, but the requirement is
“as necessary.” State your procedure here.]
Program evaluation will include, but is not limited to: [Program evaluation is required by the standard,
but there are no rules regarding how you will evaluate, so you may choose alternatives to what is
described below.]
A review of the written program.
Completion of a program evaluation checklist based on observations of workplace practices.
A review of feedback obtained from employees (to include respirator fit, selection, use, and
maintenance issues) that will be collected during the annual training session. [Add other
program evaluation methods if used at your facility.]
D-9
�The RPP will be revised as necessary and records of revisions will be kept on file with the written program.
Any procedural changes that are implemented as a result of program evaluation will be communicated to
the employees and reinforced by their supervisors.
10.0
Recordkeeping
The RPA will ensure that the following records are maintained:
Personnel medical records such as medical clearance to wear a respirator shall be retained by
{XXXXXXXXX} [specify who and where stored] as part of a confidential medical record. Medical
clearance records must be made available in accord with the OSHA Access to Employee Exposure
and Medical Records standard (29 CFR 1910.1020), and maintained for a minimum of thirty (30)
years after an employee’s separation or termination.
Documentation of training and fit testing will be kept by {XXXXXXXXX} [specify who and where
stored] until the next training or fit test.
A copy of this RPP and records of program evaluations and revisions shall be kept by
{XXXXXXXXX} [specify who and where stored] and made available to all affected employees,
their representatives, and representatives of OSHA upon request.
D-10
�RPP Appendix A: Respirator Assignments by Task or Location
[Adapt as needed for tasks and exposures in your facility]
Task or Location
Performing aerosol-generating procedures on patients
suspected or confirmed with a disease requiring
Airborne Precautions or present when such
procedures are performed [see HICPAC 2007 or other
public health guidance for lists of diseases], including:
Potential
Exposure
Infectious
aerosols
Respiratory Protection
N95 respirator or a more
protective respirator (such
as a PAPR)
[Note: your facility may
choose to specify PAPR use
(more protective than an
N95 respirator) for
aerosol-generating
procedures on a patient
with a disease requiring
Airborne Precautions]
{Sputum induction}
{Bronchoscopy}
{Aerosolized administration of medications}
{Pulmonary function testing}
{Other clinical procedures that may aerosolize
infectious agents} [Name them for your facility either
here or in your infection control plan.]
Performing aerosol-generating procedures on patients
suspected or confirmed with influenza cases or
present during such procedures.
Infectious
aerosols
N95 respirator or a more
protective respirator (such
as a PAPR)
Entry into airborne infection isolation room or other
area occupied by patients suspected or confirmed with
a disease requiring Airborne Precautions.
Infectious
aerosols
N95 respirator or a more
protective respirator (such
as a PAPR)
Performing, or present during, routine patient care
and support operations on a patient suspected or
confirmed with a disease requiring Airborne
Precautions.
Infectious
aerosols
N95 respirator or a more
protective respirator (such
as a PAPR)
Cleaning/decontaminating an area occupied by a
patient suspected or confirmed with a disease
requiring Airborne Precautions, or
cleaning/decontaminating such an area after a patient
has left but before the space has been adequately
ventilated.
Infectious
aerosols
N95 respirator or a more
protective respirator (such
as a PAPR)
Laboratory operations involving aerosol transmissible
disease pathogens [see HICPAC 2007 or other public
health guidance] for which the biosafety plan requires
respiratory protection [List specific operations here
and/or in your facility’s biosafety plan]
Infectious
aerosols
As specified in biosafety
plan
[List any other exposures and job tasks for which your
facility has determined the use of respiratory
protection is required; you may go beyond OSHA
requirements]
[Specify]
[Specify according to your
facility’s policy]
D-11
Employees
Included
[Specify type of
personnel, e.g.,
by job title (all
rows)]
�RPP Appendix B: Information for Voluntary Users
Appendix D to Sec. 1910.134: (Mandatory) Information for Employees
Using Respirators When Not Required Under the Standard
Respirators are an effective method of protection against designated hazards when properly selected and worn.
Respirator use is encouraged even when exposures are below the exposure limit, to provide an additional level of
comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator
itself can become a hazard to the worker. Sometimes, workers may wear respirators to avoid exposures to
hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards. If your
employer provides respirators for your voluntary use, or if you provide your own respirator, you need to take
certain precautions to be sure that the respirator itself does not present a hazard.
You should do the following:
1.
Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and
warnings regarding the respirator’s limitations.
2.
Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute
for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A
label or statement of certification should appear on the respirator or respirator packaging. It will tell you what
the respirator is designed for and how much it will protect you.
3.
Do not wear your respirator into atmospheres containing contaminants for which your respirator is not
designated to protect against. For example, a respirator designed to filter dust particles will not protect you
against gases, vapors or very small solid particles of fumes or smoke.
4.
Keep track of your respirator so that you do not mistakenly use someone else's respirator.
D-12
�RPP Appendix C: Medical Clearance Questionnaires
Appendix C to Sec. 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory)
To the employer: Answers to questions in Section 1, and to question 9 in Section 2 of Part A, do not require a
medical examination.
To the employee:
Your employer must allow you to answer the questionnaire during normal working hours, or at a time and place
that is convenient to you. To maintain your confidentiality, your employer or supervisor must not look at or review
your answers, and your employer must tell you how to deliver or send this questionnaire to the healthcare
professional who will review it.
Part A Section 1. (Mandatory) The following information must be provided by every employee who has been
selected to use any type of respirator (please print).
1.
Today's date:
2.
Your name:
3.
Your age (to nearest year):
4.
Sex (circle one): Male/Female
5.
Your height:
ft.
6.
Your weight:
lbs.
7.
Your job title:
8.
A phone number where you can be reached by the healthcare professional who reviews this questionnaire
(include the Area Code):
9.
The best time to phone you at this number:
in.
10. Has your employer told you how to contact the healthcare professional who will review this questionnaire
(circle one): Yes/No
11. Check the type of respirator you will use (you can check more than one category):
a. ___ N, R, or P disposable respirator (filter-mask, non-cartridge type only).
b. ___ Other type (for example, half- or full-facepiece type, powered-air purifying, supplied-air, self-contained
breathing apparatus).
12. Have you worn a respirator (circle one): Yes/No
If “yes,” what type(s):
D-13
�Part A. Section 2. (Mandatory) Questions 1 through 9 below must be answered by every employee who has been
selected to use any type of respirator (please circle “yes” or “no”).
YES
NO
1.
Do you currently smoke tobacco, or have you smoked tobacco in the last month?
2.
Have you ever had any of the following conditions?
a.
Seizures
b.
Diabetes (sugar disease)
c.
Allergic reactions that interfere with your breathing
d.
Claustrophobia (fear of closed-in places)
e.
Trouble smelling odors
Have you ever had any of the following pulmonary or lung problems?
a.
Asbestosis
b.
Asthma
c.
Chronic bronchitis
d.
Emphysema
e.
Pneumonia
f.
Tuberculosis
g.
Silicosis
h.
Pneumothorax (collapsed lung)
i.
Lung cancer
j.
Broken ribs
k.
Any chest injuries or surgeries
l.
Any other lung problem that you've been told about
Do you currently have any of the following symptoms of pulmonary or lung illness?
a.
Shortness of breath
b.
Shortness of breath when walking fast on level ground or walking up a slight hill or incline
c.
Shortness of breath when walking with other people at an ordinary pace on level ground
d.
Have to stop for breath when walking at your own pace on level ground
e.
Shortness of breath when washing or dressing yourself
3.
4.
D-14
�5.
6.
7.
YES
NO
f.
Shortness of breath that interferes with your job
g.
Coughing that produces phlegm (thick sputum)
h.
Coughing that wakes you early in the morning
i.
Coughing that occurs mostly when you are lying down
j.
Coughing up blood in the last month
k.
Wheezing
l.
Wheezing that interferes with your job
m. Chest pain when you breathe deeply
n.
Any other symptoms that you think may be related to lung problems
Have you ever had any of the following cardiovascular or heart problems?
a.
Heart attack
b.
Stroke
c.
Angina
d.
Heart failure
e.
Swelling in your legs or feet (not caused by walking)
f.
Heart arrhythmia (heart beating irregularly)
g.
High blood pressure
h.
Any other heart problem that you've been told about
Have you ever had any of the following cardiovascular or heart symptoms?
a.
Frequent pain or tightness in your chest
b.
Pain or tightness in your chest during physical activity
c.
Pain or tightness in your chest that interferes with your job
d.
In the past two years, have you noticed your heart skipping or missing a beat
e.
Heartburn or indigestion that is not related to eating
f.
Any other symptoms that you think may be related to heart or circulation problems
Do you currently take medication for any of the following problems?
a.
Breathing or lung problems
b.
Heart trouble
D-15
�8.
YES
NO
c.
Blood pressure
d.
Seizures
If you've used a respirator, have you ever had any of the following problems?
(If you've never used a respirator, check the following space and go to question 9. )
9.
a.
Eye irritation
b.
Skin allergies or rashes
c.
Anxiety
d.
General weakness or fatigue
e.
Any other problem that interferes with your use of a respirator
Would you like to talk to the healthcare professional who will review this questionnaire
about your answers to this questionnaire?
Questions 10 to 15 below must be answered by every employee who has been selected to use either a fullfacepiece respirator or a self-contained breathing apparatus (SCBA). For employees who have been selected to use
other types of respirators, answering these questions is voluntary.
10. Have you ever lost vision in either eye (temporarily or permanently)?
11. Do you currently have any of the following vision problems?
a.
Wear contact lenses
b.
Wear glasses
c.
Color blind
d.
Any other eye or vision problem
12. Have you ever had an injury to your ears, including a broken eardrum?
13. Do you currently have any of the following hearing problems?
a.
Difficulty hearing
b.
Wear a hearing aid
c.
Any other hearing or ear problem
14. Have you ever had a back injury?
15. Do you currently have any of the following musculoskeletal problems?
a.
Weakness in any of your arms, hands, legs, or feet
b.
Back pain
c.
Difficulty fully moving your arms and legs
D-16
�YES
NO
d.
Pain and stiffness when you lean forward or backward at the waist
e.
Difficulty fully moving your head up or down
f.
Difficulty fully moving your head side to side
g.
Difficulty bending at your knees
h.
Difficulty squatting to the ground
i.
Climbing a flight of stairs or a ladder carrying more than 25 lbs.
j.
Any other muscle or skeletal problem that interferes with using a respirator
Part B. Any of the following questions, and other questions not listed, may be added to the questionnaire at the
discretion of the healthcare professional who will review the questionnaire.
1.
2.
YES
NO
In your present job, are you working at high altitudes (over 5,000 feet) or in a place that has
lower than normal amounts of oxygen?
If “yes,” do you have feelings of dizziness, shortness of breath, pounding in your chest, or
other symptoms when you're working under these conditions?
At work or at home, have you ever been exposed to hazardous solvents, hazardous airborne
chemicals (e.g., gases, fumes, or dust), or have you come into skin contact with hazardous
chemicals?
If “yes,” name the chemicals if you know them:____________, _______________, ______________.
3.
Have you ever worked with any of the materials, or under any of the conditions, listed below?
a.
Asbestos
b.
Silica (e.g., in sandblasting)
c.
Tungsten/cobalt (e.g., grinding or welding this material)
d.
Beryllium
e.
Aluminum
f.
Coal (for example, mining)
g.
Iron
h.
Tin
i.
Dusty environments
j.
Any other hazardous exposures
If “yes,” describe these exposures: _____________________________________
D-17
�YES
NO
4.
List any second jobs or side businesses you have:
5.
List your previous occupations:
6.
List your current and previous hobbies:
7.
Have you been in the military services?
If “yes,” were you exposed to biological or chemical agents (either in training or combat)
8.
Have you ever worked on a HAZMAT team?
9.
Other than medications for breathing and lung problems, heart trouble, blood pressure, and
seizures mentioned earlier in this questionnaire, are you taking any other medications for any
reason (including over-the-counter medications)?
If “yes,” name the medications if you know them: _____________________________
10. Will you be using any of the following items with your respirator(s)?
a.
HEPA Filters
b.
Canisters (for example, gas masks)
c.
Cartridges
11. How often are you expected to use the respirator(s) (circle “yes” or “no” for all answers that
apply to you)?
a.
Escape only (no rescue)
b.
Emergency rescue only
c.
Less than 5 hours per week
d.
Less than 2 hours per day
e.
2 to 4 hours per day
f.
Over 4 hours per day
12. During the period you are using the respirator(s), is your work effort:
a.
Light (less than 200 kcal per hour)
If “yes,” how long does this period last during the average shift: ___ hrs. ___ mins.
Examples of a light work effort are sitting while writing, typing, drafting, or performing light assembly
work; or standing while operating a drill press (1-3 lbs.) or controlling machines.
b.
Moderate (200 to 350 kcal per hour)
If “yes,” how long does this period last during the average shift: ___ hrs. ___ mins.
Examples of moderate work effort are sitting while nailing or filing; driving a truck or bus in urban traffic;
standing while drilling, nailing, performing assembly work, or transferring a moderate load (about 35 lbs.)
at trunk level; walking on a level surface about 2 mph or down a 5-degree grade about 3 mph; or pushing
a wheelbarrow with a heavy load (about 100 lbs.) on a level surface.
D-18
�c.
Heavy (above 350 kcal per hour)
YES
NO
If “yes,” how long does this period last during the average shift: ___ hrs. ___ mins.
Examples of heavy work are lifting a heavy load (about 50 lbs.) from the floor to your waist or shoulder;
working on a loading dock; shoveling; standing while bricklaying or chipping castings; walking up an 8degree grade about 2 mph; climbing stairs with a heavy load (about 50 lbs.).
14. Will you be working under hot conditions (temperature exceeding 77 deg. F)?
15. Will you be working under humid conditions?
13. Will you be wearing protective clothing and/or equipment (other than the respirator) when
you're using the respirator?
If “yes,” describe this protective clothing and/or equipment:
16. Describe the work you'll be doing while you're using your respirator(s):
17. Describe any special or hazardous conditions you might encounter when you're using your respirator(s) (for
example, confined spaces, life-threatening gases):
18. Provide the following information, if you know it, for each toxic substance that you'll be exposed to when
you're using your respirator(s):
Name of first toxic substance:
Estimated maximum exposure level per shift:
Duration of exposure per shift:
Name of second toxic substance:
Estimated maximum exposure level per shift:
Duration of exposure per shift:
Name of third toxic substance:
Estimated maximum exposure level per shift:
Duration of exposure per shift:
The name of any other toxic substances that you'll be exposed to while using your respirator:
19. Describe any special responsibilities you'll have while using your respirator(s) that may affect the safety and
well-being of others (for example, rescue, security):
D-19
�RPP Appendix D: Selected Fit Test Protocols
[The protocols for qualitative fit testing with saccharin and Bitrex®, and the quantitative fit testing
using the ambient aerosol condensation nuclei counter (CNC) protocol are included. Edit this section
to include the specific fit test protocols from Appendix A of the OSHA standard that will be used at
your facility.]
Appendix A to Sec.1910.134: Fit Testing Procedures (Mandatory)
Part I. OSHA-Accepted Fit Test Protocols
A. Fit Testing Procedures--General Requirements.
The employer shall conduct fit testing using the following procedures. The requirements in this appendix apply to
all OSHA-accepted fit test methods, both QLFT and QNFT.
1. The test subject shall be allowed to pick the most acceptable respirator from a sufficient number of respirator
models and sizes so that the respirator is acceptable to, and correctly fits, the user.
2. Prior to the selection process, the test subject shall be shown how to put on a respirator, how it should be
positioned on the face, how to set strap tension and how to determine an acceptable fit. A mirror shall be available
to assist the subject in evaluating the fit and positioning of the respirator. This instruction may not constitute the
subject's formal training on respirator use, because it is only a review.
3. The test subject shall be informed that he/she is being asked to select the respirator that provides the most
acceptable fit. Each respirator represents a different size and shape, and if fitted and used properly, will provide
adequate protection.
4. The test subject shall be instructed to hold each chosen facepiece up to the face and eliminate those that
obviously do not give an acceptable fit.
5. The more acceptable facepieces are noted in case the one selected proves unacceptable; the most comfortable
mask is donned and worn at least five minutes to assess comfort. Assistance in assessing comfort can be given by
discussing the points in the following item A.6. If the test subject is not familiar with using a particular respirator,
the test subject shall be directed to don the mask several times and to adjust the straps each time to become
adept at setting proper tension on the straps.
6. Assessment of comfort shall include a review of the following points with the test subject and allowing the test
subject adequate time to determine the comfort of the respirator.
(a) Position of the mask on the nose
(b) Room for eye protection
(c) Room to talk
(d) Position of mask on face and cheeks
7. The following criteria shall be used to help determine the adequacy of the respirator fit:
(a) Chin properly placed;
D-20
�(b) Adequate strap tension, not overly tightened;
(c) Fit across nose bridge;
(d) Respirator of proper size to span distance from nose to chin;
(e) Tendency of respirator to slip;
(f) Self-observation in mirror to evaluate fit and respirator position.
8. The test subject shall conduct a user seal check, either the negative and positive pressure seal checks described in
Appendix B-1 or those recommended by the respirator manufacturer which provide equivalent protection to the
procedures in Appendix B-1. Before conducting the negative and positive pressure checks, the subject shall be told to
seat the mask on the face by moving the head from side-to-side and up and down slowly while taking in a few slow
deep breaths. Another facepiece shall be selected and retested if the test subject fails the user seal check tests.
9. The test shall not be conducted if there is any hair growth between the skin and the facepiece sealing surface,
such as stubble beard growth, beard, mustache or sideburns which cross the respirator sealing surface. Any type of
apparel which interferes with a satisfactory fit shall be altered or removed.
10. If a test subject exhibits difficulty in breathing during the tests, she or he shall be referred to a physician or
other licensed health care professional, as appropriate, to determine whether the test subject can wear a
respirator while performing her or his duties.
11. If the employee finds the fit of the respirator unacceptable, the test subject shall be given the opportunity to
select a different respirator and to be retested.
12. Exercise regimen. Prior to the commencement of the fit test, the test subject shall be given a description of the
fit test and the test subject's responsibilities during the test procedure. The description of the process shall include
a description of the test exercises that the subject will be performing. The respirator to be tested shall be worn for
at least 5 minutes before the start of the fit test.
13. The fit test shall be performed while the test subject is wearing any applicable safety equipment that may be
worn during actual respirator use which would interfere with respirator fit.
14. Test Exercises.
(a) Employers must perform the following test exercises for all fit testing methods prescribed in this appendix,
except for the CNP quantitative fit testing protocol and the CNP REDON quantitative fit testing protocol. For
these two protocols, employers must ensure that the test subjects (i.e., employees) perform the exercise
procedure specified in Part I.C.4(b) of this appendix for the CNP quantitative fit testing protocol, or the
exercise procedure described in Part I.C.(b) of this appendix for the CNP REDON quantitative fit-testing
protocol. For the remaining fit testing methods, employers must ensure that employees perform the test
exercises in the appropriate test environment in the following manner:
(1) Normal breathing. In a normal standing position, without talking, the subject shall breathe normally.
(2) Deep breathing. In a normal standing position, the subject shall breathe slowly and deeply, taking
caution so as not to hyperventilate.
(3) Turning head side to side. Standing in place, the subject shall slowly turn his/her head from side to side
between the extreme positions on each side. The head shall be held at each extreme momentarily so the
subject can inhale at each side.
D-21
�(4) Moving head up and down. Standing in place, the subject shall slowly move his/her head up and down.
The subject shall be instructed to inhale in the up position (i.e., when looking toward the ceiling).
(5) Talking. The subject shall talk out loud slowly and loud enough so as to be heard clearly by the test
conductor. The subject can read from a prepared text such as the Rainbow Passage, count backward from
100, or recite a memorized poem or song.
Rainbow Passage
When the sunlight strikes raindrops in the air, they act like a prism and form a rainbow. The rainbow is a
division of white light into many beautiful colors. These take the shape of a long round arch, with its path
high above, and its two ends apparently beyond the horizon. There is, according to legend, a boiling pot of
gold at one end. People look, but no one ever finds it. When a man looks for something beyond reach, his
friends say he is looking for the pot of gold at the end of the rainbow.
(6) Grimace. The test subject shall grimace by smiling or frowning. (This applies only to QNFT testing; it is
not performed for QLFT.)
(7) Bending over. The test subject shall bend at the waist as if he/she were to touch his/her toes. Jogging
in place shall be substituted for this exercise in those test environments such as shroud type QNFT or
QLFT units that do not permit bending over at the waist.
(8) Normal breathing. Same as exercise (1).
(b) Each test exercise shall be performed for one minute except for the grimace exercise which shall be
performed for 15 seconds. The test subject shall be questioned by the test conductor regarding the comfort of
the respirator upon completion of the protocol. If it has become unacceptable, another model of respirator
shall be tried. The respirator shall not be adjusted once the fit test exercises begin. Any adjustment voids the
test, and the fit test must be repeated.
B. Qualitative Fit Test (QLFT) Protocols
1. General
(a) The employer shall ensure that persons administering QLFT are able to prepare test solutions, calibrate
equipment and perform tests properly, recognize invalid tests, and ensure that test equipment is in proper
working order.
(b) The employer shall ensure that QLFT equipment is kept clean and well maintained so as to operate within
the parameters for which it was designed.
2. Isomayl Acetate Protocol (omitted - rarely used)
3. Irritant Smoke (omitted - rarely used)
4. Saccharin Solution Aerosol Protocol
The entire screening and testing procedure shall be explained to the test subject prior to conducting the screening test.
(a) Taste threshold screening. The saccharin taste threshold screening, performed without wearing a
respirator, is intended to determine whether the individual being tested can detect the taste of saccharin.
D-22
�(1) During threshold screening as well as during fit testing, subjects shall wear an enclosure about the
head and shoulders that is approximately 12 inches in diameter by 14 inches tall with at least the front
portion clear and that allows free movements of the head when a respirator is worn. An enclosure
substantially similar to the 3M hood assembly, parts # FT 14 and # FT 15 combined, is adequate.
(2) The test enclosure shall have a 3/4-inch (1.9 cm) hole in front of the test subject's nose and mouth
area to accommodate the nebulizer nozzle.
(3) The test subject shall don the test enclosure. Throughout the threshold screening test, the test subject
shall breathe through his/her slightly open mouth with tongue extended. The subject is instructed to
report when he/she detects a sweet taste.
(4) Using a DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent, the test conductor shall
spray the threshold check solution into the enclosure. The nozzle is directed away from the nose and
mouth of the person. This nebulizer shall be clearly marked to distinguish it from the fit test solution
nebulizer.
(5) The threshold check solution is prepared by dissolving 0.83 gram of sodium saccharin USP in 100 ml of
warm water. It can be prepared by putting 1 ml of the fit test solution (see (b)(5) below) in 100 ml of
distilled water.
(6) To produce the aerosol, the nebulizer bulb is firmly squeezed so that it collapses completely, then
released and allowed to fully expand.
(7) Ten squeezes are repeated rapidly and then the test subject is asked whether the saccharin can be
tasted. If the test subject reports tasting the sweet taste during the ten squeezes, the screening test is
completed. The taste threshold is noted as ten regardless of the number of squeezes actually completed.
(8) If the first response is negative, ten more squeezes are repeated rapidly and the test subject is again
asked whether the saccharin is tasted. If the test subject reports tasting the sweet taste during the second
ten squeezes, the screening test is completed. The taste threshold is noted as twenty regardless of the
number of squeezes actually completed.
(9) If the second response is negative, ten more squeezes are repeated rapidly and the test subject is
again asked whether the saccharin is tasted. If the test subject reports tasting the sweet taste during the
third set of ten squeezes, the screening test is completed. The taste threshold is noted as thirty regardless
of the number of squeezes actually completed.
(10) The test conductor will take note of the number of squeezes required to solicit a taste response.
(11) If the saccharin is not tasted after 30 squeezes (step 10), the test subject is unable to taste saccharin
and may not perform the saccharin fit test.
Note to subsection 3. (a): If the test subject eats or drinks something sweet before the screening test,
he/she may be unable to taste the weak saccharin solution.
(12) If a taste response is elicited, the test subject shall be asked to take note of the taste for reference in
the fit test.
(13) Correct use of the nebulizer means that approximately 1 ml of liquid is used at a time in the nebulizer
body.
(14) The nebulizer shall get thoroughly rinsed in water, shaken dry, and refilled at least each morning and
afternoon or at least every four hours.
D-23
�(b) Saccharin solution aerosol fit test procedure.
(1) The test subject may not eat, drink (except for plain water), smoke, or chew gum for 15 minutes
before the test.
(2) The fit test uses the same enclosure described in 3.(a) above.
(3) The test subject shall don the enclosure while wearing the respirator selected in section I.A. of this
appendix. The respirator shall be properly adjusted and equipped with a particulate filter(s).
(4) A second DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent is used to spray the fit test
solution into the enclosure. This nebulizer shall be clearly marked to distinguish it from the screening test
solution nebulizer.
(5) The fit test solution is prepared by adding 83 grams of sodium saccharin to 100 ml of warm water.
(6) As before, the test subject shall breathe through the slightly open mouth with tongue extended, and
report if he/she tastes the sweet taste of saccharin.
(7) The nebulizer is inserted into the hole in the front of the enclosure and an initial concentration of
saccharin fit test solution is sprayed into the enclosure using the same number of squeezes (either 10, 20
or 30 squeezes) based on the number of squeezes required to elicit a taste response as noted during the
screening test. A minimum of 10 squeezes is required.
(8) After generating the aerosol, the test subject shall be instructed to perform the exercises in section
I.A.14. of this appendix.
(9) Every 30 seconds the aerosol concentration shall be replenished using one half the original number of
squeezes used initially (e.g., 5, 10, or 15).
(10) The test subject shall indicate to the test conductor if at any time during the fit test the taste of
saccharin is detected. If the test subject does not report tasting the saccharin, the test is passed.
(11) If the taste of saccharin is detected, the fit is deemed unsatisfactory and the test is failed. A different
respirator shall be tried and the entire test procedure is repeated (taste threshold screening and fit testing).
(12) Since the nebulizer has a tendency to clog during use, the test operator must make periodic checks of the
nebulizer to ensure that it is not clogged. If clogging is found at the end of the test session, the test is invalid.
5. Bitrex® (Denatonium Benzoate) Solution Aerosol Qualitative Fit Test Protocol.
The Bitrex® (Denatonium benzoate) solution aerosol QLFT protocol uses the published saccharin test protocol
because that protocol is widely accepted. Bitrex® is routinely used as a taste aversion agent in household liquids
which children should not be drinking and is endorsed by the American Medical Association, the National Safety
Council, and the American Association of Poison Control Centers. The entire screening and testing procedure shall
be explained to the test subject prior to the conduct of the screening test.
D-24
�(a) Taste Threshold Screening.
The Bitrex® taste threshold screening, performed without wearing a respirator, is intended to determine
whether the individual being tested can detect the taste of Bitrex.
(1) During threshold screening as well as during fit testing, subjects shall wear an enclosure about the
head and shoulders that is approximately 12 inches (30.5 cm) in diameter by 14 inches (35.6 cm) tall. The
front portion of the enclosure shall be clear from the respirator and allow free movement of the head
when a respirator is worn. An enclosure substantially similar to the 3M hood assembly, parts #14 and #15
combined, is adequate.
(2) The test enclosure shall have a 3/4 inch (1.9 cm) hole in front of the test subject's nose and mouth
area to accommodate the nebulizer nozzle.
(3) The test subject shall don the test enclosure. Throughout the threshold screening test, the test subject
shall breathe through his or her slightly open mouth with tongue extended. The subject is instructed to
report when he/she detects a bitter taste.
(4) Using a DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent, the test conductor shall
spray the Threshold Check Solution into the enclosure. This nebulizer shall be clearly marked to
distinguish it from the fit test solution nebulizer.
(5) The Threshold Check Solution is prepared by adding 13.5 milligrams of Bitrex® to 100 ml of 5% salt
(NaCl) solution in distilled water.
(6) To produce the aerosol, the nebulizer bulb is firmly squeezed so that the bulb collapses completely,
and is then released and allowed to fully expand.
(7) An initial ten squeezes are repeated rapidly and then the test subject is asked whether the Bitrex® can
be tasted. If the test subject reports tasting the bitter taste during the ten squeezes, the screening test is
completed. The taste threshold is noted as ten regardless of the number of squeezes actually completed.
(8) If the first response is negative, ten more squeezes are repeated rapidly and the test subject is again
asked whether the Bitrex® is tasted. If the test subject reports tasting the bitter taste during the second
ten squeezes, the screening test is completed. The taste threshold is noted as twenty regardless of the
number of squeezes actually completed.
(9) If the second response is negative, ten more squeezes are repeated rapidly and the test subject is
again asked whether the Bitrex® is tasted. If the test subject reports tasting the bitter taste during the
third set of ten squeezes, the screening test is completed. The taste threshold is noted as thirty regardless
of the number of squeezes actually completed.
(10) The test conductor will take note of the number of squeezes required to solicit a taste response.
(11) If the Bitrex® is not tasted after 30 squeezes (step 10), the test subject is unable to taste Bitrex® and
may not perform the Bitrex® fit test.
(12) If a taste response is elicited, the test subject shall be asked to take note of the taste for reference in
the fit test.
(13) Correct use of the nebulizer means that approximately 1 ml of liquid is used at a time in the nebulizer
body.
(14) The nebulizer shall be thoroughly rinsed in water, shaken to dry, and refilled at least each morning
and afternoon or at least every four hours.
D-25
�(b) Bitrex® Solution Aerosol Fit Test Procedure.
(1) The test subject may not eat, drink (except plain water), smoke, or chew gum for 15 minutes before
the test.
(2) The fit test uses the same enclosure as that described in 4.(a) above.
(3) The test subject shall don the enclosure while wearing the respirator selected according to section I.A.
of this appendix. The respirator shall be properly adjusted and equipped with any type particulate filter(s).
(4) A second DeVilbiss Model 40 Inhalation Medication Nebulizer or equivalent is used to spray the fit test
solution into the enclosure. This nebulizer shall be clearly marked to distinguish it from the screening test
solution nebulizer.
(5) The fit test solution is prepared by adding 337.5 mg of Bitrex® to 200 ml of a 5% salt (NaCl) solution in
warm water.
(6) As before, the test subject shall breathe through his or her slightly open mouth with tongue extended,
and be instructed to report if he/she tastes the bitter taste of Bitrex.
(7) The nebulizer is inserted into the hole in the front of the enclosure and an initial concentration of the
fit test solution is sprayed into the enclosure using the same number of squeezes (either 10, 20 or 30
squeezes) based on the number of squeezes required to elicit a taste response as noted during the
screening test.
(8) After generating the aerosol, the test subject shall be instructed to perform the exercises in section
I.A.14. of this appendix.
(9) Every 30 seconds the aerosol concentration shall be replenished using one half the number of
squeezes used initially (e.g., 5, 10 or 15).
(10) The test subject shall indicate to the test conductor if at any time during the fit test the taste of
Bitrex® is detected. If the test subject does not report tasting the Bitrex, the test is passed.
(11) If the taste of Bitrex® is detected, the fit is deemed unsatisfactory and the test is failed. A different
respirator shall be tried and the entire test procedure is repeated (taste threshold screening and fit testing).
C. Quantitative Protocols (QNFT)
1. General
(a) The employer shall ensure that persons administering QNFT are able to calibrate equipment and perform
tests properly, recognize invalid tests, calculate fit factors properly and ensure that test equipment is in proper
working order.
(b) The employer shall ensure that QNFT equipment is kept clean, and is maintained and calibrated according
to the manufacturer’s instructions so as to operate at the parameters for which it was designed.
2.
Generated Aerosol Quantitative Fit Testing Protocol (omitted-not used)
D-26
�3.
Ambient Aerosol Condensation Nuclei Counter (CNC) Quantitative Fit Testing Protocol
(a) Portacount Fit Test Requirements.
(1) Check the respirator to make sure the sampling probe and line are properly attached to the facepiece and
that the respirator is fitted with a particulate filter capable of preventing significant penetration by the ambient
particles used for the fit test (e.g., NIOSH 42 CFR 84 series 100, series 99, or series 95 particulate filter) as per
the manufacturer's instruction.
(2) Instruct the person to be tested to don the respirator for five minutes before the fit test starts. This purges
the ambient particles trapped inside the respirator and permits the wearer to make certain the respirator is
comfortable. This individual shall already have been trained on how to wear the respirator properly.
(3) Check the following conditions for the adequacy of the respirator fit: Chin properly placed; Adequate strap
tension, not overly tightened; Fit across nose bridge; Respirator of proper size to span distance from nose to
chin; Tendency of the respirator to slip; Self-observation in a mirror to evaluate fit and respirator position.
(4) Have the person wearing the respirator do a user seal check. If leakage is detected, determine the cause.
If leakage is from a poorly fitting facepiece, try another size of the same model respirator, or another model
of respirator.
(5) Follow the manufacturer's instructions for operating the Portacount and proceed with the test.
(6) The test subject shall be instructed to perform the exercises in section I. A. 14. of this appendix.
(7) After the test exercises, the test subject shall be questioned by the test conductor regarding the comfort
of the respirator upon completion of the protocol. If it has become unacceptable, another model of respirator
shall be tried.
(b) Portacount Test Instrument.
(1) The Portacount will automatically stop and calculate the overall fit factor for the entire set of exercises.
The overall fit factor is what counts. The Pass or Fail message will indicate whether or not the test was
successful. If the test was a Pass, the fit test is over.
(2) Since the pass or fail criterion of the Portacount is user programmable, the test operator shall ensure
that the pass or fail criterion meet the requirements for minimum respirator performance in this Appendix.
(3) A record of the test needs to be kept on file, assuming the fit test was successful. The record must contain
the test subject's name; overall fit factor; make, model, style, and size of respirator used; and date tested.
4.
Controlled Negative Pressure (CNP) Quantitative Fit Test Protocol - (omitted - not used)
5.
Controlled Negative Pressure (CNP) REDON Quantitative Fit Testing Protocol - (omitted - not used)
D-27
�RPP Appendix E: User Seal Check Procedures
Appendix B-1. to Sec. 1910.134: User Seal Check Procedures (Mandatory)
The individual who uses a tight-fitting respirator is to perform a user seal check to ensure that an adequate seal is
achieved each time the respirator is put on. Either the positive and negative pressure checks listed in this
appendix, or the respirator manufacturer's recommended user seal check method shall be used. User seal checks
are not substitutes for qualitative or quantitative fit tests.
I. Facepiece Positive and/or Negative Pressure Checks.
A. Positive pressure check. Close off the exhalation valve and exhale gently into the facepiece. The face fit is
considered satisfactory if a slight positive pressure can be built up inside the facepiece without any evidence of
outward leakage of air at the seal. For most respirators this method of leak testing requires the wearer to first remove
the exhalation valve cover before closing off the exhalation valve and then carefully replacing it after the test.
B. Negative pressure check. Close off the inlet opening of the canister or cartridge(s) by covering with the palm of
the hand(s) or by replacing the filter seal(s), inhale gently so that the facepiece collapses slightly, and hold the
breath for ten seconds. The design of the inlet opening of some cartridges cannot be effectively covered with the
palm of the hand. The test can be performed by covering the inlet opening of the cartridge with a thin latex or
nitrile glove. If the facepiece remains in its slightly collapsed condition and no inward leakage of air is detected, the
tightness of the respirator is considered satisfactory.
II. Manufacturer's Recommended User Seal Check Procedures.
The respirator manufacturer's recommended procedures for performing a user seal check may be used instead of
the positive and/or negative pressure check procedures provided that the employer demonstrates that the
manufacturer's procedures are equally effective.
D-28
�RPP Appendix F: Respirator Cleaning Procedures
Appendix B-2. to Sec. 1910.134: Respirator Cleaning Procedures (Mandatory)
These procedures are provided for employer use when cleaning respirators. They are general in nature, and the
employer as an alternative may use the cleaning recommendations provided by the manufacturer of the
respirators used by their employees, provided such procedures are as effective as those listed here in Appendix B2. Equivalent effectiveness simply means that the procedures used must accomplish the objectives set forth in
Appendix B-2, i.e., must ensure that the respirator is properly cleaned and disinfected in a manner that prevents
damage to the respirator and does not cause harm to the user.
I. Procedures for Cleaning Respirators.
A. Remove filters, cartridges, or canisters. Disassemble facepieces by removing speaking diaphragms, demand and
pressure-demand valve assemblies, hoses, or any components recommended by the manufacturer. Discard or
repair any defective parts.
B. Wash components in warm (43 deg. C [110 deg. F] maximum) water with a mild detergent or with a cleaner
recommended by the manufacturer. A stiff bristle (not wire) brush may be used to facilitate the removal of dirt.
C. Rinse components thoroughly in clean, warm (43 deg. C [110 deg. F] maximum), preferably running water. Drain.
D. When the cleaner used does not contain a disinfecting agent, respirator components should be immersed for
two minutes in one of the following:
1. Hypochlorite solution (50 ppm of chlorine) made by adding approximately one milliliter of laundry bleach to one
liter of water at 43 deg. C (110 deg. F); or,
2. Aqueous solution of iodine (50 ppm iodine) made by adding approximately 0.8 milliliters of tincture of iodine (6-8
grams ammonium and/or potassium iodide/100 cc of 45% alcohol) to one liter of water at 43 deg. C (110 deg. F); or,
3. Other commercially available cleansers of equivalent disinfectant quality when used as directed, if their use is
recommended or approved by the respirator manufacturer.
E. Rinse components thoroughly in clean, warm (43 deg. C [110 deg. F] maximum), preferably running water.
Drain. The importance of thorough rinsing cannot be overemphasized. Detergents or disinfectants that dry on
facepieces may result in dermatitis. In addition, some disinfectants may cause deterioration of rubber or corrosion
of metal parts if not completely removed.
F. Components should be hand-dried with a clean lint-free cloth or air-dried.
G. Reassemble facepiece, replacing filters, cartridges, and canisters where necessary.
H. Test the respirator to ensure that all components work properly.
D-29
�Intentionally left blank
�For More Information
Contacting NIOSH
To ask questions regarding the content of this document or for more information about occupational
safety and health topics, please contact NIOSH: 1-800-CDC-INFO (1-800-232-4636); TTY: 1-888-232-6348;
e-mail: cdcinfo@cdc.gov or visit the NIOSH website at www.cdc.gov/niosh.
Contacting OSHA
To ask questions or to get more information about OSHA regulations, or to file a confidential complaint,
contact OSHA at 1-800-321-OSHA (6742) or TTY: 1-877-889-5627 or go to www.osha.gov.
DHHS (NIOSH) Publication Number 2015-117
OSHA Publication Number 3767-05 2015
�TM
U.S. Department of Labor
U.S. Department of Labor
www.osha.gov
DHHS (NIOSH) Publication Number 2015-117 | OSHA Publication Number 3767-05 2015
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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A peer reviewed publication.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on OSHA.gov. This document is in the public domain and may be freely copied or reprinted.
URL
https://www.osha.gov/publications/publication-products?publication_title=Respiratory+Protection+Program+Toolkit
Read Online
Online location of the resource.
https://www.osha.gov/sites/default/files/publications/OSHA3767.pdf
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Title
A name given to the resource
Hospital Respiratory Protection Program Toolkit
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Resources for Respirator Program Administrators.
This document was adapted from a California-specific guide, Implementing Respiratory Protection Programs in Hospitals: A Guide for Respirator Program Administrators, May 2012, which was developed by the California Department of Public Health, Occupational Health Branch, and the Public Health Institute under contract no. 254-2010-345-11 from the National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory (NIOSH-NPPTL). The guide was adapted under contract no. 254-2011-M-40839 from NIOSH-NPPTL to produce this toolkit.
Creator
An entity primarily responsible for making the resource
OSHA
Date
A point or period of time associated with an event in the lifecycle of the resource
2015-05
Relation
A related resource
Y - PPE pos 92 qualtrics 313
Y - D0.1PPE/D0.2PPE Qualtrics # 313
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
Example
Fit Testing
N95
Occupational Exposure
Personal Protective Equipment (PPE)
R-PPE
Respirator
-
https://repository.netecweb.org/files/original/933accd0939c5454fb8dd0197a71c2f6.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
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Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Jones, Rachael M., Susan C. Bleasdale, Dayana Maita, Lisa M. Brosseau, and C. D. C. Prevention Epicenters Program. 2020. "A systematic risk-based strategy to select personal protective equipment for infectious diseases." American journal of infection control 48 (1):46-51.
Abstract
<div>
<div class="sec sec-first">
<h3>Background</h3>
<p id="__p2" class="p p-first-last">Personal protective equipment (PPE) is a primary strategy to protect health care personnel (HCP) from infectious diseases. When transmission-based PPE ensembles are not appropriate, HCP must recognize the transmission pathway of the disease and anticipate the exposures to select PPE. Because guidance for this process is extremely limited, we proposed a systematic, risk-based approach to the selection and evaluation of PPE ensembles to protect HCP against infectious diseases.</p>
</div>
<div class="sec">
<h3>Methods</h3>
<p id="__p3" class="p p-first-last">The approach used in this study included the following 4 steps: (1) job hazard analysis, (2) infectious disease hazard analysis, (3) selection of PPE, and (4) evaluation of selected PPE. Selected PPE should protect HCP from exposure, be usable by HCP, and fit for purpose.</p>
</div>
<div class="sec">
<h3>Results</h3>
<p id="__p4" class="p p-first-last">The approach was demonstrated for the activity of intubation of a patient with methicillin-resistant Staphylococcus aureus or Severe Acute Respiratory Syndrome coronavirus. As expected, the approach led to the selection of different ensembles of PPE for these 2 pathogens.</p>
</div>
<div class="sec">
<h3>Discussion</h3>
<p id="__p5" class="p p-first-last">A systematic risk-based approach to the selection of PPE will help health care facilities and HCP select PPE when transmission-based precautions are not appropriate. Owing to the complexity of PPE ensemble selection and evaluation, a team with expertise in infectious diseases, occupational health, the health care activity, and related disciplines, such as human factors, should be engaged.</p>
</div>
<div class="sec sec-last">
<h3>Conclusions</h3>
<p id="__p6" class="p p-first-last">Participation, documentation, and transparency are necessary to ensure the decisions can be communicated, critiqued, and understood by HCP.</p>
</div>
</div>
<div class="sec"><strong class="kwd-title">Key Words: </strong><span class="kwd-text">Job hazard analysis, High-consequence infections, Intubation, Infection prevention, Exposure, Industrial hygiene</span></div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on journal site and PubMed Central.
URL
https://pubmed.ncbi.nlm.nih.gov/31358421/
Read Online
Online location of the resource.
https://www.ajicjournal.org/article/S0196-6553(19)30654-6/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A systematic risk-based strategy to select personal protective equipment for infectious diseases
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Personal protective equipment (PPE) is a primary strategy to protect health care personnel (HCP) from infectious diseases. When transmission-based PPE ensembles are not appropriate, HCP must recognize the transmission pathway of the disease and anticipate the exposures to select PPE. Because guidance for this process is extremely limited, we proposed a systematic, risk-based approach to the selection and evaluation of PPE ensembles to protect HCP against infectious diseases.
Creator
An entity primarily responsible for making the resource
Jones, Rachael M., Susan C. Bleasdale, Dayana Maita, and Lisa M. Brosseau, for the C. D. C. Prevention Epicenters Program.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-01
Type
The nature or genre of the resource
Publication
Relation
A related resource
Y - PPE pos 81 qualtrics 302
Y - D0.1PPE/D0.2PPE Qualtrics # 302
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Equipment and Supplies
Example
Infection Prevention and Control
Occupational Exposure
Personal Protective Equipment (PPE)
Preparedness
R-PPE
Supply Management
-
https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png
6399e3745160b9c8c9e8b00cd85fd7a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
N95 FFR Crisis Capacity strategies and flowchart
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
<p>The CDC flowchart attached to this page guides you through determining if an N95 FFR Crisis Capacity strategy is needed.<br /><br />Implementing Filtering Facepiece Respirator (FFR) Reuse, Including Reuse after Decontamination, When There Are Known Shortages of N95 Respirators.<br /><br />CDC’s Strategies for Optimizing the Supply of N95 FFRs were written to follow a continuum using the surge capacity approach in the order of <strong>conventional</strong> (everyday practice), <strong>contingency</strong> (expected shortages), and <strong>crisis </strong>(known shortages) capacities. N95 FFRs are meant to be disposed after each use. CDC developed contingency and crisis strategies to help healthcare facilities conserve their supplies in the face of shortages.</p>
<p>When the availability of N95 FFRs become limited due to an expected shortage, supplies first should be conserved using contingency strategies.</p>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-19
Contributor
An entity responsible for making contributions to the resource
2024-02-05 by J. Mundy - updated CDC link
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-09-01
2019-nCoV
CDC
Contingency and crisis capacities
Coronavirus
COVID-19
Mask
Masks
N95
R-EM
R-PPE
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Abstract
Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were assessed using an ingestible, wireless-transmission thermometer while performing patient care tasks common to a high-level isolation unit setting in powered air purifying respirator (PAPR)-level. The objective was to determine the potential for occupational health hazard due to heat stress in an environmentally controlled unit. Maximum core temperatures of the six participants ranged from 37.4 °C (99.3 °F) to 39.9 °C (103.8°F) during the 4-hr shift; core temperatures of half (n = 3) of the participants exceeded 38.5 °C (101.3 °F), the upper core temperature limit. Future investigations are needed to identify other heat stress risks both in and outside of controlled units. The ongoing COVID-19 pandemic offers unique opportunities for field-based research on risks of heat stress related to personal protective equipment in healthcare workers that can lead to both short- and long-term innovations in this field.
<p><strong class="sub-title"> Keywords: </strong> Biocontainment; Ebola; core body temperature; heat stress; protective clothing.</p>
URL
https://pubmed.ncbi.nlm.nih.gov/34383620/
Read Online
Online location of the resource.
https://www.tandfonline.com/doi/full/10.1080/15459624.2021.1949459
Citation
Citation information for the publication itself.
Herstein, J. J., A. A. Abdoulaye, K. C. Jelden, A. B. Le, E. L. Beam, S. G. Gibbs, A. L. Hewlett, A. Vasa, K. C. Boulter, T. L. Stentz, K. R. Kopocis-Herstein, W. ElRayes, C. Wichman, and J. J. Lowe. 2021. "A pilot study of core body temperatures in healthcare workers wearing personal protective equipment in a high-level isolation unit." J Occup Environ Hyg 18 (9):430-5.
Dublin Core
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Title
A name given to the resource
A pilot study of core body temperatures in healthcare workers wearing personal protective equipment in a high-level isolation unit
Subject
The topic of the resource
Personnel Management
Description
An account of the resource
Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care.
Creator
An entity primarily responsible for making the resource
Herstein JJ, Abdoulaye AA, Jelden KC, Le AB, Beam EL, Gibbs SG, Hewlett AL, Vasa A, Boulter KC, Stentz TL, Kopocis-Herstein KR, ElRayes W, Wichman C, Lowe JJ.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-08-12
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-07-13
Ebola
Example
Isolation/Biocontainment
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/eeebefea02d5333602550e607162caa9.png
81c4dcc7c31f65e87b3fb91b1c6a0565
Dublin Core
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Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2021/07/29/netec-resources-for-wearing-masks/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC Resources for Wearing Masks
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p>On July 27, the Centers for Disease Control and Prevention (CDC) updated guidance for fully vaccinated people given new evidence on the B.1.617.2 (Delta) variant of COVID-19 currently circulating in the United States. Updated mask guidelines (at the time of writing) recommend that fully vaccinated people wear a face mask in public indoor settings in areas of <a href="https://covid.cdc.gov/covid-data-tracker/#county-view" target="_blank" rel="noreferrer noopener">substantial or high transmission</a>.</p>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-07-29
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
Do not review - archived.
2019-nCoV
Archived
Blog
Coronavirus
COVID-19
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
SARS-CoV-2
-
https://repository.netecweb.org/files/original/3a22b089aa009ddf27fc2e2c3685064d.png
303c5dc3c0fad904fc8bbb5781249f36
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
NETEC. 2021. "CDC Confirms U.S. Case of Mpox." https://netec.org/2021/07/19/monkeypox-july-2021/
URL
https://netec.org/2021/07/19/monkeypox-july-2021/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
CDC Confirms U.S. Case of Mpox
Subject
The topic of the resource
Infection Control
Description
An account of the resource
NETEC recommends the “Identify, Isolate, and Inform” strategy. In this article, we provide a quick list of transmission precautions, PPE, waste, and other medical countermeasures.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-07-19
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - archive - tagged archive as is blog post
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
Do not review - archived
Archived
Blog
Healthcare Worker Safety
Infection Prevention and Control
Mpox
Occupational Exposure
Personal Protective Equipment (PPE)
R-PPE
Special Pathogens
-
https://repository.netecweb.org/files/original/675be2c02f64dc68bfb3738cc7eb9d70.png
25054111e1e8938960b522076ead75c2
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
<ul><li>To provide a review and summary of current evidence on protective effects of PPE and applicable standards, and to identify the knowledge gaps related to safety, usability, comfort and disposal of PPE.</li>
<li>To stimulate stakeholders to innovate, collaborate, design, engineer and plan for a PPE system that will increase safety and reduce the heat stress. This can be modified from current PPE already on the market or be a part of a re-imagined PPE system.</li>
<li>To serve as a guide to develop a PPE system whose parts are intentionally designed with consideration of ergonomics and human factors to fit and allow for harmonized procedures on donning and doffing PPE processes. This should result in a standardized system that will remove confusion and mistakes at the user level.</li>
</ul>
Citation
Citation information for the publication itself.
Preferred product characteristics for personal protective equipment for the health worker on the frontline responding to viral hemorrhagic fevers in tropical climates. Geneva: World Health Organization; 2018.Licence: CCBY-NC-SA3.0IGO.
URL
https://www.who.int/publications/i/item/9789241514156
Dublin Core
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Title
A name given to the resource
Preferred Product Characteristics for Personal Protective Equipment for the Health Worker on the Frontline Responding to Viral Hemorrhagic Fevers*in Tropical Climates
Subject
The topic of the resource
Infection Control
Description
An account of the resource
*Ebola, Marburg and other hemorrhagic fevers that share similar human-to-human transmission characteristics<br /><br />Guidance document. <br /><br /><div class="detail">
<div class="label"><strong>WHO Team</strong></div>
<div class="value"><span> Access to Assistive Technology and Medical Devices, </span> <span> Access to Medicines and Health Products, </span> <span> Health Product Policy and Standards, </span> <span> Medical Devices and Diagnostics<br /><br /></span></div>
</div>
<div class="detail">
<div class="label"><strong>Number of pages</strong></div>
<div class="value">37<br /><br /></div>
</div>
<div class="detail">
<div class="value">
<div><strong class="label-sm">ISBN: </strong><span>978 92 4 151415 6</span></div>
</div>
</div>
<div class="detail">
<div class="label"><strong><br />Copyright</strong></div>
<div class="value">CC BY-NC-SA 3.0 IGO</div>
</div>
Creator
An entity primarily responsible for making the resource
WHO
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-09-26
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Donning and Doffing
Ebola
Healthcare Worker Safety
Marburg
Personal Protective Equipment (PPE)
R-PPE
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/ce504e646f407de1b84afbfa3d9c4de0.png
b2149eab946126230e19368ea32dc0a9
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2021/06/30/ppe-evaluating-whats-in-your-supply/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE: Evaluating what’s in your supply
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
<h3>Facilities need to continually reevaluate usage of personal protective equipment approved under Emergency Use Authorization.</h3>
Throughout the COVID-19 pandemic there have been supply chain issues for all organizations regarding access to appropriately approved personal protective equipment (PPE). Due to these supply shortages, several emergency use authorizations (EUA) were initially granted that allowed for the usage of various PPE outside of their intended purposes, usage beyond their stated shelf-life, usage of international but not U.S. certified/approved versions, etc.<br /><br />These EUA were never intended to be long-term solutions or static, however, and have been continually changing. Many EUAs have now been repealed for a variety of reasons or have been allowed to expire. <br /><br />Those who have purchased/are purchasing PPE under EUA should continually evaluate their stock to make sure that the items they have previously purchased and are using remain under their EUA and are in compliance with their respiratory protection program and/or other occupational health and safety requirements.<br />
<h4>Read more on the NETEC blog post: <a href="https://netec.org/2021/06/30/ppe-evaluating-whats-in-your-supply/">PPE: Evaluating What’s In Your Supply</a></h4>
<h3>Some Websites with EUA approved PPE:</h3>
<ul>
<li>Personal Protective Equipment EUAs (FDA: US Food & Drug Administration): <a href="https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/personal-protective-equipment-euas" target="_blank" rel="noreferrer noopener">https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/personal-protective-equipment-euas</a></li>
<li>Emergency Use Authorization--Archived Information: Terminated or Revoked EUAs and Coronavirus Disease 2019 (COVID-19) EUA - ARCHIVED INFORMATION (FDA: US Food & Drug Administration): <a href="https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization-archived-information" target="_blank" rel="noreferrer noopener">https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization-archived-information</a></li>
<li>Public Health Emergency Determinations to Support an Emergency Use Authorization (U.S. Department of Health and Human Services): https://www.phe.gov/emergency/news/healthactions/determination/Pages/default.aspx</li>
</ul>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-06-30
Contributor
An entity responsible for making contributions to the resource
2024-01-08 by J. Mundy - a link is dead - tagged archived
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
Do not review - old blog post - tagged archived
2019-nCoV
Archived
Blog
Coronavirus
COVID-19
Personal Protective Equipment (PPE)
R-EM
R-PPE
-
Dublin Core
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Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Ridder, M. P., K. D. Paladino, J. J. Lowe, and M. E. Rupp. 2021. "A Practical Approach to Filtering Facepiece Respirator Decontamination and Reuse: Ultraviolet Germicidal Irradiation." Curr Treat Options Infect Dis:1-12.
Abstract
<div class="abstract">
<div class="abstract-content selected">
<p><strong class="sub-title"> Purpose of review: </strong> Prior outbreaks of respiratory viruses have demonstrated the need for adequate personal protective equipment (PPE) for healthcare workers, particularly filtering facepiece respirators (FFR). Due to shortfalls of PPE during the SARS CoV-2 pandemic, the need for FFR decontamination and reuse (FFR-DR) strategies is paramount. This paper aims to discuss primary decontamination strategies, with an in-depth analysis of ultraviolet germicidal irradiation (UVGI), arriving at the decontamination strategy utilized at the Nebraska Medical Center (NMC).</p>
<p><strong class="sub-title"> Methods: </strong> Review of the primary literature in regard to FFR-DR as well as a synopsis of the current protocol for FFR-DR at NMC.</p>
<p><strong class="sub-title"> Recent findings: </strong> UVGI demonstrates effective decontamination of multiple pathogens-including several human respiratory viruses-while maintaining mask integrity and filtering capacity. UVGI was associated with degradation of strap integrity at higher doses than that utilized for decontamination or with reuse beyond 20 times.</p>
<p><strong class="sub-title"> Summary: </strong> UVGI effectively decontaminates N95 FFRs without significant reduction to fit or strap integrity and can be employed as a strategy for FFR-DR in times of emergency.</p>
</div>
<p><strong class="sub-title"> Keywords: </strong> Decontamination and reuse; Filtering facepiece respirator; Microwave-generated steam; Ultraviolet germicidal irradiation; Vaporized hydrogen peroxide; Warm moist heat.</p>
</div>
<p class="copyright" id="copyright">© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.</p>
<div class="conflict-of-interest">
<h3 class="title">Conflict of interest statement</h3>
<div class="statement">
<p>Conflict of interestMark P. Ridder, Katie D. Paladino, John J. Lowe, and Mark E. Rupp declare that they have no conflicts of interest.</p>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on PubMed Central.
URL
https://pubmed.ncbi.nlm.nih.gov/33841050/
Read Online
Online location of the resource.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8023544/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A Practical Approach to Filtering Facepiece Respirator Decontamination and Reuse: Ultraviolet Germicidal Irradiation
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Prior outbreaks of respiratory viruses have demonstrated the need for adequate personal protective equipment (PPE) for healthcare workers, particularly filtering facepiece respirators (FFR). Due to shortfalls of PPE during the SARS CoV-2 pandemic, the need for FFR decontamination and reuse (FFR-DR) strategies is paramount.
Creator
An entity primarily responsible for making the resource
Ridder, M. P., K. D. Paladino, J. J. Lowe, and M. E. Rupp.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-04-06
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
2019-nCoV
Coronavirus
COVID-19
N95
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Respirator
-
https://repository.netecweb.org/files/original/18aced362e18491f53631b96468d00ce.pdf
3c63f15f52a643991ee12cd45f7f9be1
PDF Text
Text
Protege tu piel durante este invierno
La mejor estrategia de ataque comienza con una buena estrategia de defensa, especialmente cuando se trata de
proteger tu piel este invierno. La higiene de manos previene infecciones, pero la piel seca y grietada que resulta
por el lavado de manos permite con mas facilidad que las bacterias entren. La protección de la piel, combinada
con el uso de mascarillas y la practica de higiene de manos, provee un plan de ataque mas adecuado.
Cuidado de manos
Ciudado facial
Lava e hidrata tus manos con frecuencia
Humecta tu cara con frecuencia
• Utiliza cremas o aceites sin base de petróleo y
utiliza protector solar con el SPF de 30 o mas.
• Usa protector de labios sin base de petróleo y
limítate a no lamer tus labios.
• Lava tus manos con jabón y agua y
luego sécalas.
• Mientras tus manos están
húmedas, aplica cremas con base
de petróleo, pero libres de
fragancia y colorantes artificiales.
• Si usas desinfectante de manos,
deja que las manos se sequen y
luego aplica la crema hidratante.
Cuidado de piel irritada
• Si tu piel esta seca o partida, aplica crema de protección
para la piel y luego cúbrela con vendas o gazas.
• Si la irritación continua, contacta a tu doctor.
Cuidado de mascarillas o cubre bocas
• Lava tu piel frecuentemente y manten una
mascarilla adicional disponible.
• Utiliza extensiones de mascarilla para prevenir
la irritación a la parte posterior de las orejas.
• En caso de que la mascarilla o cubrebocas se
humedezca, colocala en una bolsa de papel y
deja la bolsa abierta para permitir que la
humedad se evapore.
Guía general
• Evita el contacto de productos con base de petróleo con mascaras ya que estos interfieren con la protección del cubre
bocas, además de que restringen el flujo del aire, atrapan la humedad, y producen exceso de humedad.
• Toma líquidos para mantener tu piel hidratada lo cual ayuda también con la irritación generada por el hygiene de manos, el
aire seco, y el clima en general.
• Asegúrate de incluir pausas para beber líquidos cuando uses mascarillas o cubres tu piel por un largo tiempo.
12-16-20
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Protege tu piel durante este invierno
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
This printable flyer infographic is a Spanish language version of "<a href="https://repository.netecweb.org/items/show/1447">Protect Your Skin this Winter</a>." It provides information for occupational health related to skin care during the winter months of the COVID-19 pandemic. The best offense is a good defense, especially when protecting your skin this winter. While frequent hand hygiene prevents infection, the dry, cracked skin it may leave behind makes it easy for bacteria to enter. Good skin care provides a strong offense when wearing a mask and practicing frequent hand hygiene.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-12-16
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Cleaning
Coronavirus
COVID-19
Español
Gloves
Mask
Masks
N95
Occupational Health
Public Health
R-PM
R-PPE
Spanish
-
https://repository.netecweb.org/files/original/ef06a3b90988c90ff4d97ed0711f71af.pdf
4aabc5785fd880daa5f1f2b9fb296e78
PDF Text
Text
Pasos para el uso seguro de cualquier mascarilla
Ya sea una mascarilla de papel o tela, una que utilice bandas para oreja o corbatas – sigue los siguientes
pasos para colocarla y removerla de manera segura.
Al colocar tu mascarilla
�
¡Lava tus manos o
usa desinfectante
de manos!
Coloca las bandas al
rededor de la oreja o
sujetar apropiadamente
las corbatas alrededor
de la cabeza y de la
nuca.
Confirme que la
mascarilla cobra la
nariz, la boca, y que
se extienda por
debajo de la barbilla.
Debe resultar en un
ajuste apretado.
Posicionar la mascarilla
Constatar que el ajuste
sobre el puente de la nariz sobre la cara sea firme
y ajustarla al rededor de tu
(especialmente si
cara presionando el clip
accesorios para
nasal – no pellizque.
sostener la mascarilla
son usados). También
asegurarse de sea
sencillo respirar.
Si la mascarilla será
reusada, ajustarla
firmemente va a requerir
tocar el frente.
Asegurarse de seguir la
higiene de manos.
Al quitarte tu mascarilla
�
¡Lava tus manos o
usa desinfectante
de manos!
Evite tocar los ojos,
nariz, o boca al remover
la mascarilla.
Remover la mascara
usando solo las
corbatas o bandas.
Si la mascarilla será
reusada en el futuro,
colocarla en un recipiente
transpirable.
10-15-20
Colocar mascarillas
de tela en la lavadora
o deshacerse de
mascarillas de papel.
¡Lava tus manos o
usa desinfectante
de manos!
�
Guide
Document providing operation or response information, general guidance documents.
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Pasos para el uso seguro de cualquier mascarilla
Subject
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Elementos en Español
Description
An account of the resource
This printable flyer infographic is a Spanish language version of "<a href="https://repository.netecweb.org/items/show/1360">Steps for Safe Use of Any Mask</a>." Whether your mask is cloth or paper, uses ear loops or ties - use these steps to safely put on and take off your mask.<br /><br />Ya sea una mascarilla de papel o tela, una que utilice bandas para oreja o corbatas – sigue los siguientes<br />pasos para colocarla y removerla de manera segura.
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NETEC
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2020-10-15
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2024-01-01
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Infection Prevention and Control; PPE
2019-nCoV
Coronavirus
COVID-19
Donning and Doffing
Español
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Spanish
-
https://repository.netecweb.org/files/original/670d18d8085ae21a8685cf4ece662128.pdf
da02e0517d3c7c26c9dc8ba163fbaad1
PDF Text
Text
Infection Prevention and Control and
Environmental Health and Safety for COVID-19
Isolation and Quarantine Hotels
Tailoring Existing Recommendations and Implementing Innovative Strategies
Within the Hotel Setting
December 2020
AUTHORS:
Priya Dhagat, MS, MLS(ASCP)CM, CIC
Syra Madad, DHSc, MSc, MCP
Rituparna Pati, MD, MPH
Janet Wang, BS
ACKNOWLEDGEMENTS:
Heather Papowitz, MD, MPH
Mary Fornek, RN, BSN, MBA, CIC, FAPIC
New York City Health + Hospitals/Community Care
AFFILIATES:
New York City Health + Hospitals
New York City Department of Health and Mental Hygiene
Centers for Disease Control and Prevention
�Table of Contents
I. Introduction ............................................................................................................................................................ 2
Overview ............................................................................................................................................................................. 2
Definitions ........................................................................................................................................................................... 3
II. Preparation and Planning for a Hotel Program ........................................................................................................ 3
Defining the Objective and Eligibility Criteria .................................................................................................................... 3
Developing a Team .............................................................................................................................................................. 3
III. Choosing a Hotel ................................................................................................................................................... 4
Location Considerations ..................................................................................................................................................... 4
Interior Specifications .......................................................................................................................................................... 4
IV. Physical and Environmental Health and Safety Considerations ............................................................................... 6
Safety and Security Management ....................................................................................................................................... 6
Hazardous Waste and Medical Waste Management .......................................................................................................... 6
Fire Safety ........................................................................................................................................................................... 6
V. Infection Prevention and Control Considerations: Floorplan .................................................................................... 7
Entrance and Screening....................................................................................................................................................... 7
Lobby ................................................................................................................................................................................... 7
Elevators .............................................................................................................................................................................. 8
Adapting a Floorplan and Designating Key Areas ................................................................................................................ 8
VI. Infection Prevention and Control Considerations: Clinical Operations................................................................... 10
Placement of Clients in Isolation or Quarantine ................................................................................................................ 10
Clinical Management and Services .................................................................................................................................... 10
Discontinuation of Isolation and Quarantine..................................................................................................................... 11
VII. Infection Prevention and Control Considerations: Personal Protective Equipment (PPE) and Supply ..................... 11
PPE and Transmission-based Precautions ......................................................................................................................... 11
Extended Use and Reuse of PPE ........................................................................................................................................ 12
Other Supply and Equipment ............................................................................................................................................ 12
VIII. Infection Prevention and Control Considerations: Housekeeping, Linen Management, and Food Services ........... 13
Selection of Cleaning and Disinfection Products ............................................................................................................... 13
Cleaning and Disinfection Protocols .................................................................................................................................. 13
Daily Cleaning, Terminal Cleaning, and Linen Management of Client Rooms ................................................................... 14
Food Services..................................................................................................................................................................... 14
IX. Infection Prevention and Control Considerations: Signage and Inservice Training for Hotel Staff ........................... 15
Signage .............................................................................................................................................................................. 15
Inservice Training .............................................................................................................................................................. 15
Protocols and Registers ..................................................................................................................................................... 16
X. Special Considerations for Risk Reduction Hotels .................................................................................................. 16
Appendix A: Example Checklists for Infection Prevention and Environmental Health and Safety Hotels .............................. 18
Appendix B: Example Guidance for Terminal Cleaning of Client Rooms ................................................................................ 29
Appendix C: Example Signage ................................................................................................................................................ 30
Appendix D: Guidance for Management of Clients with COVID-19 or Symptoms of COVID-19 in Risk Reduction Hotels .... 39
1
�I. Introduction
Overview
During a public health disaster or medical emergency, alternate sites may be established to care for a sudden or
projected influx of patients. In order to transform a non-traditional space into a safe area for refuge or outpatient needs,
traditional methods of patient care may need to be modified based on the population cared for and the available space
and resources.
Several types of alternate care sites, such as schools, sports arenas, or hotels, may be established to relieve strained
healthcare facilities. In the context of infectious disease emergencies, such as the COVID-19 pandemic, innovative
strategies may need to be implemented in these settings to reduce the risk of infection transmission. It is essential to
ensure that routine and standard infection prevention and control (IPC) principles and practices for alternate care settings
fit the needs of the population, space, staff, and clinical activities.
Several guidance documents offer general recommendations for alternate care sites in the context of disasters or health
emergencies, including basic IPC guidance.1 However, there is a gap of knowledge and experience in environmental health
and safety and IPC practices specifically for the hotel environment. In this document, we provide an overview of the
environmental health and safety and IPC measures implemented in the New York City COVID-19 isolation and quarantine
hotel programs. Our experience and recommendations reflect lessons learned during the early months of the COVID-19
pandemic in New York City, when many health care facilities were operating under crisis capacity and alternate care settings
such as hotels were opened to serve low acuity, ambulatory individuals who were unable to safely isolate or quarantine in
their homes. Several months into the pandemic, isolation and quarantine hotels continued to be used as part of the NYC
Test and Trace Corps to provide a space for those who were unable to safely separate at home.
This document provides a resource for infection preventionists, healthcare worker safety officers, emergency managers,
public health professionals, social workers and those involved in initial selection and set up of COVID-19 isolation or
quarantine hotels.
This document should not be used in place of any local emergency management or infection prevention plan. As with any
disaster or emergency, guidance and recommendations continually evolve. As the global community of infection
prevention specialists learns and shares more of its best practices, this document should serve as one of many different
tools to be supplemented by the most current COVID-19 guidance. Sources for additional guidance include the Centers for
Disease Control and Prevention (CDC), local and state health departments, and other emergency preparedness,
environmental health and safety, and infection prevention organizations.2,3
NYC COVID-19 Hotel Program
The NYC Hotel program consisted of a number of hotels throughout the five boroughs. It was supported by a coordinated
effort from multiple NYC agencies working in concert with the overall COVID-19 response with the following objectives:
(1) provide space for physical distancing to reduce COVID-19 transmission, (2) support and expand health system capacity
to limit morbidity and mortality and (3) mitigate challenges faced by those unable to safely physically distance at home by
providing equitable access to safe isolation and quarantine.
Hotels alleviated the burden on hospitals by providing additional space and healthcare services. Clients were assessed for
eligibility to be placed in hotels based on their mortality risk, ability to care for themselves and isolate at home,
independence with activities of daily living, and other mental and behavioral health and social criteria.
Definitions
Client: An individual who resides in an isolation or quarantine hotel.
Isolation: Separates sick people with a contagious disease from people who are not sick.4
2
�Quarantine: Separates and restricts the movement of asymptomatic persons who were exposed to a contagious disease
to see if they become sick.4
Crisis capacity: Strategies that are not commensurate with U.S. standards of care but may need to be considered during
periods of known resource shortages.5 The adaptive spaces, staff and supplies provide sufficiency of care in the setting of
a catastrophic disaster (i.e., provide the best possible care to patients given the circumstances and resources available).
Isolation and Quarantine Hotels: Utilized for laboratory-confirmed positive COVID-19 individuals regardless of symptoms
(including asymptomatic or pre-symptomatic), individuals exhibiting COVID-19 symptoms, and their exposed contacts.
These individuals either do not warrant care within a hospital setting or are recovering and no longer need care in the
hospital. Isolation and quarantine hotel rooms can be provided either in separate hotels or in the same hotel on different
floors to separate individuals that are either confirmed to be positive for COVID-19 or have been exposed to or have
symptoms of COVID-19 from those that are contacts.
Risk Reduction Hotels: Utilized for people who do not have COVID-19 or symptoms of COVID-19 but are at risk due to their
living or employment situation. Two major goals of risk reduction hotels are: (1) Reduce density in congregate settings
(e.g., supportive housing, correctional institutions, homeless shelters) or in hospitals when additional space is needed due
to a surge in COVID-19 inpatients by moving individuals to a hotel who no longer require care in the hospital but still need
to complete the course of isolation (2) Provide temporary housing for front-line essential workers in traditional health
care settings. (e.g., nurses, doctors, community-based health workers, housekeeping, environmental, administrative, and
transportation staff) to reduce the risk of exposure for members of their household.
II. Preparation and Planning for a Hotel Program
A. Defining the Objective and Eligibility Criteria
When planning for hotels to serve as alternate care sites (ACS), it is critical to establish eligibility and exclusion
criteria for the population that will be served. Potential clients may include confirmed COVID-19 positive clients with mild
or moderate symptoms, clients with CLI, contacts of COVID-19 cases, and asymptomatic individuals who need to move
from a high-risk environment such as congregate care settings, prisons, and group homes, to a lower risk environment
(see section on risk reduction hotels). The hotel program should define its population during early planning stages.
Eligibility and exclusion criteria should specify age restrictions, level of clinical acuity such as oxygen requirements, comorbidities, level of mobility, and independence with activities of daily living (ADLs).
Simultaneously, the hotel program must establish pathways for clients to access its services. For New York City Health and
Hospitals (H+H) hotels, clients could access services directly through self-referral, or they could be referred by a care
provider. Community outreach and messages in the media were essential to the success of the hotel program in NYC, to
raise awareness amongst medical providers and the public. Public messaging on the hotels can be found on the NYC
Department of Health and Mental Hygiene (DOHMH) website as well as on the NYC Health + Hospitals website.
B. Developing a Team
The selection of a hotel, protection of environmental health and safety, and continuous monitoring of IPC
practices requires a multi-disciplinary approach. Ideally, each hotel should consider designating individuals to serve on a
team that consists of:
1. Team lead – Provides oversight and direction for hotel operations. Updated and implements plans, troubleshoots
challenges and monitors progress.
3
�2. Infection prevention and control (IPC) specialist - Serves as subject matter expert on standards and best practices
of IPC and the use of personal protective equipment (PPE) within the hotel environment. Trains hotel staff,
monitors adherence to best practices and tracks exposures and new cases of infection.
3. Environmental health and safety specialist – Perform risk assessments to mitigate environmental health and
safety risks and implements standards and best practices to ensure client and staff safety. The environmental
health and safety specialist should be well-versed in principles of worker safety and environment of care.
4. Hotel manager – An employee of the hotel who serves as the liaison with the agency responsible for providing
isolation and quarantine services. The hotel manager should understand the basic principles of public health and
IPC to ensure these are systematically implemented within the hotel environment.
5. Supply and logistics – Manage procurement, delivery, storage/warehouse of supplies and monitors stocks
including burn rates and outages.
6. Partner agencies (e.g., contractors for social services and client management) – Provide direct care or support of
clients, such as health wellness checks and social services (support for housing, childcare, financial and other
support needs). Leadership of the agencies should understand and implement the basic principles of public health
and IPC and support the training and monitoring of staff under their supervision.
7. Hotel maintenance and security – Implement and monitor recommendations made by the team lead and the IPC
and environmental health and safety specialists.
8. Wraparound services (meal delivery, laundry, environmental services) - Implement and monitor the
recommendations of the IPC and environmental health and safety specialists.
This team should be in close coordination with local public health and emergency response and have direct channels of
communication with key leaders of the response who are setting the standards for IPC and environmental health and
safety.
III. Choosing a Hotel
A. Location Considerations
The specific intentions of a hotel program play an important role when considering the location of the hotel. If the hotel
program will serve to decant a sudden actual or projected influx of patients from healthcare facilities, it would be optimal
for the hotel to be near the overburdened facilities. If the hotel will be used for isolation and quarantine, it may be ideal
to have it located in communities that are most impacted or where there is a high demand for isolation and quarantine
services. The hotel should not be in any potential evacuation zones, especially during the hurricane season when hotels
may be needed as general population disaster shelters.6
B. Interior Specifications
When choosing a hotel for COVID-19 isolation or quarantine there are many factors to consider; however, a top priority is
client safety by ensuring a safe environment for care. The first step is to perform a walk-through of the hotel to assess for
the following physical specifications:
i.
Main Entrance and Floor Plan
The width of the entrance doors should be wide enough to fit a stretcher in the event emergency services are required.
Straight corridors with a clear line of site of guest doors are ideal for staff to have an unobstructed visual of all room doors
at-a-glance. The width of the guest floor corridors should be wide enough to fit a stretcher and equipment without
compromising fire safety by being able to place permissible equipment, such as supply carts and hand hygiene stations, to
one side of the corridor. Consider the total number of rooms on each floor, and of those, the number of rooms that would
be used for clients based on safe client to staff ratios; in addition, consider the number of rooms that would be used for
other purposes such as clean and soiled utility rooms. The number of client rooms per floor should be manageable and
4
�make efficient use of staff to provide a safe environment of care. Consider the of rooms with full roll-in showers to comply
with the Americans with Disabilities Act (ADA).
Additionally, the number of elevator banks for guests and service, and up to date inspection records, should be accounted
for to ensure efficient process flow. The hotel should also have meeting rooms or conference spaces for administrative
usage and storage of supplies.
ii.
Fire Safety Management
When touring or assessing a hotel, fire safety measures should be assessed and documented. Each of the following
measures should be reviewed and verified in order for a hotel to be considered a suitable site:
•
•
•
•
•
•
•
iii.
Fire alarm system is fully operational and maintenance records are up to date
Fire safety features and equipment are clearly labeled and fully operational
o Fire and smoke doors
o Patient room doors are self-closing and have positive latching
o Fire extinguishers are readily available and accessible
▪ Monthly inspections should not have any gaps
Egress paths are clearly labeled and obstruction free
The building has a sprinkler system
o Depending on age of building, some hotels may not be fully sprinklered. This is acceptable if the fire safety
plan was approved based on existing conditions and in compliance with Department of Building Certificate
of Occupancy.
Smoke and carbon monoxide alarms are present in each sleeping room
o Preventative maintenance schedule for battery changes
Fire Safety Director is on site at each shift
Hotel’s fire safety and evacuation plans were reviewed by the Safety Officer
Other Features
Other features that may be assessed include:
• Cooling tower for the HVAC system 7: Are cleaning and disinfection records up to date and compliant per state or
local requirements?
• Generator: Which utility systems does it support (elevators, emergency lighting)?
• Kitchen: Ideal for the hotel program staff to have access to kitchen to address client dietary restrictions,
preferences, and specific requests.
• Loading dock: Is this access point secured at all times?
• Roof access: Who has the ability to access the roof? It is restricted and/or monitored to prevent clients from
accessing the area?
• Parking: Is there enough available self-parking with easy access?
• Ventilation: Ensure the building ventilation systems are working properly and maintained per standard protocols
for optimal indoor air quality. Avoid using fans.
IV. Physical and Environmental Health and Safety Considerations
The following environment of care standards may be considered when planning and creating a safe environment of care
for the hotel program: Physical Safety and Security Management, Hazardous Materials and Waste, and Fire Safety
Management. Depending on the level of clinical acuity of clients, medical equipment and utilities management may need
to be explored if more advanced services such as life support, medical gas or emergency power supply systems need to be
5
�provided. Under those circumstances, planning and operational considerations must be discussed with clinical providers
and other subject matter experts within the hotel program team.
A. Safety and Security Management
To ensure safety and security, it is recommended for staff entering the hotel to wear and properly display their
identification.
Room door locks and locking mechanisms (deadbolt) may be removed in case immediate medical intervention is
necessary. To further protect client security, cameras may be installed on each floor, and designated staff members may
be stationed in each hallway to monitor and report all activities on the floor, such as unauthorized individuals entering
and exiting each client room, 24-hours a day.
Within the client room, openable windows must be assessed to ensure regulation of permissible openings per local
jurisdiction requirements, for example less than 4.5 inches in New York City.8 Any objects that could easily break and
become a sharp, such as glasses, should also be removed. Furthermore, tripping hazards must be assessed inside the
room, hallways, and throughout the hotel. Any defects or incompliance must be reported to the hotel management for
immediate correction.
B. Hazardous Materials and Medical Waste Management
Since isolation and quarantine hotels are facilities for low acuity clients, there should be little to no hazardous materials or
regulated medical waste to manage, with the exception of alcohol-based hand sanitizers, which is a highly flammable
item.9 To ensure safety, consider separating alcohol-based hand sanitizers from the other supplies and place it in an area
with little to no combustible materials in a fire rated room. Depending on the total quantity, flammable storage cabinets
may be preferred.
C. Fire Safety
Hotels are in the business of housing and providing sleeping accommodations; therefore, in general, fire safety
management is usually well maintained by the hotel management. However, it is important to assess and adhere
diligently to fire safety performance standards to ensure continuous readiness for fire and life safety systems and
equipment. This can be done by meeting with the hotel management and ensuring that all required and applicable
inspections are up-to-date and in accordance with state and local requirements. It is equally important to provide
employees with fire safety training and have them review the fire safety plan for the hotel. The plan should include:
•
•
•
•
•
•
What specific roles the staff must perform if/and when there is a smoke or fire condition
When and how to activate the fire alarm
How to contain smoke and fire
How to use a fire extinguisher
How to assist and relocate clients
How to evacuate to areas of refuse
V. Infection Prevention and Control Considerations: Floor Plan
Safety and IPC practices should be optimized throughout the hotel. All locations within the hotel should be assessed and
monitored to reduce risks of exposure and promote hand hygiene, physical distancing, use of masks, and environmental
cleaning and disinfection.
6
�A. Entrance and Screening
Screening staff and visitors for signs and symptoms of COVID-19 upon entering the hotel is a key step in preventing
exposure to disease within the hotel environment. Consider limiting, as well as designating, points of entry for specific
groups or vendors. Visitor restrictions should also be considered; if visitors are allowed, they should be documented in a
log of daily visitors with temperature and symptom screening.
A screening station at the entrance of the hotel or just within the lobby serves to monitor entry and exit from the hotel,
both from a physical safety and infection control standpoint. Clients in isolation or quarantine typically remain in their
rooms throughout their stay to reduce the risk of transmitting COVID-19. Therefore, most of the daily traffic into and out
of hotels is expected to be from hotel staff.
Screening consists of symptom checks and temperature monitoring at every entry. Standard screening questions may
include the following10:
1. Have you recently tested positive for COVID-19?
2. Have you been advised to self-quarantine because of exposure to someone who has tested positive for COVID-19,
or have you been in close contact with a COVID-19 positive person without wearing PPE?
3. Do you have new fever, cough, shortness of breath or other symptoms of illness?
4. Have you recently travelled to an area subject to travel quarantine?
If the individual answers “Yes” to any of the screening questions, then entry into the hotel may be denied. If the individual
is a hotel staff member, a supervisor or manager should be notified to guide and facilitate established protocols (e.g.,
relief from duty; self-isolation). If the individual answers “No” to the questions, a temperature check may be conducted. If
the temperature is above the established threshold, then entry to the hotel should not be permitted. All individuals
entering the hotel should wear a facemask and be reminded about physical distancing.
Staff who perform entry screening must receive training on basic principles of IPC, the PPE protocol, the screening
protocol, and how to check temperatures without exposing themselves to unnecessary risks. 11 For example, during
screening, staff could stand behind a physical barrier, such as a glass or plastic partition.
No-touch infrared thermometers should be considered; however, it is important to note that supply chain and inventory
may fluctuate, leading to different models and manufacturers of thermometers. Ensure an EPA-approved disinfectant is
available to clean and disinfect thermometers following manufactures recommendations if the thermometer requires
direct contact. Additionally, it is recommended to maintain appropriate distance between the screening station and
individual to conform to physical distancing measures. Floor markers or decals may be used to encourage physical
distancing awareness.
In addition to thermometers and EPA-approved disinfectant wipes, the screening stations should be equipped with
respiratory hygiene supplies consisting of tissues, facemasks, hand sanitizer and a waste bin. Staff at the screening station
must remind individuals to sanitize their hands and provide a facemask to anyone entering the hotel if not already
wearing one as a method of source control.
B. Lobby
The lobby space in any hotel is often a space for communal gathering. However, in an isolation or quarantine hotel, clients
should remain in their rooms as much as possible and not gather in the lobby. The lobby space should be used only by
hotel staff for specific tasks. To encourage physical distancing throughout the lobby or lounge spaced, seating may be
removed or sectioned off. If seating remains in place, ensure all seating is spaced out at least 6 feet apart and consider
establishing a routine schedule for cleaning and disinfecting any seating if used. Bar and dining areas within the hotel
lobby may also be sectioned off, unless used by hotel staff for specific tasks. If used, seating should be spaced at least 6
feet apart. Restrooms should be restricted for staff use only.
7
�To promote hand hygiene, alcohol-based hand sanitizer should be placed throughout the lobby or lounge areas, if used.
High-touch surfaces should be minimized as much as possible, including payment consoles, ATM machines, touch screens
and writing utensils. If used, these surfaces should be routinely cleaned and disinfected using an EPA-approved
disinfectant.
Culturally appropriate signage should be placed throughout all areas within the lobby that reinforce key messages about
COVID-19, physical distancing, hand hygiene, and mask use in different languages as needed. Non-essential common
areas should be marked as closed, including shops, business centers, activity rooms, gyms, pools, and guest lounges.
Appendix C contains a complete list and examples of signs to promote best practices for COVID-19 IPC in hotels.
C. Elevators
The small, enclosed space of an elevator is an area within hotels that presents a higher risk of SARS-CoV-2 transmission.
While elevator traffic should be limited in hotels where clients are expected to remain in their rooms as much as possible,
there remains a sizeable amount of traffic from staff and/or wrap-around services. The number of passengers in an
elevator at one time should be limited to ensure physical distancing, with ideally 6 feet of separation between passengers.
Elevator floors can be marked to indicate where each person should stand. Signs on every elevator bank and inside the
elevators should indicate the maximum number of passengers allowed and should reinforce the requirement to wear
facemasks. The panel of buttons and handrails inside the elevator are high-touch surfaces which require routine cleaning
and disinfection, and passengers should be reminded to perform hand hygiene after every elevator ride; alcohol-based
hand sanitizer should be available by all elevator doors.
D. Adapting a Hotel Floor and Designating Key Areas
Adapting a hotel floor to fit the needs to care for isolated and quarantined individuals requires strategic planning to
ensure basic IPC and patient safety measures are in place. The floor plan, number of available rooms, and rooms that may
be decommissioned for uses other than housing individuals must be evaluated to fit the basic standards of IPC and
environmental health and safety. An important consideration when assessing the hotel floor plan is how it compares to a
healthcare facility floorplan and what features important for IPC can be replicated in the hotel.
i.
Clean Utility Room
Ideally, each floor that will be used for clients should have dedicated utility rooms for safe storage of clean supplies,
equipment, soiled linen, and other items. All nonessential furniture and other items within the hotels rooms that will be
decommissioned for utility rooms should be removed to allow for adequate space to be utilized while limiting cross
contamination. This may include bed frames, mattresses, pillows, televisions, iron and ironing boards.
The clean utility room may be used for storage of clean and unused PPE and various medical supplies and equipment
based on patient acuity levels and care activities determined by care providers. Medical supply and equipment should be
stored appropriately. Consider storing items at least 6 inches above the floor, similar to the healthcare environment.12
Corrugated boxes should not be stored in the clean utility room.13 Supply should be well organized, spaced appropriately,
and labelled. If tables are used to hold supply, ensure supply is not stacked or placed in any manner that may damage the
physical integrity. If drawers or bins are used to hold supply, ensure supply is not overstuffed and bins are routinely
cleaned. A dedicated cart with a protective cover should be considered for linen storage, if applicable.14 Access to and use
of PPE and supply should be closely monitored or locked, especially during times of crisis capacity.
Clean utility rooms should not be used as staff break rooms. Food and drink should not be allowed into the clean utility
rooms. Ideally, personal belongings such as backpacks, purses, coats and umbrellas, should be stored in a separate and
dedicated room or area. If staff belongings must be stored in the clean utility room due to lack of easily accessible,
dedicated and secure areas, strict processes must be put in place to protect personal belongings and to limit cross
contamination.
8
�ii.
Soiled Utility Room
The soiled utility room may be used for storage of soiled linen, PPE that has already been worn and will be re-used due to
crisis capacities and supply chain shortages, and other equipment that must undergo cleaning and disinfection such as
supply carts or meal carts. In healthcare facilities, soiled utility rooms are typically negative pressure rooms, however
establishing negative pressure in a hotel room may be challenging. Therefore, the room door should remain closed and, if
possible, locked.15
All non-essential items should be removed from soiled utility rooms to maximize space. If space is still limited, then areas
within the soiled utility room should be designated and utilized for particular tasks or storage of specific items by adapting
the given space to minimize contamination.
If operating under crisis capacity, PPE for extended use and re-use may be stored in a dedicated area within the soiled
utility room or a separate designated room for reuse, if available.
iii.
Donning and Doffing Areas
In healthcare facilities, PPE is usually donned and doffed is designated areas inside or outside a patient’s room. However,
the hotel environment may have limitations in space thus requiring adaptations to donning and doffing areas on a hotel
floor. Furthermore, the hotel environment may lack equipment (e.g., separate hands washing sinks or large waste bins)
found in healthcare facilities. Therefore, it is recommended that specific separated areas are dedicated for donning and
doffing areas. If possible, they should be positioned to ensure a unidirectional flow of traffic to minimize the potential for
cross contamination. Signage can reinforce the separation of spaces and the unidirectional flow by indicating where PPE is
allowed and not allowed upon entry. See Appendix C for examples of signage.
To mimic a healthcare environment, donning PPE should be done in a clean, dedicated area away from clients. There
should be enough space in the room to adhere to physical distancing, appropriate storage of clean PPE and signage to
guide staff through the steps of donning correctly. A section of the clean utility room may be dedicated for donning clean
PPE, if a separate donning room is not available. Entry into the area for donning PPE should be strictly limited to clinical
staff. If operating under crisis capacity, access to and usage of PPE should be closely monitored.
Particular attention must be paid to assigning a designated area for doffing on every floor with individuals in isolation or
quarantine. Doffing involves the removal of PPE that may be contaminated and therefore must always be handled with
utmost care and attention. Soiled gloves should be doffed after providing care and before exiting the client’s room. Staff
should doff all other PPE in a separate room designated for doffing before entering any shared spaces, such as elevators
and stairwells and public hallways, to reduce the risk of exposure for others.
If a separate room for doffing is not available, a section of the soiled utility room may be dedicated for doffing PPE. The
section of the room for doffing may be marked by tape on the floor and signs on the walls. There should be ample room
to adhere to physical distancing, and signage to guide staff through each step of doffing correctly. Hand sanitizer should
be readily available, and hands-free trash bins should be large enough to hold disposable PPE from one shift. If operating
under crisis capacity and re-using PPE, disinfectant and tools for labeling and storing PPE must be provided and handled
with care to limit the risk of cross-contamination. PPE for extended use and re-use may be stored in a dedicated area
within the soiled utility or a separate designated room for reuse.
If space is severely limited on hotel floors and it is not possible to designate a soiled utility or doffing area on every floor,
hotel staff should design a unidirectional flow of traffic between floors to reduce the risk of cross-contamination. Ideally,
staff should doff PPE before leaving any isolation or quarantine floor. However, if that is not possible, then dedicated
stairwells or elevators may be considered to reduce cross contamination between floors.
iv
Break Areas and Documentation Areas
Areas for staff to complete administrative work and take breaks, including meals, should be separated from areas of client
traffic. Ideally, staff spaces should be on a separate “staff only” floor, where only facemasks are worn (with the exception
9
�of staff from environmental services). Trash bins should be hands-free and hand hygiene stations should be plentiful.
Mask use and physical distancing should be reinforced through the spacing of seats and workstations at least 6 feet apart.
Food and drink may be consumed in dedicated break areas.
VI. Infection Prevention and Control Considerations: Clinical Operations
A. Placement of Individuals in Isolation or Quarantine
Clients in isolation should be separated from clients in quarantine. In some settings, entire hotels have been dedicated to
either category. In other settings, hotels designate floors for isolation and other floors for quarantine. Factors to consider
in floor assignments include proximity to PPE supply and donning and doffing spaces. Isolation floors require staff to wear
all recommended PPE for COVID-19, whereas quarantine floors may require limited PPE, such as a facemask and eye
protection. Furthermore, clinical acuity and proximity to medical staff should be considered when assigning rooms and
floors to clients isolated for known or suspected COVID-19. Hotel programs can triage clients and place those at higher
risk of complications in areas of the hotel that can be quickly accessed by medical staff and that has a simple exit route in
case of the need to transfer to a facility that provides higher level care.
B. Clinical Management and Services
On-site wellness checks and clinical services may be provided to hotel clients according to the client need, acuity level,
and health risk stratification (e.g., age and chronic diseases).
Clinical services provided at the hotel may range from provider phone calls, telemedicine, in-person wellness checks,
more in-depth clinical services and health maintenance, medication management and management of medical
emergencies. Hotel programs should establish a relationship with nearby healthcare facilities or mobile testing units so
that all clients have access to COVID-19 testing and rapid turn-around of test results, if and when needed.
To reduce transmission of COVID-19 in the hotel setting, IPC practices should minimize chance of exposure, promote
standard infection control principles, and be adjusted according to level of care and transmission risk. Considerations
include:
10
•
Enforce infection control standards in the transport vehicle to and from the hotel to reduce exposure to front line
transport workers according to public health and IPC standards in transport services.16
•
Provide initial triage with clinical screening and entry screening to admit clients who require minimal medical and
personal attention, including for assisted daily living (ADL) requiring less intensive care. If a higher level of care is
needed based on initial screening, transfer to a healthcare facility may be required.
•
Outline clear expectations for clients so they are aware of clinical services provided and the IPC standards
including telemedicine, self-quarantine, self-monitoring and reporting of symptoms and self-administration of
medicines. This may include signing a document laying out the expectations of clients and enforcement of
personal and broader IPC measures during their stay in the hotel.
•
Assign hallway monitors who remain seated in client hallways to address client needs immediately and limit
unnecessary movement outside of rooms.
•
Limit face-to-face interaction while providing daily medical and wellness checks and use appropriate PPE and
public health practices (see PPE sections below) through teleservices (calls and video), remaining outside the
client’s door with appropriate distancing, allowing for the client to check their own vitals (e.g., pulse oximetry)
and self-administration and observed management of medicines.
•
Limit face-to-face interaction with medical or mental health providers through the use of telemedicine services,
and if on-site services are required attempt to support with wellness checks.
�•
Establish clear protocols for escalation of a newly symptomatic or diagnosed client (contacts in quarantine or in
risk reduction hotels) to quickly put in place source control through the use of masks, isolation of client,
environmental cleaning and use of appropriate PPE and public health measures by staff and providers.
•
Establish clear protocols for escalation for emergency management and transfer to a hospital or other care facility
including patient flow out of the hotel, transport, use of appropriate PPE for close contact with the patient and
environmental cleaning.
C. Discontinuation of Isolation and Quarantine
It is imperative to monitor public health recommendations for discontinuing isolation or quarantine. Recommendations
for individuals with mild to moderate symptoms are typically applicable to a hotel setting, however, additional
consideration for a longer time of isolation for severe, critical and immunocompromised clients should be reviewed
according to the latest public health recommendations.17 Support services, such as case management, should be engaged
early to identify discharge options for clients who may have more challenging dispositions.
VII. Infection Prevention and Control Considerations: Personal Protective
Equipment (PPE) and Supply
A. PPE and Transmission-based Precautions
Staff working in isolation or quarantine hotels must adhere to standard and transmission-based precautions when
interacting or caring for clients with suspected or confirmed COVID-19. The level of client interaction and activity may
impact the type of PPE used. The following are considerations that may be adapted based on supply availability and/or
level of interaction:
•
•
•
•
•
All staff should wear a facemask while in any area of the hotel. Cloth masks are not a replacement for PPE, such as
medical or procedural masks or respiratory protection, when required.18
Gloves should be worn when in direct contact with clients, their belongings or environment.
Based on CDC guidance at the time of publishing this document, staff working in client care areas should wear at
a minimum a mask and eye protection; this would include hall monitors or “wellness coordinators” who check on
the well-being of clients without providing hands-on care.19
Fit tested respirators are preferred over facemasks for all staff working in the client care area; however, if in short
supply, respirators should be prioritized for aerosol generating procedures, although unlikely to occur in the hotel
setting.
Gowns should be worn when providing care that requires direct client contact to prevent the transfer of
pathogens to their hand and clothing. Staff who remain outside the client’s room and thereby limit their exposure
to pathogens may not need to wear a gown. If in short supply, gowns should be prioritized for aerosol generating
procedures and high-contact care activities.20 Refer to Appendix C for COVID-19 PPE Recommendations for Hotel
Staff for a complete description of the PPE used for each cadre.
B. Extended Use and Reuse of PPE
When healthcare facilities are operating under contingency and crisis capacity, isolation and quarantine hotels are also
likely to be operating under conditions in which PPE supplies are stressed, running low, or absent. The extended use and
reuse of PPE may be appropriate in settings such as isolation and quarantine hotels where clients all have the same
infectious disease (COVID-19). Extended use and reuse must be carefully managed and monitored for each type of PPE.
The table below summarizes considerations for minimal PPE requirements and incorporates key recommendations to
11
�optimize PPE during shortages from the CDC.15 As discussed above, PPE that is being re-used should be doffed and stored
in a designated space away from clean or new PPE, in a manner that limits the risk of cross-contamination as well as selfcontamination during re-donning.
PPE
Extended and Reuse *
Facemask
All staff to wear facemask (surgical or procedure)
N95 Respirator
Staff performing or in the area of aerosol generating
procedures (AGPs) must wear a fit tested N95 respirator
or higher.
Eye Protection
Staff caring for clients or otherwise within 6 feet to wear
eye protection (e.g., goggles or face shield).
Gloves
Gloves to be used when interacting or caring for clients or
client environment (e.g., while inside client room or
handling belongings).
Gown
Gowns should be prioritized for AGPs, high-contact client
care activities or activities where splashes and sprays are
anticipated.
Facemask can be extended use as needed.21
N95 should be discarded after AGPs unless a barrier was
used to extend the use of the N95. If no AGPs were
performed, the N95 may be worn for extended use and
stored in breathable paper bags for limited reuse.
Eye protection can be extended use and reused as
needed.
For reuse, eye protection must be cleaned and
disinfected.22
Avoid extending the use and reusing gloves. Refer to
latest public health PPE guidance if operating under crisis
capacity.
Gowns should be discarded after AGPs or activities with
splashes or sprays. In the absence of AGPs, splashes or
sprays, and if operating under crisis capacity, gowns may
be worn for extended use and limited re-use; they should
be hung up for storage (e.g., wall hooks, hangers on coat
racks or shower bars); they should not be bundled or
folded and they should maintain some degree of
separation from other gowns or items.
*Any PPE that has been damaged, visibly soiled or otherwise has its integrity or fit compromised must be disposed of and
not be extended or reused.
C.
i.
Other Supply and Equipment
Hallway Supply Cart
Similar to isolation carts within a healthcare facility, supply carts may be placed within a hotel hallway, if needed. The goal
of the supply cart is to adapt the standard stationary isolation cart found in healthcare settings to fit the needs of low
acuity patient care such as temperature checks or wellness monitoring. The supplies needed for each supply cart should
be discussed with other team members to ensure appropriate processes are in place to ensure safety and adherence to
IPC practices. Examples of items stored within supply carts include:
•
•
•
•
12
PPE (clean gloves and gowns, to replace those that may get dirty)
Hand sanitizer
Disinfectant wipes
Single-use disposable patient care equipment (such as stethoscopes, if used)
�Trash bins and hand sanitizer may be placed adjacent to each supply cart to facilitate prompt glove removal and hand
hygiene between clients.
Supply carts may stay in one location on the floor or may have wheels and move with care providers as they complete
wellness checks or patient rounds. If supply carts move from one floor to another, all outer facing surfaces of the cart
should be cleaned and disinfected before it leaves the floor and enters any shared spaces, such as elevators or public
hallways. Supply carts should be considered a high-touch surface that requires routine, frequent disinfection, even if they
do not move off the floor. Mobile supply carts can be stored in the soiled utility room before disinfection, or in the clean
utility room after all surfaces and contents have been disinfected.
ii.
Hand Hygiene Stations
Frequent handwashing is a core practice of IPC. Sinks throughout the hotel must be routinely checked and resupplied with
soap and paper towels. Hand sanitizing stations should be visible and easily accessible in high traffic areas throughout the
hotel, including the front lobby and by elevator banks. Hand sanitizer with at least 60% alcohol should be readily available.
Disinfectant wipes should be strategically placed to facilitate continuous disinfection of high touch areas (e.g., at the client
intake area in case pens need to be shared at sign-in, or on the supply cart for disinfecting re-usable medical equipment).
VIII. Infection Prevention and Control Considerations: Housekeeping,
Linen Management, and Food Services
A. Selection of Cleaning and Disinfection Products
The use of EPA-approved disinfectants for use against SARS-CoV-2 for cleaning surfaces can reduce the risk of exposure to
SARS-CoV-2.23 Many products recommend keeping the surface wet for a period of time to be effective against SARS-CoV2; users should follow the instructions on the product label.
If disinfectants are in short supply, then alternative solutions with at least 70% alcohol or a mixture of water and bleach
may be used.24 Hotel staff should be trained on the safe use of disinfectants, including any necessary use of PPE.
B. Cleaning and Disinfection Protocols
The frequency of cleaning and disinfection of high touch surfaces in common areas (e.g., lobby, floor corridor, or
meeting/break rooms) should be correlated with the level of use and frequency of potential contamination. Cleaning staff
should follow written protocols to ensure standard and consistent practices. Examples of high touch surfaces include, but
are not limited to, doorknobs, elevator buttons, phones, touch screens, tables, countertops, handrails, desks, keyboards,
faucets, and sinks. Frequency of cleaning and disinfection may vary. For example, certain high touch surfaces such as
doorknobs, phones and touchscreens may require cleaning and disinfection numerous times per day, whereas other
surfaces, such as floors, may require cleaning and disinfection at least daily.25 A comprehensive cleaning and disinfection
plan that is tailored to fit the needs of the hotel program and include cleaning frequencies and persons responsible,
should be developed in consultation with subject matter experts within the hotel team.
C. Daily Cleaning, Terminal Cleaning, and Linen Management of Client Rooms
In order to limit potential COVID-19 exposure, hotel staff should consider developing a protocol for routine cleaning and
linen management, thereby limiting entry into client rooms for specific scheduled purposes, medical emergencies, or for
providing repair services. Alternatively, clients can be encouraged to clean their own rooms daily. The hotel team should
consider developing a trash collection plan and schedule to determine best practices for trash collection while limiting the
number of times staff enter the client room. Consider notifying clients of trash collection schedule and asking them to
place trash by their doorway for easy collection.
13
�Terminal cleaning of a room should be performed after the client has been discharged. Ideally, wait at least 24 hours after
the client’s departure before cleaning. If 24 hours is not feasible, wait as long as possible.17 It is critical that cleaning staff
or vendors are appropriately trained and adhere to PPE and IPC standards while performing their duties.
Terminal cleaning is typically performed in two stages: cleaning, which involves the use of soap and water or a cleaning
detergent to reduce the number of germs and impurities, followed by the use of disinfection. Soft surfaces such as
carpets or rugs, and electronics such as TVs and remote controls, require special consideration, consultation with hotel
staff, and referencing to manufacturers recommendations.
Refer to Appendix B for an example of terminal cleaning protocol for hotel rooms, based on CDC guidance for cleaning the
home.
Staff entering the client room and handling client linens or laundry should be trained on how to safely collect and handle
items and on the appropriate use of PPE. Frequency of collection of linens (and/or client laundry) should be determined
by the hotel team in consultation with the agency providing the service. The hotel team may consider instructing clients
to collect their linens and laundry and place in a washable cloth bag outside of their rooms on collection days. Linens
should be laundered according to manufacturer’s instructions. At a minimum, launder items using the warmest water
setting appropriate for the items, and dry items completely. Impermeable covers for mattresses and pillows may be
considered to ensure proper cleaning and to prevent the mattress or pillows from becoming contaminated.26
D. Food Services
The hotel team must determine the responsible entity for meal preparation, assembly, and distribution. Staff designated
for these tasks must receive education on the basic principles of IPC and food safety. Specific dietary needs for clients may
be evaluated in consultation with external partners.
Pre-prepared meal boxes may be considered for clients in isolation or quarantine hotels, as it allows for enhanced IPC
processes to be in place. All food (pre-assembled meal boxes, snacks, and beverages) should be stored in a dedicated,
secure, temperature-controlled room away from client floors.
When delivering food or meal boxes to clients, consider the following:
•
•
•
•
Use a dedicated meal delivery cart to transport meals from the food service area to the client floor.
Consider a hand-off of the meal delivery cart from food service staff to staff who are stationed on the client
floors. This will help limit traffic on client floors and the need for additional staff to don PPE.
Limit entry into the client room. Consider either handing the meal box to the client at the door or placing the
meal box on top of the cart (ensuring nothing else is placed on the top shelf of cart) and ask the client to retrieve
it at the door.
Once all meals are delivered, the meal cart should be cleaned and disinfected and then either returned to the
food services area or temporarily placed in the clean utility room.
IX. Infection Prevention and Control Considerations: Signage and In-service
Training
A. Signage
Posting signage throughout the hotel is an effective way to convey essential IPC strategies. Consider posting signage in
public areas regarding:
•
14
Key facts about COVID-19
�•
•
•
•
Hand hygiene (including instructions on hand sanitizing and hand washing with soap and water)
Respiratory etiquette
Physical distancing
Do’s and don’ts of wearing facemasks
Additionally, specific signage and job action posters may be posted throughout patient care floors for healthcare workers
as it relates to services and processes performed. Examples include:
• Clean and soiled utility rooms (with key instructions)
• Transmission based isolation precautions
• Donning and doffing procedures and photo guides
• PPE extended use and reuse procedures or photo guides
• Preventing cross contamination and standard precautions
Please see Appendix C for examples of signs that have been adapted for the hotel setting.
B. In-service Training for Hotel Staff
Retrofitting the hotel environment to fit the needs of specific populations requires planning and development of
appropriate processes. As these processes are developed, it is essential to routinely provide education and training to
ensure staff are familiar with them. Additionally, it is important that staff know how to keep themselves safe and what the
hotel program is doing to keep them safe. All staff should be encouraged to self-monitor for COVID-19 symptoms and be
instructed not to come to work if they test positive for COVID-19, develop symptoms, had recent exposure to someone
diagnosed with COVID-19, or recently travelled to an area subject to travel quarantine. Non-punitive leave policies should
be established to ensure that hotel staff feel comfortable staying home when sick or required to quarantine.27 Examples of
training topics include:
•
•
•
•
•
•
COVID-19 symptoms, transmission, and how to keep safe
PPE guidance, based on location and care activities provided
Extended PPE use and reuse protocols (if operating under contingency or crisis capacities)
Basic principles of IPC (hand hygiene, strategies to prevent cross contamination, standard and transmission-based
isolation precautions)
Approaches to reinforce best practices among hotel clients
Environmental and fire safety
In-service trainings should be led by qualified IPC experts. The content of the training should be consistent with the IPC
and safety guidance instituted at the hotel. For example, if higher acuity clients are isolated within the hotel, then the
training and resources should cover IPC processes relevant to the clinical services provided on site.
Hotels may employ new staff with regular frequency. Further, IPC and practice guidelines may change. Therefore, it is
important to plan for frequent, recurrent trainings to keep all staff up to date on the latest guidance and best practices.
In-service trainings may be conducted either on-site or virtually through video platforms. Virtual trainings ensure physical
distancing and have the added advantage of being able to share the video with staff who could not attend the live session.
Each training session should allow time for staff to ask the trainers questions and to voice concerns related to IPC in their
setting. Outside of training sessions, daily staff huddles should be used as opportunities to share updates on guidance and
to reinforce key safety and infection control practices.
15
�C. Protocols and Registers
Standard operating procedures and protocols can help achieve standardization of practices and processes in hotel
programs. Hotel programs often involve collaboration across multiple agencies and partners. Therefore, written policies
help ensure consistency and transparency across all members of the hotel team. Protocols should document consensus
on a universal approach to one operational aspect of the program; for example, management of a client in quarantine
who needs isolation, or a protocol for disinfection of high-touch surfaces in common areas. Refer to Appendix A for list of
suggested protocols included in the IPC Checklist for Isolation and Quarantine Hotels.
It is possible that staff from different agencies or partners are expected to follow the protocol of their individual
employers, especially in the instance of suspected or confirmed COVID-19. The hotel team may decide that staff should
follow protocols of their employers if it directly reflects the responsibility of the employers. The hotel team may consider
maintaining a list of staff who develop symptoms or test positive for COVID-19 to ensure prompt communication and
collaboration with agencies, individual employers, and local health departments, and in effort to evaluate, inform, and
document current and future interventions to control further spread of infection among staff at the hotel. The IPC
Checklist for Isolation and Quarantine Hotels (refer to Appendix A) lists registers or logs for consideration.
X. Special Considerations for Risk Reduction Hotels
Risk reduction hotels offer a lower risk environment for SARS-CoV-2 infection for residents of high-risk environments, such
as congregate care settings, shelters and prisons.28 Congregate care settings often feature common kitchens, and shared
dining spaces and bathrooms, increasing the risk of person-to-person COVID-19 transmission. For these reasons, city
agencies along with community partners may establish risk reduction hotels to transfer clients to more optimal settings
for effective IPC.
In contrast to isolation and quarantine hotels, risk reduction hotels serve individuals who are not known or suspected to
be COVID-19 positive. The mission of these hotels is to prevent new COVID-19 cases by optimizing IPC protocols and best
practices. If a client is exposed to COVID-19 and develops symptoms or tests positive, the hotel must be prepared to
immediately isolate the known or suspected case.
Most of the IPC policies and practices of isolation and quarantine hotels apply to risk reduction hotels; however, there are
a few important differences. While clients should be educated on the importance of mask use, physical distancing and
hand hygiene, clients should be free to leave their rooms as long as they have not recently had a known exposure to or
developed symptoms of COVID-19. Consider how to determine COVID-19 status prior to transfer to hotel. For example,
some hotel programs may require documentation of a negative COVID-19 test result within a specific time period prior to
accepting a client, whereas other hotel programs may use screening questions to rule out an exposure to or symptoms of
COVID-19.
Clients should be encouraged to report symptoms or exposures to someone diagnosed with COVID-19 to a member of the
hotel team. Expectations for keeping themselves and others safe should be incorporated into the “Rules and Regulations”
that clients sign at the time of transfer to a hotel. Hotel programs must decide on the frequency of screening clients for
symptoms or exposures if they believe clients are not likely to volunteer this information themselves.
Visitors should be discouraged. If visitors are allowed in the hotel they should be screened upon entry and denied
entrance if the screening or temperature check is positive. All visitors and staff must wear masks and adhere to physical
distancing. Signs reinforcing best practices should be posted throughout the hotel, in multiple languages as needed, and
designed to capture the attention of clients who will be leaving their rooms, using the elevators, and entering and exiting
the lobby frequently. Additional PPE such as eye protection may not be necessary as long as the risk reduction hotel
remains COVID-19 free and does not transform into a clinical care site. A small supply of PPE should be safely stored in the
event that a client develops symptoms or tests positive and needs to be isolated.
16
�Finally, risk reduction hotels should be closely tied to the local public health system and healthcare facilities. Most risk
reduction hotels in NYC were staffed with nurses on-site, to ensure that clients can immediately address health concerns.
Clients should have access to healthcare providers and COVID-19 testing with rapid turn-around times of test results.
Protocols should clearly delineate steps to take if a client develops COVID-19 symptoms or tests positive, for example,
isolate in place versus transfer to an isolation hotel (see Appendix D for an example protocol for isolation in place). All
positive tests should be reported to the local health department to immediately initiate contact tracing. A local healthcare
facility should be identified as the default provider for emergency care.
Refer to Appendix A for an example of an IPC checklist specifically for risk reduction hotels and Appendix D for guidance
for management of clients with COVID-19 or symptoms of COVID-19 in risk reduction hotels.
17
�Appendix A: Example Infection Prevention and Control and Environmental Health
and Safety Hotel Checklists
Infection Prevention and Control Checklist for COVID-19 Isolation and Quarantine Hotels
Name of hotel:
Location of hotel:
Client census:
Number of staff who have direct contact with clients:
Date of review:
Agencies associated with hotel:
Client capacity:
Y
N
Comments
Front desk/Registration/Lobby
Entry and exit of clients, staff and essential personnel
is monitored
All staff and visitors are required to wear masks while
in the hotel
Staff working in the lobby are wearing masks
Hand sanitizer that contains at least 60% alcohol is
available in lobby
Signs reinforcing physical distancing, use of masks
and hand hygiene are posted in lobby
Multi-user surfaces are minimized (no shared pens,
no public phones)
High-touch surfaces are cleaned after every use
(payment consoles, ATM machines, touch screens)
Non-essential common areas are closed with
appropriate signage (activity rooms, pools, lounges,
computer rooms, shops, ice machines)
Elevators
Elevator banks on every hotel floor have signage that
limit the number of passengers and reinforce physical
distancing, hand hygiene and use of masks
Elevators have signs or markings to indicate how
many people can be in the elevator at once and
where each person should stand
Staff Spaces
All entry points have signage indicating masks must
be worn while in hotel
Staff space for administrative work, breaks, and
food/drink are separated from client traffic
Staff workspaces (keyboards, computer mouse, desk
phones) are disinfected prior to each shift
18
If communal areas cannot be closed, mark the seats
that are available and space apart
�Signs reinforcing social distancing, use of masks, hand
hygiene, and safe habits are posted in staff work and
break areas
Staff are wearing facemasks
Hand sanitizer that contains at least 60% alcohol
and/or handwashing sinks are available in staff
spaces
Doors are kept open, where permitted
Fans are not being used
Hands-free trash bins are available
Signs on the inside of bathroom doors remind staff to
wash hands and then use a paper towel to the open
door, or to use hand hygiene after opening bathroom
door
Staff Training and Practices
Staff share information with clients on COVID-19
symptoms and transmission, rules for
isolation/quarantine, how to keep themselves safe
and what the hotel is doing to keep them safe
All staff (hotel and health care providers) have been
educated on the basic principles of infection
prevention and control, COVID-19 transmission, how
to keep themselves safe and what the hotel is doing
to keep them safe
All staff have been informed to self-monitor for signs
and symptoms of COVID-19 and not come to work if
they develop symptoms or have been exposed to
someone with COVID-19 (family member, partner,
roommate)
Staff are utilizing available technology (telephone or
video conferences) to check in on clients and limiting
direct contact, when appropriate
Clients in isolation with confirmed or suspected
COVID-19 should be prioritized for in-person
assessments
Staff who interact with clients have received training
on PPE requirements and how to correctly don and
doff PPE
At least one staff member is available and
responsible during each shift for monitoring correct
PPE donning and doffing
Staff have access to just-in-time resources and
ongoing/refresher trainings
PPE Donning and Doffing (Try to observe donning and doffing, if possible)
PPE protocols have been adapted based on
conventional, contingency or crisis standards
19
�PPE donning and doffing spaces have appropriate
signage and are separated from client traffic and staff
break rooms
PPE doffing space is separate from PPE donning and
PPE re-use storage space
PPE doffing space has hands-free waste bins, hand
sanitizer and/or handwashing sink
Process and storage of PPE for extended use and reuse follows current local guidance
Staff don and doff PPE correctly, according to current
guidance
Visual aids for each step of donning and doffing are
posted on walls
Spaces where PPE is required are clearly marked and
separated from spaces where PPE is not permitted
(also marked with signage)
Staff doff PPE after interacting with clients and
before entering common areas, such as elevators or
other spaces that are shared with non-clients
Client Spaces (Try to directly observe as many items below as possible)
All staff and essential visitors wear masks and eye
protection whenever they are within 6 feet of a client
Staff wear masks, eye protection and gloves during
wellness checks. Long-sleeved gowns and N95
respirators are prioritized for high-contact care
activities or when splashes and sprays are
anticipated.
Gowns are preferred over coveralls, if available
Staff wear N95 respirators, eye protection, longsleeved gowns and gloves when cleaning client
spaces
Gowns are preferred over coveralls, if available
Staff change gloves and perform hand hygiene
between tasks, such as after touching client, client
belongings or their environment
Common areas are closed or restricted (no shared
bathrooms, ice and water machines are taped off)
Signs remind clients to remain in their rooms, wear
masks if they must leave room, practice hand
hygiene, and maintain physical distancing
Food/drink for staff is prohibited in client spaces,
including clean and soiled utility rooms
Hand sanitizer is available and contains at least 60%
alcohol
Equipment and Supplies
20
�PPE and supplies are stored 18 inches from ceiling
and 6 inches from floor in a room that is guarded or
locked at all times
PPE is available and enough stock is on hand to meet
future needs
Hand sanitizer is available and contains at least 60%
alcohol
All sinks have liquid soap and paper towels; protocol
is in place to restock regularly
Disinfection wipes are available and accessible
Cleaning products are considered effective against
SARS-CoV-2 by the EPA
Supply carts for wellness checks are routinely
checked, restocked and decontaminated, with
documentation (refer to supply cart content list and
decontamination protocol)
Clean Utility areas are identified with appropriate
signage in locations that can safely store clean carts
and supplies
Soiled Utility areas are identified with appropriate
signage in locations where carts and supplies can be
safely disinfected
Clean and Soiled Utility areas have signage indicating
required PPE and hand hygiene
Non-essential items are removed from Clean and
Soiled Utility areas (e.g., chairs, linens, TV, etc.)
A clean meal cart (with shelves) is available and
stored in Clean Utility area when not in use and is
disinfected after use
Decontamination of High-Touch Surfaces
Elevator buttons are wiped with a disinfectant as
often as possible, preferably every hour
Door handles, light switches, wall phones, remote
controls and bathroom fixtures in staff spaces are
wiped with a disinfectant as often as possible,
preferably every hour
All other high-touch surfaces are cleaned as often as
possible, preferably every hour (countertops,
stairwell doors, handrails)
Protocols (Ask to see written protocols/algorithms)
PPE requirements for every cadre
Management of clients in quarantine who need to be
isolated
21
�Management of staff with high-risk exposure to
COVID-19
Management of staff with suspected or confirmed
SARS-CoV-2 infection
Testing staff for COVID-19
Contact tracing of new COVID-19 cases, in
collaboration with local agencies and health
department protocols
Return to work criteria for staff
Processing of clean and dirty client linens and laundry
Disinfection of carts and reusable equipment
Food delivery to clients
Discharge criteria for clients
Daily and terminal cleaning of client rooms
Registers/Logs
Maintain a secure list of staff with symptoms of
COVID-19, how long they are out of work, if they
have been tested for COVID-19, and test results
Maintain a secure list of staff with close exposures to
COVID-19, how long they are out of work, if they
develop symptoms, if they have been tested for
COVID-19, and test results
22
�Infection Prevention and Control Checklist for COVID-19
Risk Reduction Hotels
Name of hotel:
Location of hotel:
Client census:
Number of staff who have direct contact with clients:
Date of review:
Agencies associated with hotel:
Client capacity:
Y
Front desk/Registration/Lobby
Entry and exit of clients, staff and essential personnel
is monitored
All staff and visitors are required to wear masks while
in the hotel
Staff working in the lobby are wearing masks
Hand sanitizer that contains 60% alcohol is available in
lobby
Signs reinforcing social distancing, use of masks and
hand hygiene are posted in lobby
Multi-user surfaces are minimized (no shared pens, no
public phones)
High-touch surfaces are cleaned after every use
(payment consoles, ATM machines, touch screens)
Non-essential common areas are closed with
appropriate signage (activity rooms, pools, lounges,
computer rooms, shops, ice machines)
Elevators
Elevator banks on every hotel floor have signage that
limit number of passengers and reinforce social
distancing, hand hygiene and use of masks
Elevators have signs or markings to indicate how many
people can be in the elevator at once and where each
person should stand
Staff Spaces
All entry points have signage indicating masks must be
worn while in hotel
Staff space for administrative work, breaks, and
food/drink are separated from client traffic
Staff workspaces (keyboards, computer mouse, desk
phones) are disinfected prior to each shift
Signs reinforcing physical distancing, use of masks,
hand hygiene, and safe habits are posted in staff work
and break areas
Staff are wearing masks
Hand sanitizer that contains at least 60% alcohol
and/or handwashing sinks are available in staff spaces
Doors are kept open, where permitted
23
N
Comments
If communal areas cannot be closed, mark the seats
that are available space apart
�Fans are not being used
Hands-free trash bins are available
Signs on the inside of bathroom doors remind staff to
wash hands and then use a paper towel to open door,
or to perform hand hygiene after opening bathroom
door
Clients and Staff Training
Clients have been educated on COVID-19 symptoms
and transmission, how to keep themselves safe and
what the hotel is doing to keep them safe
All staff (hotel and health care providers) have been
educated on the basic principles of infection
prevention and control, COVID-19 transmission, how
to keep themselves safe and what the hotel is doing to
keep them safe
All staff have been informed to self-monitor for signs
and symptoms of COVID-19 and not come to work if
they develop symptoms or have been exposure to
someone diagnosed with COVID-19 (family member,
partner, roommate)
Staff are utilizing available technology (telephone or
video conferences) to check in on clients and limiting
direct contact
If direct physical contact with a client is necessary,
staff are wearing appropriate PPE
Cleaning staff have received PPE training and are
wearing masks, eye protection, long-sleeved gowns
and gloves while cleaning client and common spaces
PPE doffing occurs in a respace separate from all
other activities with appropriate signage, hand-free
waste bins, and hand sanitizer and/or sinks
Client Spaces (Try to directly observe as many items below as possible)
Staff, essential visitors and clients are wearing masks
anytime they are within 6 feet of a another individual
Common areas are closed or restricted (no shared
bathrooms, ice and water machines are taped off)
Signs remind clients to wear masks when they leave
room, perform hand hygiene, and maintain physical
distancing
Signs encourage clients to self-monitor for COVID-19
signs and symptoms and to call client supervisor if
they feel unwell or develop symptoms
Hand sanitizer is available and contains at least 60%
alcohol
Equipment and supplies
PPE and supplies are stored 18 inches from ceiling and
6 inches from floor in a Clean Utility room that is
guarded or locked at all times
24
�PPE is available and enough stock is on hand to meet
future needs
Hand sanitizer is available and contains at least 60%
alcohol
All sinks have liquid soap and paper towels; protocol is
in place to restock regularly
Disinfection wipes are available and accessible
Cleaning products are considered effective against
SARS-CoV-2 by the EPA
Decontamination of High Touch Surfaces
Elevator buttons are wiped with a disinfectant as
often as possible, preferably every hour
Door handles, light switches, wall phones, remote
controls and bathroom fixtures in staff spaces are
disinfected as often as possible, preferably every hour
All other high-touch surfaces are cleaned as often as
possible, preferably every hour (countertops, stairwell
doors, handrails)
Protocols (Ask to see written protocols/algorithms)
PPE requirements for every cadre
Protocol to guide staff on what to do if a client needs
isolation (COVID-19 test positive, or person under
investigation)
Protocol to guide staff on what to do if a client needs
quarantine (exposure to a COVID-19 case)
Management of staff with high-risk exposure to
COVID-19
Management of staff with suspected or confirmed
COVID-19
Testing clients and/or staff for COVID-19
Contact tracing of new COVID-19 cases, in
collaboration with local agencies and health
department protocols
Return to work criteria for staff
Processing client linens and laundry
Food delivery to clients
Discharge criteria for clients
Daily and terminal cleaning of client rooms
Registers/Logs (ask to see each register)
Maintain a secure list of clients who develop
symptoms of COVID-19, date of symptom onset, if
they have been tested, and test results
Maintain a secure list of staff with symptoms of
COVID-19, how long they are out of work, if they have
been tested for COVID-19, and test results
Maintain a secure list of staff with exposures to
COVID-19, how long they are out of work, if they
25
�develop symptoms, if they have been tested for
COVID-19, and test results
Environmental Health and Safety Readiness Checklist
for COVID-19 Hotels
Safety and Security
Yes
No
N/A
Comments
Yes
No
N/A
Comments
1. Are the bedroom door locks disabled and
deadbolts/locks (digital, reinforcement locks,
swing bar) removed? (Doors must continue to
have positive latching)
2. Perform test: Able to open door from the
outside of the room once the door is closed from
inside the room
3. Is there adequate lighting in all areas of
operation
4. Are open spaces (meeting, convention,
ballrooms) and other open areas restricted for
access?
5. Are emergency exits and egress paths clear of
obstructions and accessible?
6. Is roof accessible to clients? If yes, is it
restricted?
7. Does the site director or security staff have a
master key to client rooms?
8. Are all fire/smoke doors, including guest room
doors, properly latching and functioning? Each
door must be checked.
9. Is there camera access to all client care areas
and common areas?
10. Are radios available for use, if needed?
Staff Safety
11. Is fire safety in-service performed?
12. Is infection control in-service performed?
13. Is security escalation contact in-service
performed?
14. Are there staff workstations on every floor
where there are clients?
15. Is site service contact information available for
Security, Engineering, Housekeeping and AOD
(Administer on Duty)?
26
�Patient Safety and Readiness
Yes
No
N/A
16. Do client room windows open? If yes, not more
than the local requirement? Each window must
be checked.
17. Removal of sharps (glasses or other breakable
items- such as coffee pots)
Comments
Consider removing items that can
be easily broken or used as a
sharp object if clients have
behavioral health risks
18. Removal of hotel items- iron, hair dryer, hangers
Infection Control
19.
Is there a designated elevator for COVID positive
clients?
20.
If question #19 is yes, is there staff dedicated to
operating the elevator?
21.
Is there a designated elevator for COVID
negative clients and staff?
22.
Is there designated elevator for staff services
such as food, housekeeping and engineering?
23.
Are hand hygiene stations with 60% alcoholbased hand sanitizers available on all floors?
24.
Is liquid soap is available in all staff bathrooms?
25
Are proper and designated infection prevention
and control signs placed in client care areas?
Space Allocation
26.
Is there a dedicated clean utility room that only
contains only clean supplies and no food/drinks
and/or personal belongings?
27.
Is there a dedicated soiled utility room that
contains no food/drinks and/or personal
belongings?
Is kitchen preparation or a storage area for
patient and staff food available?
Is the clean linen in the clean supply and linen
storage area covered?
28.
29.
Information Technology
30. Is Wi-Fi available throughout each floor?
31. Capacity- write the number of current users
under “Comments”
32. Bandwidth- write the approximate number
under “Comments”
27
Yes
No
N/A
Comments
Yes
No
N/A
Comments
Yes
No
N/A
Comments
�33. Can the hotel’s IT support open up Wi-Fi for the
hospital’s purposes? Can the service set
identifier be configured for a password and not
force users to web page to click ”accept”?
34. Can WIFI be made to not timeout for users?
28
�Appendix B: Example Guidance for Terminal Cleaning of Client Rooms
Terminal Cleaning of Client Rooms in COVID-19 Hotels
Adapted from CDC Guidance for Cleaning and Disinfecting Households
All cleaning staff should wear appropriate PPE: disposable gowns, disposable gloves, eye protection and face masks or N95 respirators
•
•
•
Cleaning
•
•
•
•
Disinfecting
Soft Surfaces
(e.g., carpeted
floor, rugs and
drapes)
•
•
•
•
Clean the surface using soap and water or with cleaners appropriate for use on these surfaces.
Launder items (if possible) according to the manufacturer’s instructions. Use the warmest appropriate
water setting and dry items completely.
Disinfect with an EPA-registered household disinfectant. These disinfectants meet EPA’s criteria for use
against COVID-19.
Vacuum as usual.
For electronics, such as tablets, touch screens, keyboards, remote controls and TVs, remove visible
contamination if present.
• Consider putting a wipeable cover on electronics.
• Follow manufacturer’s instruction for cleaning and disinfecting.
If no guidance, use alcohol-based wipes or sprays containing at least 70% alcohol. Dry the surface thoroughly.
•
Wear disposable gloves when handling dirty laundry from someone who is isolating or quarantining then
discard after each use. Clean your hands immediately after your gloves are removed.
o If possible, do not shake dirty laundry. This will minimize the possibility of dispersing the virus into the
air.
o Launder items as appropriate in accordance with the manufacturer’s instructions. If possible, launder
items using the warmest appropriate water setting for the items and dry items completely. Dirty
laundry from someone who has COVID-19 can be washed with other people’s items.
•
Clean and disinfect clothes hampers according to guidance above for surfaces. If possible, place a bag liner
that is either disposable (can be thrown away) or can be laundered.
Linens, clothing
and other items
that must be
laundered
29
Recommend use of EPA-registered household disinfectants. See the Safety Data Sheet (SDS) for safe
handling and first aid instructions.
Follow the instructions on the label to ensure safe and effective use of the product.
Many products recommend:
o Keeping the surface wet for a period of time (see product label).
o Taking precautions, such as wearing gloves and ensuring appropriate ventilation, while using the
product.
OR
•
Electronics
Wear disposable gloves, a gown, eye protection and a mask while cleaning and disinfecting.
Clean surfaces using soap and water, then use a disinfectant.
Cleaning with soap and water reduces the number of germs, dirt and impurities on the
surface. Disinfecting kills germs on surfaces.
Practice routine cleaning of frequently touched surfaces.
o More frequent cleaning and disinfection may be required based on each surface’s level of use.
o Surfaces and objects in public places, should be cleaned and disinfected before each use.
High-touch surfaces include:
o Tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets,
and sinks.
�Appendix C: Example Signage
Accessible version: https://www.cdc.gov/coronavirus/2019-ncov/downloads/stop-the-spread-of-germs.pdf
30
�Accessible version: https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID19-symptoms.pdf
31
�CLEAN UTILITY
ROOM
• DO NOT wear PPE when entering this area,
other than a mask and eye protection.
• ALWAYS perform hand hygiene prior to
entering.
• This is NOT a break room.
DO NOT eat or drink in this room.
• Keep room secure at all times.
32
�SOILED UTILITY
ROOM
• DO NOT place personal belongings or clean
items in this room.
• Once items are disinfected, immediately
move to Clean Utility Room.
• Perform hand hygiene after exiting room.
• Keep room secure at all times.
33
�COVID-19 Personal Protective Equipment Recommendations for Hotel Staff
Staff
PPE
Comment
•
•
•
Security/Front Desk
•
•
Clean hands before & after touching mask.
Avoid touching outer area of mask.
Store mask safely and in a clean paper bag or container if
planned for reuse throughout the shift.
Discard mask if it becomes wet or contaminated.
Gloves as needed if touching client belongings.
In addition to the above:
Wellness
Coordinators
Or
Hall Monitors
•
•
•
•
•
•
Clinical Staff
Or
Staff Entering
Room
•
EVS/Housekeeping
Eye protection (face shield or goggles)
Staff should wear gloves for contact with clients
their environment. client belongings.
Always perform hand hygiene after removing gloves.
At a minimum, staff should wear facemask, eye protection
and gloves while in the client care area.
N95 Respirators should be prioritized for aerosol generating
procedures.
Gowns should be prioritized for:
➢ Aerosol generating procedures
➢ Care activities where splashes and sprays are
anticipated
➢ High-contact client care activities that provide
opportunities for transfer of pathogens to the hands
and clothing of HCP (e.g., dressing, bathing/showering,
transferring, providing hygiene, changing linens,
changing briefs or assisting with toileting, device care or
use, wound care)
Staff should wear gown, gloves, eye protection, and N95
respirator due to the high risk of transfer of pathogens to
hands and clothing, and the potential of aerosolization
during cleaning and disinfection of environment.
Adapted from: cdc.gov/coronavirus/2019-ncov/hcp/alternative-care-sites.html
34
or
�35
�36
�37
OILED UTILITY
ROOM
�38
�Appendix D: Guidance for Management of Clients with COVID-19 or Symptoms of
COVID-19 in Risk Reduction Hotels
Objective: Clients of risk reduction hotels are vulnerable to COVID-19. Isolation of clients who have COVID-19 is necessary
in order to prevent the spread of COVID-19 to hotel staff and other clients. The community-based organization (CBO) at
the hotel provides critical case management and social services to the clients. This document offers guidance for the safe
isolation of clients with COVID-19 or symptoms of COVID-19 with continuation of critical social services and support in the
hotels.
I.
Clients should be isolated if:
1. They are diagnosed with COVID-19
OR
2. They have signs or symptoms of COVID-19 (fever, cough, shortness of breath, chills, sore throat, muscle aches,
new loss of taste, or new loss of smell)
II.
Upon identification of need for isolation:
1.
2.
3.
4.
5.
6.
7.
III.
The client should be directed to stay in their room. The client must wear a mask at all times, except when alone
in the hotel room.
Staff should call the on-site clinical team to conduct an initial in-person assessment that includes vital signs,
symptom screening, and documentation of close contacts.
a. If there are any emergency clinical concerns (such as trouble breathing), staff should immediately notify
an emergency medical technician (EMT) or call 911.
The clinical team will confer with the EMT and on-call physician to determine if the client can stay in the hotel for
isolation, according to “Considerations during assessment” below.
Considerations during assessment:
a. Immediately initiate efforts to transfer the client to a health care facility if they:
i. Are 65 or older.
ii. Have underlying health conditions, that place them at increased risk of developing complications
from COVID-19.
iii. Have any emergency warning signs (such as trouble breathing, persistent pain or pressure in the
chest, bluish lips or face, inability to wake or stay awake, and new confusion).
b. If none of the above, then the client may remain in the hotel for isolation under the following conditions:
i. EMT services are on-site 24/7.
ii. On-site clinical staff have the capacity to conduct two daily checks of vital signs and symptoms
through telemedicine, if possible, or in-person if clinically indicated.
iii. Clinical or CBO staff can provide critical social support and services.
iv. The client does not require medical or supportive care from a health aide or caretaker.
v. The client agrees (ideally in writing) to remain in their hotel room 24 hours a day (except during a
medical emergency) for as long as isolation is required and follow other isolation hotel rules.
The clinical team will arrange to test the client for COVID-19, if that has not already been done.
CBO staff will notify hotel operations leadership of the client in need of isolation and the care plan.
Clinical and CBO staff will follow local contact tracing protocols for notifying and managing close contacts of the
client identified as positive for COVID-19.
Guidelines for caring for clients in isolation in hotel room:
1. Client should remain in isolation until all of the following are true (as isolation protocols may change, refer to
current protocols from state and local health authorities):
39
�a. At least 10 days after symptom onset or 10 days from the date of the first positive test if never
symptomatic.29
b. Absence of fever for at least 24 hours without fever-reducing medications (such as Tylenol, ibuprofen,
and aspirin).
c. Overall improvement of symptoms (such as cough or shortness of breath).
2. Clients should be educated on:
a. COVID-19 symptoms and emergency warning signs.
b. How to check temperature and pulse oximetry twice daily and report to staff during wellness checks.
c. The name and phone number of the clinical team member to call if symptoms worsen or if pulse oximetry
saturation falls below 92%.
d. How COVID-19 is spread and why it is important to stay in the room to prevent the infection from
spreading to others in the hotel.
e. How to make arrangements with the clinical team or CBO staff to leave the room only to receive essential
medical care.
f. Why they must always wear a mask in the presence of other people, even when in their hotel room.
g. Who to call if they need to see a health care provider to let the provider know ahead of time they have
COVID-19.
h. How long they will stay in the room (at least 10 days from start of infectious period).
i. What services will be provided to them while in the room.
j. What to do if they need to leave room to smoke.
k. What to do if they need non-medical assistance or supplies etc. (such as calling the front desk or client
supervisor).
3. Clients should be provided with:
a. A mask to be worn whenever they are in the presence of others, including in their hotel room.
b. Thermometer and pulse oximeter, if they are capable of self-monitoring.
c. Enough soap or hand sanitizer.
d. Essential medications.
e. Essential clothes, toiletries and personal items.
f. Ongoing support, education, and monitoring for the duration of their hotel stay.
g. Food delivery to their door for all meals.
IV.
Guidelines for clinical staff:
1. Conduct an initial assessment at a distance if possible (See section II).
2. Provide the client with name and phone number of a nurse or EMT to call if symptoms worsen or oxygen
saturation falls below 92%.
3. Educate the client on what to expect and how the staff will care for them (see Section III).
4. Ensure access to COVID-19 testing if the client develops COVID-19 symptoms and has not yet tested positive.
5. Contact clients in isolation at least two times per shift to check on temperature, pulse oximetry and symptoms,
using telemedicine if possible.
6. If performing in-person wellness checks, prepare to wear appropriate PPE (at minimum, a mask, eye protection
and gloves), doff the PPE before leaving the client space, perform hand hygiene and disinfect any medical
equipment that will be re-used.
7. Be prepared with appropriate PPE (mask, eye protection, gloves and gown) to enter the room if a client needs
urgent medical support.
8. Be prepared to call security and immediately enter the room if there is no response from the client at the time of
wellness checks.
9. Arrange for the safe and immediate transfer of clients to the hospital if needed
40
�V.
Clinical and/or CBO team
1.
2.
3.
4.
41
Text or call the client at least twice daily.
Look for any emergency warning signs that require immediate medical attention.
Continue to provide existing social and wellness programs by video.
Consider additional wellness and mental health support for clients in isolation. Resources include:
a. NYC Well which offers 24/7 well-being and emotional support. For free counseling, call 1-888-NYC-WELL (1888-692-9355), text “WELL” to 65173, or visit www.nyc.gov/well to chat with a counselor.
b. New York State’s COVID-19 Emotional Support Helpline. Call 844-863-9314 to talk to specially trained
volunteer professionals. They can listen, offer support and offer referrals to care.
c. For additional resources on how to cope, visit the NYC Health Department’s Coping and Emotional WellBeing page.
�References:
1. Federal Healthcare Resilience Taskforce Alternate Care Site Toolkit (third edition)
https://files.asprtracie.hhs.gov/documents/acs-toolkit-ed1-20200330-1022.pdf
2. “Infection Prevention for Alternate Care Sites.” American Professionals in Infection Control, 2009, Retrieved from
https://apic.org/wp-content/uploads/2020/03/APIC-ACS.pdf
3. “Infection prevention and control during health care when coronavirus disease (COVID-19) is suspected or
confirmed.” World Health Organization. June 29, 2020. Retrieved from
https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC-2020.4
4. “Quarantine and Isolation.” Centers for Disease Control and Prevention. September, 17 2017. Retrieved from
https://www.cdc.gov/quarantine/index.html
5. “Optimizing Supply of PPE and Other Equipment during Shortages.” Centers for Disease Control and Prevention.
July 16, 2020. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
6. “Interim Guidance for General Population Disaster Shelters During the COVID-19 Pandemic”. October 12, 2020.
Retrieved from
https://www.cdc.gov/coronavirus/2019-ncov/php/eh-practitioners/general-population-disaster-shelters.html
7. “Considerations for Hotel Owners and Managers: How to Prevent Legionnaires’ Disease”. August 15, 2019.
Retrieved from
https://www.cdc.gov/legionella/wmp/hotel-owners-managers.html
8. “Window Guards. What Building Owners Need to Know.” Department of Housing Preservations and
Development; NYC Department of Health and Mental Hygiene. June 2020. Retrieved from
https://www1.nyc.gov/assets/doh/downloads/pdf/win/win-savelives-bro.pdf
9. “Fire Safety and Alcohol-Based Hand Sanitizer (ABHS).” Centers for Disease Control and Prevention. April 29,
2019. Retrieved from
https://www.cdc.gov/handhygiene/firesafety/index.html#:~:text=Alcohol%2Dbased%20hand%20sanitizer%20(AB
HS)%20effectively%20kills%20most%20germs,for%20use%20by%20the%20CDC.&text=ABHS%20contains%20eth
yl%20alcohol%2C%20which,is%20considered%20a%20flammable%20liquid.
10. “Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus
Disease 2019 (COVID-19) Pandemic.” July 15, 2020. Retrieved from
https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html
11. “General Business Frequently Asked Questions”. September 14, 2020. Retrieved from
https://www.cdc.gov/coronavirus/2019-ncov/community/general-business-faq.html
12. “Sterilizing Practices.” Centers for Disease Control and Prevention. September 18, 2016. Retrieved from
https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/sterilizing-practices.html
13. “Boxes and Shipping Containers.” The Joint Commission. July 23, 2020. Retrieved from
https://www.jointcommission.org/standards/standard-faqs/ambulatory/infection-prevention-and-controlic/000002145/
14. “Linen Management - Developing Requirements for Covering, Storage and Transport.” The Joint Commission.
November 1, 2017. Retrieved from https://www.jointcommission.org/standards/standardfaqs/ambulatory/infection-prevention-and-controlic/000002111/#:~:text=A%20clean%20liner%20within%20the,at%20all%20time%20during%20storage.
15. “Soiled Utility Room Security - Risk Assessment.” The Joint Commission. May 19, 2020. Retrieved from
https://www.jointcommission.org/standards/standard-faqs/home-care/environment-of-care-ec/000001225/
16. “Cleaning and Disinfection for Non-emergency Transport Vehicles.” April 14, 2020. Retrieved from:
https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/disinfecting-transport-vehicles.html
17. “Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings.” Centers for Disease Control
and Prevention. July 20, 2020. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-inhome-patients.html
42
�18. “How to Select, Wear, and Clean Your Mask.” Centers for Disease Control and Prevention. August 27,
2020.Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-facecoverings.html
19. “Considerations for Alternate Care Sites.” Centers for Disease Control and Prevention. April 24, 2020. Retrieved
from https://www.cdc.gov/coronavirus/2019-ncov/hcp/alternative-care-sites.html
20. “Strategies for Optimizing the Supply of Isolation Gowns.” October 9, 2020. Retrieved from
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html
21. “Strategies for Optimizing the Supply of Facemasks.” June 28, 2020. Retrieved from
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
22. “Strategies for Optimizing the Supply of Eye Protection.” July 15, 2020. Retrieved from
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/eye-protection.html
23. “List N: Disinfectants for Coronavirus (COVID-19)”. October 5, 2020. Retrieved from
https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19
24. “Cleaning and Disinfection for Households.” Centers for Disease Control and Prevention. July 10, 2020. Retrieved
from https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html
25. “Cleaning and Disinfecting Your Facility.” Centers for Disease Control and Prevention. July 28, 2020. Retrieved
from https://www.cdc.gov/coronavirus/2019-ncov/community/disinfecting-building-facility.html
26. “Background G. Laundry and Bedding.” Centers for Disease Control and Prevention. November 5, 2015. Retrieved
from https://www.cdc.gov/infectioncontrol/guidelines/environmental/background/laundry.html
27. “Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential
Exposure to COVID-19.” July 18, 2020. Retrieved from https://www.cdc.gov/coronavirus/2019ncov/hcp/guidance-risk-assesment-hcp.html
28. Saloner S, Parish K, Ward J. “COVID-19 Cases and Deaths in Federal and State Prisons.” JAMA. 202; 324(6):602603.
29. “Discontinuation of Isolation for Persons with COVID-19 Not in Healthcare Settings.” July 20, 2020. Retrieved from
https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-home-patients.html
For additional guidance and resources, refer to:
•
•
•
•
•
43
Pan American Health Organization (PAHO): Infection prevention and control practices for care of patients in
nontraditional settings with focus to the novel coronavirus (COVID-19). Interim recommendations, 18 May 2020
Pan American Health Organization (PAHO): Technical Recommendations for the Selection of Alternative Medical
Care Sites (AMCS)
Pan American Health Organization (PAHO): Considerations for the Use of Hotels during the COVID-19 Pandemic.
Interim technical working document, version 5 (2 April 2020)
American Industrial Hygiene Association (AIHA): Reducing the Risk of COVID-19 Using Engineering Controls
American Society for Healthcare Engineering (ASHE): Converting Alternate Care Sites to Patient Space Options
�
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Title
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Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Infection Prevention and Control and Environmental Health and Safety for COVID-19 Isolation and Quarantine Hotels
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
Infection Prevention and Control and Environmental Health and Safety for COVID-19 Isolation and Quarantine Hotels: Tailoring Existing Recommendations and Implementing Innovative Strategies Within the Hotel Setting
Creator
An entity primarily responsible for making the resource
NYC Health + Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-01
Contributor
An entity responsible for making contributions to the resource
2022-02-08 by PPE group NYCHH (AS)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-02-08
2019-nCoV
Coronavirus
COVID-19
Crisis Standards of Care
Environmental Services
Example
Infection Prevention and Control
Isolate
Isolation/Biocontainment
Personal Protective Equipment (PPE)
Quarantine
R-EM
R-PPE
SARS-CoV-2
Waste Management
-
https://repository.netecweb.org/files/original/3d37bdf52bb67b20010c9ca37f493307.pdf
e424f8deb24ccbb29437698f8782e06b
PDF Text
Text
Anatomía de una mascarilla de procedimiento
Lo que se debe saber
Capa interior
Elásticos
Asegure la mascarilla a la
cara y ayude a colocar los
lados de la mascarilla para
que no queden espacios.
La capa interior
(generalmente blanca) es
de material absorbente.
Mantiene la humedad de tu
respiración.
Capa intermedia
Puente nasal
La capa intermedia es una
tela de fibra no tejida
fuertemente adherida que
actúa como un filtro entre
usted y el aire fuera de la
mascarilla.
El puente nasal da
forma a la mascarilla
para un ajusto perfecto
en la nariz
Capa externa
Pliegues
Los pliegues siempre
deben estar boca abajo
para evitar la captura de
partículas por gravedad.
La capa exterior, por lo general,
es un material resistente a los
fluidos que protege su mascarilla
de las pequeñas gotas.
09-24-20
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Anatomía de una mascarilla de procedimiento
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
This printable flyer infographic is a spanish language version of "<a href="https://repository.netecweb.org/items/show/1344">Anatomy of a Procedure Mask</a>".<br /><br />Lo que se debe saber - Anatomía de una mascarilla de procedimiento.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-24
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Español
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
Spanish
-
https://repository.netecweb.org/files/original/c9c489c2f773e4026b4ddc870cd2f7e5.pdf
2bed0550b0f2ed3db9b072d1ca7df63c
PDF Text
Text
Cómo usar una mascarilla
Siga estas reglas generales para obtener la mejor
protección de su mascarilla.
Colgando de la oreja
Porque?
El interior de su mascarilla puede volverse
contaminado.
MANTENGA
LAZOS
DETRÁS DE
LAS OREJAS
CUBRE TU NARIZ
No cruce los lazos para acortar
Porque?
Cruzar los lazos puede causar espacios en el costado
de la máscara y permitirle respirar aire contaminado.
CUBRE TU BOCA
MANIPULE LA
MASCARILLA
USANDO
ÚNICAMENTE LOS
LAZOS
COLOQUE TURBAS
HACIA ABAJO
ERRORES COMUNES
En lugar:�� Haga un pequeño nudo en el lazo detrás
de la oreja. Cuando anude las correas o use un sable
para la oreja, asegúrese de que no haya espacios
laterales.
No toques
Porque?
Puede contagiarse el virus de las manos y contagiarlo
a otra persona.
NO USE SU MÁSCARA:
Bajo la nariz
En lugar:��Manejar solo con correas/ lazos.
Porque?
Puede inhalar aire sin filtrar dentro y fuera
de la nariz.
No la pongas en su bolsillo
Porque?
La contaminación de su mascarilla entrará en su
bolsillo y posiblemente se extenderá a sus llaves,
su monedero y sus manos.
Bajo el mentón
Porque?
Los contaminantes en el exterior de su
mascarilla pueden transferirse a su piel.
En lugar��� Colóquelo en una bolsa transpirable o,
si la máscara está mojada, cuélguela del lazo
para que se seque.
09-15-20
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Cómo usar una mascarilla
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
This is a spanish language version fo the printable flyer infographic "<a href="https://repository.netecweb.org/items/show/1339">How to Wear a Mask</a>". <br /><br />Siga estas reglas generales para obtener la mejor protección de su mascarilla.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-15
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Español
Infection Prevention and Control
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
Respiratory Pathogen
Spanish
-
https://repository.netecweb.org/files/original/29e42076c0bfde1363a6cf0c3bd12533.pdf
ea389d00dad815c02b1ddee1514cadcb
PDF Text
Text
01-04-21
���
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Surgical Safety Best Practices and Innovations
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This printable flyer infographic and interactive resource discusses best practices and innovations for surgical safety during the COVID-19 pandemic. Learn about best practices during surgical procedures to help prevent cross contamination in an operating room. Click the hotspots to see PPE strategies based on a patient's COVID-19 status and innovations that improve safety.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-01-04
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM) - covid specific resource, relevancy for non covid environment
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-14
2019-nCoV
Coronavirus
COVID-19
Gloves
Gown
Hood
Infection Prevention and Control
Mask
Masks
N95
Occupational Health
Personal Protective Equipment (PPE)
Physical Infrastructure
R-PM
R-PPE
Treatment and Care
-
https://repository.netecweb.org/files/original/a774a0db971b073b9b4808ec56f4d0fc.pdf
d31268c301ac350d58a0ddc339a41bc1
PDF Text
Text
12-04-20
�12-04-20
�12-04-20
�12-04-20
�12-04-20
�12-04-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Safety for Dental Practices
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This printable flyer infographic discusses safety for dental practices. Recovery from and response to a disaster happen at the same time - in the short, intermediate, and long term. Recovery requires collaboration between the private and public sectors.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-12-04
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM) - covid specific resource, relevancy for non covid environment
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-14
2019-nCoV
Coronavirus
COVID-19
Infection Prevention and Control
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
-
https://repository.netecweb.org/files/original/74f6e3e22fd7e0488a66c148923d45aa.pdf
aea063b515406bebade13c3c7d5fa5cb
PDF Text
Text
putting
PPE
ON
1/2
PAPR
system
Launderable gown
Inner gloves
Outer gloves
Gloves
1
2
Batch work and plan
ahead, having items
available
outside each
patient room.
3
If you already have a mask on:
Sanitize
hands.
Remove
mask.
Store
mask.
Put on first
pair of gloves.
Sanitize
hands.
Belt, Battery, Helmet
4
Secure the
belt around the
waist.
5
Secure the
battery on the left
side of the belt.
6
7
Check the LED lights
to ensure the battery
is fully charged.
Connect
the helmet
to the
battery.
8
Put helmet on head
and size to fit by
turning ratchet knob to
adjust the headband.
9
Adjust fan
speed to
comfort.
10
11
Disconnect
the battery.
Take off the helmet and place
it inside the PAPR hood.
Ensure the white
HEPA filter is on
top, the helmet is
inside filter pouch,
and the adjustable
knob is outside of
the filter pouch.
Hood
12
Slide the helmet into the hood
until it snaps in the center
hole. Snap helmet into the
hood on the left and right side
snaps of the face shield.
13
Set the
assembled PAPR
hood aside.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�putting
PPE
ON
2/2
PAPR, launderable gown, double gloves
Gown, Gloves, PAPR
14
Sanitize first
pair of gloves.
15
Put on gown outside room.
Open-end faces your back.
Tie gown at the neck.
16
17
Tie gown at waist.
Insert PAPR
power cord
connector into
the battery.
18
19
Put the helmet
on, letting the
hood drape
around your
shoulders over
the gown.
Straighten the
hood draping and
tie it down.
20
21
Pull cuffs half way
over palm of the
inner glove.
22
Sanitize
second
pair of
gloves.
Put on
second
pair of
gloves.
Entry
23
ENTER
room
DO NOT enter the
room if you do not
achieve a proper fit of
the PAPR system.
24
Do not touch or
re-adjust PAPR
system inside the
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�extended
wear
EW
INSIDE
room
1/2
PAPR, launderable gown, double gloves
Next patient:
COVID+
Gloves
1
Sanitize outer gloves.
2
Remove outer gloves.
Exit
3
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�extended
wear
EW
OUTSIDE
room
2/2
PAPR, launderable gown, double gloves
Next patient:
COVID+
Gloves
1
After outer
glove removal
in the patient
room,
exit and...
2
Pull cuffs half way
over palm of the
inner glove.
Put on fresh
outer gloves.
Walking
3
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
4
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
5
Sanitize outer
gloves.
6
7
Enter
NEXT
COVID-19
patient
room or
area.
Do not touch face or readjust PAPR system inside
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�taking
PPE
OFF
INSIDE
1/2
room
PAPR, launderable gown, double gloves
Next patient:
NOT COVID+
Gown, Gloves
1
Sanitize outer gloves.
4
2
Remove outer gloves.
With your back to the
exit, have a buddy
stand outside the
room and do the
next two steps while
wearing clean gloves.
6
7
Sanitize inner gloves.
5
Reach back
and release the
neck portion.
8
Remove
the gown
into the
designated
bin.
Untie the
waist.
3
Sanitize inner gloves.
Exit
9
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�taking
PPE
OFF
OUTSIDE
2/2
room
PAPR, launderable gown, double gloves
Next patient:
NOT COVID+
Hood
1
After gown
and outer
glove
removal...
5
2
Sanitize
gloves.
6
Pull face
shield
forward
and
release
helmet pin.
Place wipe
on table.
3
4
Untie
the
PAPR
hood.
Grasp face
shield at the
sides and
pull out
snaps.
7
Grab hood top,
pull back,
then pull
forward to
remove hood,
avoiding
your face.
If reusing, place hood
in designated bin.
Helmet, Battery, Belt
8
Sanitize
gloves.
9
Remove helmet
motor. DO NOT
touch your
face.
10
Put on mask.
11
12
Wipe
helmet.
Remove and
wipe battery.
13
14
Remove and
wipe belt.
Sanitize
gloves.
15
Remove
gloves.
16
Wash
hands.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Donning, Doffing Next patient: COVID+, Doffing Next patient: NOT COVID+.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/conserving-ppe.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PAPR - ACE - Launderable gown - Double Gloves
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<h2>ACE</h2>
<h3>PAPR (reuse)</h3>
<h3><strong>Launderable</strong> gown (reuse)</h3>
<h3>Double gloves</h3>
<p>Instructions for ACE PPE.</p>
<p>Useful for when you are...</p>
<ul><li>...experiencing PPE supply issues.</li>
<li>...caring for a symptomatic patients.</li>
<li>...performing aerosolizing procedures.</li>
</ul><p><em>These instructions were last updated on August 19, 2020</em></p>
<p>("V15")</p>
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-13
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
Contingency and crisis capacities
Coronavirus
COVID-19
Example
Gloves
Gown
Infection Prevention and Control
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/f8efb4c6ff7f7cd9165f9a7afb2554fb.pdf
6722459a7290e34570a1561ffcd4acdb
PDF Text
Text
Learn
more about
HOW MASKS WORK
Masks filter droplets but not air particles
?
Did you know ?
While viral particles are small, they don’t exist
on their own. They are contained in fluid, like
water or mucus, in droplets. And one droplet
can contain multiple viral particles.
Air molecules
Droplets
Mask
Air molecules like carbon dioxide (0.00065 micron)
and oxygen (0.0005 micron) are much smaller
than the tiny droplets (1 micron). This is why air
molecules pass through masks much more easily.
Airborne
virus
respiratory fluid
0.1μm
0.5μm
(0.2-100μm)
2020 Emory University, created by Visual Medical Education. Updated December 2, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice. EMORY
UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
HOW MASKS WORK
Why do you wear a mask?
?
Did you know ?
A mask uses small holes to keep out bigger
objects. The holes are small enough to allow
air molecules through. Most of the microscopic
droplets that contain viral particles are too large
to pass through.
A good mask does both:
COVID-19 is spread by droplets:
Like the flu, COVID-19 viral particles are
contained in microscopic wet droplets.
The droplets float around on air currents
and eventually fall onto surfaces.
A mask keeps
your germs
contained while
still allowing
you to exhale
normally.
It also keeps
other people’s
germs from
getting into your
mouth and nose,
while letting you
inhale normally.
2020 Emory University, created by Visual Medical Education. Updated December 2, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice. EMORY
UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
HOW MASKS WORK
Fibers are the key to protection
Credit: Stanford University, Cui et al.
The material of a mask is made up of fibers. Different masks use different types
of fibers. But many masks, like N95 respirators and procedure masks, are made of
materials that are naturally sticky to droplets. Though the droplets get caught, the
smaller molecules of the gasses in the air you breathe do not stick to the fibers.
The four ways virus-carrying droplets get stuck to fibers:
Some droplets have head-on
collisions with the fibers. The
droplet smashes right into a
fiber and sticks to it.
Some droplets graze the
fibers while passing by and
get stuck to them.
Even if the droplets avoid an
initial collision, currents of
air swirl the droplets around
until most of them end up
running into a fiber.
Some masks, like procedure
masks and N95s, are made
of fibers that carry a static
electricity charge which pulls
the droplets towards the fibers.
2020 Emory University, created by Visual Medical Education. Updated December 2, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice. EMORY
UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
HOW MASKS WORK
Mask layers
Bandanas and other
very thin or nearly see
through face coverings
have very few fibers.
It might filter some
larger droplets but a
lot of smaller droplets
get through.
A cloth mask is
better because
it is thicker, has
more tightly
woven layers,
and offers more
protection.
A cloth mask with
multiple woven
layers is better
than a regular cloth
mask because it is
thicker and offers
more protection.
Part of how effective a mask is has to do with
how close the fibers are together and how many
layers of fibers you have. The more tightly they
are packed and the more layers there are, the
more chances the droplets have to get stuck.
Procedure masks have
multiple non-woven
layers that make a
tricky maze for droplets
to get through. And
the static charge of the
fibers causes droplets
to stick to them.
KF94, N95, and KN95
have a dense mesh
work of static-charged
fibers that filter in both
directions and allow you
to breathe. Check the
NIOSH website list of
up-to-date respirators.
2020 Emory University, created by Visual Medical Education. Updated December 2, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice. EMORY
UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
HOW MASKS WORK
Look for the balance of breathable and filteration
If it’s too many layers:
A mask you buy at the store will
not have too many layers.
Dense fabrics are better than ones that you
can see through. Multiple layers are more
effective than just one, but don’t use so many
layers that you can’t breathe through them.
It is not a good fit if:
air will not be able to get through the mask and you can’t breathe.
If you make the mask too many layers,
it will be too hard to breathe through.
IMPORTANT
air is not going through or being filtered by
the mask.
If you are layering masks, never layer
a mask under a respirator or the
respirator will not form a seal.
If the mask is too big you will have big
gaps beside your nose or cheeks where
air will come in.
It’s okay if your mask dents in when
inhaling and balloons out when exhaling.
If you wear the mask under your nose,
air will only go through your nose.
2020 Emory University, created by Visual Medical Education. Updated December 2, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice. EMORY
UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
Emory VME
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/pdf-2/how-masks-work.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Learn more about how masks work
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This printable flyer infographic has information about how masks work, including how masks filter air, why you wear a mask, fibers in a mask, masks layers, and finding the balance of breathable and filtration.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-12-02
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Example
Mask
Mask Education
Masks
N95
Personal Protective Equipment (PPE)
Public Health
R-PPE
Respiratory Pathogen
Respiratory Protection
-
https://repository.netecweb.org/files/original/ff65004e5cde1dd822a7761f6dd209ec.pdf
0181bd6ba653c56c6ac933d6730b1f57
PDF Text
Text
Learn
more about
MASKS
?
Did you know ?
Some masks and respirators have
exhalation valves. These are not
acceptable during COVID because they can
release viral particles in the air.
How are types of masks different?
Cloth Mask
2,3
Pros
•
•
•
Keeps other safe by preventing
exhalation of viral particles
Washable and reusable
Easy to make on your own
Less filtration
No airborne particle protection
Susceptible to some droplets
N95 Respirator
1,2
1,2
Pros
Pros
•
•
•
•
•
•
May offer some additional protection
if others don’t mask
Medical grade certfied
Affordable and disposable
Cons
Cons
•
•
•
Procedure Mask
•
•
•
Not designed for multiple uses
Healthcare providers need them
Doesn’t filter airborne particles
Dense filter
Filters airborne particles and droplets
Medical grade certfied
Cons
•
•
•
Harder to breathe
Healthcare providers need them
Require training to wear properly
Affordability
Affordability
Affordability
Reusability
Protection
Reusability
Protection
Reusability
Comfort level
Comfort level
Comfort level
Protection
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
What to do when...?
I’m hot, thirsty, or hungry
?
Did you know ?
Batching your breaks is the best and
safest idea. The more you take on and
off your mask, the less effective of a
barrier it is.
I need to make/answer this call
Cool down
Foggy glasses
Use ear buds
If you feel hot, take off your mask
without touching your face and
take a break.
This means air is escaping
from your mask. Wash hands
and refit mask in a designated
safe area.
Hold your phone away from
your face and mask.
Speaker phone
Really hydrate
Eat enough
Drink plenty of water before
putting your mask on.
Eat enough in one setting to
stay energized.
Turn up the volume or
put on speaker phone.
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative
Creative Commons
Commons Attribution-NonCommercial-NoDerivs
Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
?
Did you know ?
Making your cloth mask out of cotton
fabric is affordable, as well as helping
it be more breathable and comfortable
against your skin.
What to do when...?
This feels uncomfortable on my skin
Wash up
Moisturize
Au naturel
Wash your face
before and after
wearing your mask.
Apply lotion or
vaseline after
washing your face to
protect your skin.
Avoid wearing
make up under your
mask.
Drink up!
Roll it in
Get crafty
Consider using a skin
protectant approved
for facial use if skin is
irritated.
Use handmade ear
savers so the mask
straps won’t put too
much pressure on
your ears.
Drink water to help
moisturize your
skin from the inside
out.
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative
Creative Commons
Commons Attribution-NonCommercial-NoDerivs
Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
?
Did you know ?
When wearing a mask, do not:
Pull below chin or hang around neck
Touch outside of mask or touch phone to mask
Touching your face is a subconscious
habit that is often a response to feeling
stressed. Take deep breaths and time to
relax so you touch it less often.
Pull below nose
Wear on forehead
Leave straps hanging or hang from one ear
Remove mask to cough or talk
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative
Creative Commons
Commons Attribution-NonCommercial-NoDerivs
Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
?
Did you know ?
How to take your mask on and off
It takes at least 20 seconds to wash your
hands properly? Sing “Happy Birthday” to
yourself two times while scrubbing them with
soap and water if you don’t have a timer.4
Properly putting on masks
1
2
Wash your
hands and
sanitize if
you can.
Make sure your mask
fits properly and feels
comfortable. Talk and make
sure the mask doesn’t slip.
You don’t want to readjust
once it’s on.
Properly taking masks off
1
2
Try not to
touch your
face when
you remove
mask.
If you are reusing
mask, it can be
helpful to store
it in a paper bag.
Fold mask with
inside surface
facing outside.
3
Wash your hands or sanitize
after handling your mask.
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative
Creative Commons
Commons Attribution-NonCommercial-NoDerivs
Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
?
Did you know ?
Properly handle your mask
Cleaning Mask
The heat cycle of most washing machines and is
effective for degrading most viruses.5
Storing Mask
To wash or not to wash?
Disposing of mask
When to discard
Cloth masks can be reused
many times. Clean it regularly
and immediately if it gets
soiled.
Surgical masks and N95
respirators will break
down in a washing
machine or with
scrubbing.1,2
If you are wearing a procedure
mask - discard if it becomes
visibly soiled.
Washing your cloth mask
in a washing machine is
sufficient to get it clean.3
Wash hands or sanitize
Dry
Hang to dry and store in a
bag when completely dry.
When storing your mask, fold
your cloth or surgical mask in
half and place in a paper bag.
Your hands must be cleaned
after handling your mask.
Be sure to wash your hands,
and sanitize before doing
anything else.
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative
Creative Commons
Commons Attribution-NonCommercial-NoDerivs
Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
Materials
Making your own cloth mask (w/o sewing)
•
•
•
•
1
4
Cut the bottom off a
folded coffee filter. Keep
the top part
Fold the top down.
Fold the bottom up.
2
5
Lay 20” x 20” (50cm x 50 cm)cloth flat
in a rectangle. Fold the cloth in half.
Place hair ties around the
folded cloth, 6 inches apart.
6
3
20” x 20” (50cm x 50 cm) cotton cloth
(Bandana, T-shirt)
Coffee filter
Two hair ties
Scissors
Fold the cut filter in the
center of the folded cloth.
Fold the side of the cloth in
toward the middle and tuck.
7
6 inches
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative
Creative Commons
Commons Attribution-NonCommercial-NoDerivs
Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
Materials
Making your own cloth mask (sewing)
• Two 10” x 6” (26cm x 16 cm)rectangles of tightly woven
cotton fabric
• Two 6” (16 cm) pieces of string, cloth strips, or hair ties
• Needle & thread, or bobby pin & sewing machine
• Scissors
1
Cut out the two 10” x 6” (26cm
x 16cm) rectangles and stack
on top of each other.
2
Fold the double layer of fabric over the long
sides for 1/4 inch (0.6 cm) and stitch. This
hem is to strengthen the mask.
Make ear loops by threading a 6” (16cm) string
through the wider hem on each side and knotting.
Fold over 1/2 inch (1.2 cm) along
the short sides and stitch down.
This hem is for the ear loops.
1/2 inches
(1.2 cm)
1/4 inches
(0.6 cm)
4
3
5
Pull on the ear loops so the
knots are tucked inside the hem.
6
stitch
knot
stitch
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative
Creative Commons
Commons Attribution-NonCommercial-NoDerivs
Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
Exhalation valves
DO NOT WEAR A MASK WITH AN EXHALATION VALVE
Most masks with exhalation valves do not have a filter built
into the valve, so the moist air you exhale goes right out into
the air around you. If you are an asymptomatic carrier than
you could spread COVID to others.
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative
Creative Commons
Commons Attribution-NonCommercial-NoDerivs
Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�Learn
more about
MASKS
Citations
1. Food and Drug Administration, information and comparison of surgical and N95 respirators.
https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgicalmasks-face-masks
2. Johns Hopkins School of Public Health, information on types of masks and their uses.
https://www.jhsph.edu/covid-19/articles/the-right-mask-for-the-task.html
3. Center for Disease Control, information about cloth masks for the general public.
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
4. The Mayo Clinic, information on proper hand-washing technique.
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/hand-washing/art-20046253
5. World Health Organization, technical brief on boiling water and sanitzing.
https://www.who.int/water_sanitation_health/dwq/Boiling_water_01_15.pdf
6. Preliminary research on UV light as a disinfectant.
https://www.sciencedaily.com/releases/2020/04/200414173251.htm
https://www.nebraskamed.com/COVID/how-were-using-ultraviolet-light-to-slow-the-n95-mask-shortage
2020 Emory University, created by Visual Medical Education. Updated July 30, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other
professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR
FITNESS FOR A PARTICULAR PURPOSE.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
Emory VME
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/pdf/learn-about-masks.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Learn more about masks
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This printable flyer infographic provides information on how types of masks are different, what to do when, what not to do when wearing a mask, how to take your mask on and off, how to properly handle your mask, making your own mask, and on exhalation valves.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-30
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Example
Mask
Masks
N95
Personal Protective Equipment (PPE)
Public Health
R-PPE
Respiratory Pathogen
Respiratory Protection
-
https://repository.netecweb.org/files/original/fe1e00f9c44f400bba2d6a27f2fb770f.png
04fa464b3df0258b1e9d22bbd9bd163f
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_73382
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NIOSH PPE Tracker App
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
<p>The NIOSH PPE Tracker mobile app can help healthcare and non-healthcare systems track their personal protective equipment (PPE) inventory. Facilities can use the app to calculate their average PPE consumption rate or “burn rate.” The app estimates how many days a PPE supply will last given current inventory levels and PPE burn rate. Based on the <a href="https://www.cdc.gov/niosh/topics/pandemic/docs/PPE-Burn-Rate-Calculator-Version-3.xlsx">PPE Burn Rate Calculator Excel spreadsheet</a>, the app features several improvements, including an easy-to-use interface and the ability to add restock. <br /><br />The app is available for both iOS and Android devices.</p>
<p><strong>Key Features</strong></p>
<p>With the NIOSH PPE Tracker app, you can</p>
<ul>
<li>Track different types of PPE, such as gowns, gloves, surgical masks, respirators, face shields, and more</li>
<li>Track inventory by number of boxes or number of individual units</li>
<li>Add restock when calculating inventory totals</li>
<li>Calculate burn rate by type of PPE (such as gloves) and for specific units (such as small gloves)</li>
<li>Calculate PPE burn rate by the number of patients being treated and track changes in PPE usage as the number of patients fluctuates</li>
<li>Download inventory and burn rate data and share reports via email</li>
</ul>
Creator
An entity primarily responsible for making the resource
CDC, NIOSH
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-11
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Relation
A related resource
Y - PPE pos 91 qualtrics 312
Y - D0.1PPE/D0.2PPE Qualtrics # 312
2019-nCoV
Checklist
Coronavirus
COVID-19
Emergency Management
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-PPE
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/278e22c004ef8ca70aee86b00b909a87.png
23d4d251e2f3df636bd36072f5a1a669
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Safe and Proper N95 Storage" src="https://www.youtube.com/embed/RLKjU1q9Tf4?w" frameborder="0"></iframe>
URL
https://youtu.be/RLKjU1q9Tf4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Safe and Proper N95 Storage
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Paper Bagging: How to properly and safely store your N95. This video shows an animation of the proper technique for safely storing your N95. Created by Emory VME (https://med.emory.edu/ppe) and NETEC (https://netec.org/).
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-11-20
Relation
A related resource
Y - PPE pos 99 qualtrics 319
Y - D0.1PPE/D0.2PPE Qualtrics # 319
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - great if re-use is emergently needed. Does this still belong in SPORSA?
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Infection Prevention and Control
Just in Time training (JIT)
N95
Personal Protective Equipment (PPE)
R-PPE
Respirator
Respiratory Pathogen
Respiratory Protection
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Lane, Morgan, Colleen S. Kraft, Marie Ayers, Kari Love, Erik Brownsword, and Mary Elizabeth Sexton. 2020. "Novel Approach to Deployment of Crisis Situation Supply of N95 Respirator Models in a Healthcare System." American journal of infection control.
Abstract
<div class="abstract-content selected">
<p>Given supply constraints of N95s in the US during the COVID-19 pandemic, healthcare facilities have turned to extended use protocols and new sources of N95s. Because fit testing every employee for every new mask is not feasible, our Infection Prevention Department developed a method for rapid deployment of new N95s.</p>
</div>
<p><strong class="sub-title"> Keywords: </strong> N95s; infection prevention; pandemic; rapid deployment.</p>
<p class="copyright" id="copyright">Copyright © 2020. Published by Elsevier Inc.</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Available with Elsevier account, or free on PubMed Central
URL
https://pubmed.ncbi.nlm.nih.gov/33159996/
Read Online
Online location of the resource.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8800390/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Novel Approach to Deployment of Crisis Situation Supply of N95 Respirator Models in a Healthcare System
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
Given supply constraints of N95s in the US during the COVID-19 pandemic, healthcare facilities have turned to extended use protocols and new sources of N95s.
Creator
An entity primarily responsible for making the resource
Lane, Morgan, Colleen S. Kraft, Marie Ayers, Kari Love, Erik Brownsword, and Mary Elizabeth Sexton.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-11-04
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
Relation
A related resource
Y - PPE pos 88 qualtrics 309
Y - D0.1PPE/D0.2PPE Qualtrics # 309
2019-nCoV
Coronavirus
COVID-19
Emergency Management
N95
Occupational Exposure
Personal Protective Equipment (PPE)
Procedure
Process
R-EM
R-PPE
R-Res&Pub
Respirator
-
https://repository.netecweb.org/files/original/b264eba050eef62fcd21774118230156.pdf
db35838b8338eee872fe3833a9a2030e
PDF Text
Text
putting
PPE
ON
1/1
N95
respirator
Coveralls
Face
shield
Inner gloves Outer gloves
Coveralls, Gloves
1
2
Batch work and plan
ahead, having items
available
outside each
patient room.
3
If you already have a mask on:
Sanitize
hands.
Remove
mask.
4
Store
mask.
Put on first
pair of gloves.
Sanitize
hands.
5
6
Put on coveralls outside room.
Open-end faces your front.
Put on second
pair of gloves
over the cuffs of
the coveralls.
Sanitize
gloves.
Zip up the front of the coveralls.
N95
7
8
Put on N95,
ensuring proper
seal.
Ensure straps
are not crossing.
9
Place hands over
the front of the
N95. Breathe an
easy deep breath
in and out.
Sanitize outer
gloves.
If you feel air
escape the
edges, refit
and repeat.
Face Shield, Entry
10
11
Put on face
shield.
12
Sanitize
outer
gloves.
13
ENTER
room
Do not touch face or readjust N95 or face shield
inside room.
DO NOT enter the room if
you do not achieve a proper
respirator seal.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�extended
wear
EW
INSIDE
room
1/2
N95, face shield, coveralls, double gloves
Next patient:
COVID+
Gloves
1
Sanitize outer gloves.
2
Remove outer gloves.
3
Sanitize inner gloves.
Exit
4
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�extended
wear
EW
OUTSIDE
room
2/2
N95, face shield, coveralls, double gloves
Next patient:
COVID+
Gloves
1
After outer
glove removal
in the patient
room,
exit and...
2
Sanitize
inner
gloves.
Put on fresh
outer gloves.
Walking
3
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
4
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
7
5
Sanitize outer
gloves.
6
Enter NEXT
COVID-19
patient
room or
area.
Do not touch face or readjust N95 or face shield
inside room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�taking
PPE
OFF
INSIDE
1/2
room
N95, face shield, coveralls, double gloves
Next patient:
NOT COVID+
Gloves, Coveralls
1
5
2
Sanitize
outer gloves.
Sanitize
inner gloves.
9
Remove
outer gloves.
6
3
Sanitize
inner gloves.
7
10
Wipe down
torso, arms,
and legs.
8
Grasp
coveralls
around
lower back
area and
pull down.
Zip
down
coveralls.
Remove and
step out of the
coveralls by
marching and
stomping on
the arms of the
coveralls.
4
Remove
into bin
for reuse
without
touching
outside of
coveralls.
11
Remove
coveralls
from
shoulders
and pull
down below
knees.
Sanitize
gloves.
Exit
12
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�taking
PPE
OFF
OUTSIDE
2/2
room
N95, face shield, coveralls, double gloves
Next patient:
NOT COVID+
Gloves, Setup
1
After glove and
gown removal
in the patient
room,
exit and...
2
Put on fresh
gloves.
3
Sanitize
gloves.
Place wipe
on table.
N95
4
5
Remove face shield
and place on wipe.
Sanitize
gloves.
6
7
Remove
N95, lower
strap
and then
upper.
Store
N95.
8
Sanitize
gloves.
Put on
mask.
Face Shield
9
10
11
Place
shield in
bag to dry.
Wipe shield. Sanitize in the following
order:
12
Wipe
table.
14
Back of
shield.
Elastic
band.
Foam
band.
Sanitize
gloves.
13
Remove
gloves.
Wash hands with
soap and water
or sanitize hands.
Front of
shield.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
Emory VME
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/emergency-dept-ppe.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Emergency Department PPE: ACE, N95 (reuse), Face shield (reuse), Coverall (reuse), Double gloves
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19: Printable PDF<br />Putting PPE ON, Extended Wear, Taking PPE OFF<br /><p>Instructions for ACE PPE.</p>
<p>Useful for when you are...</p>
<ul><li>...experiencing PPE supply issues.</li>
<li>...caring for a symptomatic patients.</li>
<li>...performing aerosolizing procedures.</li>
</ul><p><em>These instructions were last updated on August 17, 2020.</em></p>
<p>("V11")</p>
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-17
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-01
2019-nCoV
Contingency and crisis capacities
Coronavirus
Coveralls
COVID-19
Donning and Doffing
Emergency Department
Example
Extended wear
Face shield
Gloves
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/419933b82a54349a24f4d783c91cdb3b.pdf
769764272610d00e7849b8de80628911
PDF Text
Text
putting
PPE
ON
1/1
CAPR
system
Coveralls
Inner gloves Outer gloves
Gloves
2
1
Batch work and plan
ahead, having items
available
outside each
patient room.
If you already have a mask on:
Sanitize
hands.
Remove
mask.
Store
mask.
3
Sanitize
hands.
Put on first
pair of gloves.
Lens Cuff
4
Remove the
lens protector
liner from the
front side of the
lens cuff.
5
6
Secure the lens cuff by
aligning the center hole
over the center attachment
post on the helmet.
Attach the left and
right side lens cuff
mounting holes over
the left and right
side attachment
posts of the helmet.
Tip: The lens cuff
will click when it is
properly secured.
7
Lift the cuff
flappers to
rest against
the foam
pads at the
ends of the
comfort strip.
8
9
Insert
the power
cord
connecter
into the
battery.
Check the LED lights
to ensure the battery
is fully charged.
10
Adjust fan
speed to
comfort.
Battery, Belt
11
12
Secure the battery
to the belt using the
battery clip.
Secure the belt
around the waist.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�putting
PPE
ON
2/2
CAPR, coveralls, double gloves
Helmet
13
14
Hold the helmet near
the rear headband with
one hand, pull down on
top of the lens cuff with
the other.
Turn ratchet knob
counterclockwise
to loosen the
headband.
15
18
16
Place the
chin into the
lens cuff while
pulling the
helmet over
and down on
the head.
17
Turn the
ratchet knob
counter
clockwise to
tighten the
headband.
Slide the fingers
around the cuff
under the chin
to ensure slight
tension.
19
Check for proper fit, ensure:
The cuff flappers
are perpendicular
to the head.
LED indicators
are in your
peripheral vision.
The cuff
flappers are 1/4
inch from the
temples.
The bottom of
the headband
rests 1/2 inch
from eyebrows.
Tip: If the headband
is not in an
appropriate height,
doff, adjust the
headband height
position, and redo.
Entry
20
21
Put on coveralls outside room.
Open-end faces your front.
22
Sanitize
first pair
of gloves.
Put on second
pair of gloves.
Zip up the front of the coveralls.
23
24
Sanitize
second
pair of
gloves.
ENTER room
DO NOT enter the room if
you do not achieve a proper
fit of the CAPR system.
25
Do not touch or
re-adjust CAPR
system inside the
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�extended
wear
EW
INSIDE
room
1/2
CAPR, coveralls, double gloves
Next patient:
COVID+
Gloves
1
Sanitize outer gloves.
2
Remove outer gloves.
3
Sanitize inner gloves.
Exit
4
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�extended
wear
EW
OUTSIDE
room
2/2
CAPR, coveralls, double gloves
Next patient:
COVID+
Gloves
1
After outer
glove removal
in the patient
room,
exit and...
2
Sanitize
inner
gloves.
Put on fresh
outer gloves.
Walking
3
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
4
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
5
6
Sanitize outer
gloves.
7
Enter NEXT
COVID-19
patient
room or
area.
Do not
touch
face or
re-adjust
CAPR
system
inside
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
INSIDE
1/3
room
CAPR, coveralls, double gloves
Next patient:
NOT COVID+
Gloves, Coveralls
1
5
2
Sanitize
outer gloves.
Sanitize
inner gloves.
9
Remove
outer gloves.
6
3
Sanitize
inner gloves.
7
10
Wipe
down
torso,
arms, and
legs.
8
Grasp
coveralls
around
lower back
area and
pull down.
Zip
down
coveralls.
Remove and
step out of the
coveralls by
marching and
stomping on
the arms of the
coveralls.
4
Remove
into bin
for reuse
without
touching
outside of
coveralls.
11
Remove
coveralls
from
shoulders
and pull
down below
knees.
Sanitize
gloves.
Exit
12
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
OUTSIDE
2/3
room
CAPR, coveralls, double gloves
Next patient:
NOT COVID+
Lens Cuff
1
After coveralls
and outer glove
removal...
4
2
Sanitize
gloves.
Place first wipe
on table.
3
Grab lens cuff at
the left and right
side attachments.
Remove and by
pulling outward and
forward.
5
Place lens
cuff on wipe.
6
Wipe front and
back of lens cuff.
Allow to dry.
Store lens
cuff in a gallon
sized bag
labeled with
your name.
Helmet
7
Sanitize
gloves.
8
Place
second
wipe on
table.
13
9
Grasp outer-shell of helmet
and take off.
Ensure that
the helmet
cord doesn’t
touch your
body.
14
Wipe inside of the
helmet.
15
Sanitize
gloves.
11
10
Place helmet
on first wipe.
12
Sanitize
gloves.
Put on
mask.
16
Hold inside
of the
helmet and
flip onto
second
wipe.
Wipe outside of the
helmet.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
OUTSIDE
3/3
room
CAPR, coveralls, double gloves
Next patient:
NOT COVID+
Battery
17
18
Wipe
helmet
cord.
Sanitize
gloves.
19
20
Remove
and wipe
battery.
Sanitize
gloves.
21
22
Remove
belt and
wipe.
Sanitize
gloves.
Gloves
24
23
25
Remove
gloves.
Wash
hands.
Sanitize
gloves.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
Emory VME
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/emergency-dept-ppe.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Emergency Department PPE: ACE, CAPR (reuse), Coverall (reuse), Double gloves
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19: Printable PDF<br />Putting ON PPE, Extended Wear, Taking OFF PPE<br /><p>Instructions for ACE PPE.</p>
<p>Useful for when you are...</p>
<ul><li>...experiencing PPE supply issues.</li>
<li>...caring for a symptomatic patients.</li>
<li>...performing aerosolizing procedures.</li>
</ul><p><em>These instructions were last updated on August 17, 2020.</em></p>
<p>("V9")</p>
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-17
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-01
2019-nCoV
CAPR
Contingency and crisis capacities
Coronavirus
Coveralls
COVID-19
Donning and Doffing
Emergency Department
Example
Extended wear
Gloves
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/7967ccc6a3d5df49fb5f50508ac284c0.pdf
96c36b2d5cd689ec646d29116b7d5121
PDF Text
Text
putting
PPE
ON
1/1
Coveralls
PAPR
system
Inner gloves Outer gloves
Gloves
1
2
Batch work and plan
ahead, having items
available
outside each
patient room.
If you already have a mask on:
Sanitize
hands.
Remove
mask.
Store
mask.
3
Put on first
pair of gloves.
Sanitize
hands.
Helmet
4
Secure the
belt around the
waist.
5
Secure the
battery on the left
side of the belt.
6
7
Check the LED lights
to ensure the battery
is fully charged.
Connect
the helmet
to the
battery.
8
Put helmet on head
and size to fit by
turning ratchet knob to
adjust the headband.
9
Adjust fan
speed to
comfort.
10
Disconnect
the battery.
11
Take off the helmet and place
it inside the PAPR hood.
Ensure the white
HEPA filter is on
top, the helmet is
inside filter pouch,
and the adjustable
knob is outside of
filter pouch.
Hood
12
13
Slide the helmet into the hood
until it snaps in the center
hole. Snap helmet into the
hood on the left and right side
snaps of the face shield.
Set the
assembled PAPR
hood aside.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�putting
PPE
ON
2/2
PAPR, coveralls, double gloves
Coveralls, Gloves, PAPR
14
15
Sanitize
first pair
of gloves.
Put on coveralls outside room.
Open-end faces your front.
16
17
Insert PAPR
power cord
connector into
the battery.
Put the helmet on,
letting the hood drape
around your shoulders
over the coveralls.
18
19
Zip up the front
of the coveralls.
Straighten the
hood draping and
tie it down.
21
20
Put on
second pair
of gloves.
Sanitize
second
pair of
gloves.
Entry
22
23
ENTER
room
DO NOT enter the
room if you do not
achieve a proper fit of
the PAPR system.
Do not touch or
re-adjust PAPR
system inside the
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�extended
wear
EW
INSIDE
room
1/2
PAPR, coveralls, double gloves
Next patient:
COVID+
Gloves
1
Sanitize outer gloves.
2
Remove outer gloves.
3
Sanitize inner gloves.
Exit
4
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�extended
wear
EW
OUTSIDE
room
2/2
PAPR, coveralls, double gloves
Next patient:
COVID+
Gloves
1
After outer
glove removal
in the patient
room,
exit and...
2
Sanitize
inner
gloves.
Put on fresh
outer gloves.
Walking
3
4
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
5
6
Sanitize outer
gloves.
7
Enter NEXT
COVID-19
patient
room or
area.
Do not touch face or readjust PAPR system inside
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
INSIDE
1/2
room
PAPR, coveralls, double gloves
Next patient:
NOT COVID+
Gloves, Coveralls
1
5
2
Sanitize
outer gloves.
Sanitize
inner gloves.
9
Remove
outer gloves.
6
3
Sanitize
inner gloves.
7
10
Wipe
down
torso,
arms, and
legs.
8
Grasp
coveralls
around
lower back
area and
pull down.
Zip
down
coveralls.
Remove and
step out of the
coveralls by
marching and
stomping on
the arms of the
coveralls.
4
Remove
into bin
for reuse
without
touching
outside of
coveralls.
11
Remove
coveralls
from
shoulders
and pull
down below
knees.
Sanitize
gloves.
Exit
12
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
OUTSIDE
2/2
room
PAPR, coveralls, double gloves
Next patient:
NOT COVID+
Hood
1
After gown
and outer
glove
removal...
5
2
Sanitize
gloves.
Place
wipe on
table.
6
Pull face
shield
forward
and
release
helmet pin.
3
4
Untie
the
PAPR
hood.
7
Grab hood
top, pull back,
then pull
forward to
remove hood,
avoiding your
face.
Grasp face
shield at the
sides and
pull out
snaps.
If reusing,
place
hood in
designated
bin.
Helmet, Belt, Battery
8
Sanitize
gloves.
9
Remove
helmet motor,
DO NOT touch
your face.
13
10
Put on
mask.
14
Remove
and wipe
belt.
11
Sanitize
gloves.
Wipe
helmet.
15
12
Remove
gloves.
Remove
and
wipe
battery.
16
Wash
hands.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
Emory VME
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/emergency-dept-ppe.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Emergency Department PPE: ACE, PAPR (reuse), Coveralls (reuse), Double gloves
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19: Printable PDF<br />Putting ON PPE, Extended Wear, Taking OFF PPE<br /><p>Instructions for ACE PPE.</p>
<p>Useful for when you are...</p>
<ul><li>...experiencing PPE supply issues.</li>
<li>...caring for a symptomatic patients.</li>
<li>...performing aerosolizing procedures.</li>
</ul><p><em>These instructions were last updated on August 17, 2020. </em></p>
<p>("V10")<em><br /></em></p>
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-17
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-01
2019-nCoV
Contingency and crisis capacities
Coronavirus
Coveralls
COVID-19
Donning and Doffing
Emergency Department
Example
Extended wear
Gloves
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/62ee949618d3590b9f39fbeefa7b8041.pdf
bd3e742ac2f2dc73c2befbac7afe2570
PDF Text
Text
Are N95 respirators with
Exhalation valves
appropriate for COVID?
??
Protecting your patients
1
2
cover
3
When you
exhale,
the valve
flaps
open.
valve
respirator
surface
Exhalation valve is a one-way
valve that opens only when you
exhale.
Airborne particles travels
freely through the valve.
N95 without a valve
doesn’t allow droplets to
go across the respirator.
How does this apply to COVID?
Not protected
Protected
N95 without valve
N95 without valves can prevent contaminants
dispersing between you and other people.
N95 + valve
Exhaled airborne contaminants pass through
the valve on the N95.
Your respirator protects you, but the patient
is at risk if you are an asymptomatic or
presymptomatic carrier.
Likewise, valves on other
masks are also ineffective to
protect those around you.
What are exhalation valves for?
N95 with valves are invented
for industrial use.
N95 with valves do not
protect patients.
They block out inhalation of
airborne contaminants while
cooling the user.
Always wear a respirator
that doesn’t have a valve
to protect those around you
from getting infected.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated July 2, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
Emory VME
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/general-ppe-guidance.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
N95 Exhalation valves
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p class="html-content">COVID-19 General PPE Guidance: Are N95 respirators with exhalation valves appropriate for COVID?<br /><br />Healthcare providers have often worn N95's with exhalation valves to enhance comfort. In the COVID-19 era, these can be a vehicle for transmission from the provider to the patient. This one page education sheet explains more about why this is a concern and what you should use instead.</p>
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-02
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-01
2019-nCoV
Airborne Transmission
Coronavirus
COVID-19
Decontamination
Droplet Transmission
Example
Infection Prevention and Control
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/547a6a6348c42c231d7c20eea1757061.pdf
58c15b6d621967fb57ae25a2fe3de61b
PDF Text
Text
Cleaning Your Face Shield
Emory University, created by Visual Medical Education. Updated July 20, 2020
1
2
3
4
5
6
7
8
Wipe* front and
back of shield.
Place shield
upside down to
dry or in bag.
Wipe elastic band. Wipe foam band.
Sanitize gloves.
Remove gloves.
*Use approved disinfectant wipes and gloves.
Wipe table.
Wash hands with
soap and water or
sanitize hands.
�Using Your Face Shield
Basics of eye protection:
• You are expected to wear both a procedure mask and eye protection for all
interactions with patients – this prevents you from being exposed if a patient
cannot wear a mask and is unexpectedly COVID positive.
• If you are not working with COVID+ patients or PUIs, you can either leave
your eye protection on throughout the day or remove it between patient encounters. Your mask must remain on at all times.
Face shield maintenance:
• Write your name on the face shield or goggles in Sharpie.
• Store it in a drawstring bag with your name on it when you aren’t using it.
• Continue to reuse unless broken. If eye protection breaks, notify your leader.
Take off your face shield and clean with disinfecting wipes:
• After seeing a COVID+ patient or PUI unless you are working in a warm zone,
or seeing multiple confirmed COVID+ patients back to back.
• If there is any visible soiling.
• Before you store it in your bag.
Emory University, created by Visual Medical Education. Updated July 20, 2020
�
Dublin Core
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Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
Emory VME
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/general-ppe-guidance.html
Dublin Core
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Title
A name given to the resource
Face shield decon card
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p class="html-content">COVID-19: General PPE Guidance: This card was designed for Emory Healthcare workers to keep in their ID badge case. It depicts the proper steps and guidance for decontaminating <strong>face shield</strong> for reuse.</p>
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-20
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-01
2019-nCoV
Coronavirus
COVID-19
Decontamination
Example
Face shield
Gloves
Hand Hygiene
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/452c52803b65e5a1bc8d1de721f43ed1.pdf
2a390bc1ddf49f99c5dd7f0a9f806de8
PDF Text
Text
10-15-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
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Title
A name given to the resource
Steps for Safe Use of Any Mask
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This is a printable flyer infographic covering the safe use of any type of mask.<br /><br />Whether your mask is cloth or paper, uses ear loops or ties - use these steps to safely put on and take off your mask.<br /><br />Go to the <a href="https://repository.netecweb.org/items/show/1467">Spanish language version</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-15
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - contains reuse
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control; PPE
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Donning and Doffing
Infection Prevention and Control
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/8e2a972a29c32d53ac5718615308a737.pdf
589fbcd9c0276532cbfe9c156f3c5ed1
PDF Text
Text
09-24-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Anatomy of a Procedure Mask
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This printable flyer infographic discusses the anatomy of a Procedure Mask, and what you need to know.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-07
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - Think to keep for now - general info that should not change & could be helpful for winter resp. virus season
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
2019-nCoV
Coronavirus
COVID-19
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
Respiratory Pathogen
Respiratory Protection
-
https://repository.netecweb.org/files/original/b9a7dc174b35f2edea69f5c53526e331.pdf
498380f8fe455dbdbf4f23568ddb8b51
PDF Text
Text
09-15-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
How to Wear a Mask
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Follow these guidelines for the best protection from your mask.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-15
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group- Think to keep for now - general info that should not change & could be helpful for winter resp. virus season
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
2019-nCoV
Coronavirus
COVID-19
Infection Prevention and Control
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Gandhi, Monica, Chris Beyrer, and Eric Goosby. 2020. "Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer." Journal of General Internal Medicine.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on SpringerLink and Pub Med Central.
URL
https://pubmed.ncbi.nlm.nih.gov/32737790/
Read Online
Online location of the resource.
https://link.springer.com/article/10.1007/s11606-020-06067-8
Dublin Core
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Title
A name given to the resource
Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Although the benefit of population-level public facial masking to protect others during the COVID-19 pandemic has received a great deal of attention, we discuss for one of the first times the hypothesis that universal masking reduces the “inoculum” or dose of the virus for the mask-wearer, leading to more mild and asymptomatic infection manifestations.
Creator
An entity primarily responsible for making the resource
Gandhi, Monica, Chris Beyrer, and Eric Goosby.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-31
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
2019-nCoV
Coronavirus
COVID-19
Infection Prevention and Control
Mask
Masks
N95
Pandemic
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/b9423bf471c704e2f8d2afdbfc9ab758.pdf
e1f3dec713c671f537403f615ead14b3
PDF Text
Text
NETEC COVID-19 Webinar Series:
Got Masks? PPE Compliance and Fatigue
in the First Responder Realms
�Content Outline (TOC)
Welcome
Amanda Grindle, MSN, RN
�Overview
Welcome: Amanda Grindle, RN, MSN
PPE Compliance and Fatigue in First Responder Realms
Questions and Answers: Lekshmi Kumar, MD, MPH
Michael Carr, MD
Ben Tysor, NRP
Wade Miles, NRP
Questions and Answers with NETEC:
NETEC Resources: Amanda Grindle, RN, MSN
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
PPE Compliance and Fatigue
in the First Responder Realms
Questions and Answers
Lekshmi Kumar, MD, MPH
Ben Tysor, NRP
Michael Carr, MD
Wade Miles, NRP
�QUESTION 1:
“I had COVID-19 in July. I recovered and I’m now back at work. Do I need to
wear all of the same PPE as those who haven’t had it or am I immune to it?”
Immunity
Re-infection
•
•
•
•
•
•
•
•
SARS-CoV-2-specific antibodies identified
Neutralizing antibodies
Cell-mediated component
Varying degrees of immunity
Testing positive after recovery – what does it mean?
No symptomatic re-infection within 3 months identified
Ongoing antibody trend studies
Not enough known to recommend against PPE after recovery
PPE Guidelines Should Continue to be Followed
ü Healthcare: Airborne, contact, eye shield as indicated
ü Community: Masks, social/physical distancing
ü Public health measures: stay-at-home, public gathering bans, travel restrictions
�QUESTION 2:
“My employer has provided us with several different types of PPE since March, but
they have not provided us guidance on how to use it. How can I educate myself to
make sure I’m using it properly?”
ü OSHA requires employer to ensure EMS are medically cleared, properly trained,
and fit tested to use a respirator such as an N95 or PAPR. Gowns and coveralls
may have manufacturer recommendations for use
ü Use checklists for donning and doffing
ü Use buddy system for donning and doffing
https://www.cdc.gov
https://netec.org
https://asprtracie.hhs.gov
�QUESTION 3:
“Fatigue is rising, what techniques can we utilize to continue to meet PPE compliance?”
Barriers to HCW adherence to PPE
•
•
•
•
•
Task burden
Infection prevention / control guidelines
Education and training
Supplies and environment
Ensuring compliance
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013582/full
�QUESTION 4:
“Given limited resources of N-95 masks should we be
saving our masks and PPE for COVID positive patients?”
Extended use versus Reuse
Proper donning, doffing, storage
Discard soiled respirators
Follow manufacturer’s instructions
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/eye-protection.html
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
�QUESTION 5:
“What if we respond to an MVA and do not suspect the
patient has the virus, do we still need to wear a mask?”
In a pandemic
Existing infection protocols
will/should be followed until declared “over”
Local incidence
• Higher incidence = higher risk
ü COVID-19 data tracker for your region
ü CDC website: https://covid.cdc.gov/covid-data-tracker/
Asymptomatic transmission
• Percentage of asymptomatic infections estimated to be 20-50% (ASPR and CDC)
• “Current Best Estimate”
• 40% asymptomatic • 50% transmission occurring prior to symptom onset
Pandemic - protocols prevent spread
• Community: masks, social/physical distancing
• Public health measures
• Region-specific guidelines
• Based on local infection rates
�QUESTION 6:
“What if it’s an inter-facility transfer and the patient is known negative?”
Standard precautions
(at all times)
AND
Transmission-based precautions
(if required based on the suspected diagnosis)
Patient PPE - Face mask on patient for source control
Provider PPE - Gloves, eye protection and N95
PPE selection if aerosolizing procedures are anticipated - Gloves, N-95 facemask, eye
protection, gown or coverall
• Leave back and side doors open and exhaust fans on high if possible
Limit the number of providers in patient compartment to one
• Unless more are required to provide life-saving patient care
�QUESTION 7:
“Should we be wearing masks and socially distancing at our EMS headquarters?”
EMS personnel should wear a facemask at all times while in service, including in
breakrooms or other spaces where they might encounter co-workers!
Non-essential personnel should be encouraged to work from home
Continue symptom screening
Continue practicing physical distancing
Important to remember
SARS-CoV-2 is not limited to direct patient care interactions
https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-for-ems.html
�QUESTION 8:
“I work for a fire service, so I spend a lot of time with the same people.
Do we really need to wear masks and socially distance at the station?”
Common policy in fire stations is to wear a mask or face covering while on shift
Physical distancing alternatives to wearing a mask
for entire shift:
• Traffic flow
• Stagger mealtimes
• Isolated physical fitness • Sleeping and study area
• Meal preparation
Must wear PPE to do our part in protecting ourselves
and our families
Photo credit: Brownsville Herald
There have been more COVID-19 deaths in the fire service
than all the other combined line of duty deaths this year
https://www.firerescue1.com/coronavirus-covid-19/articles/firefighters-and-masks-survey-highlights-division-within-the-ranks-KtlwtylREyUBB6YC/
�QUESTION 9:
“My partner and I are on shift and in the ambulance together for 12 hours,
do we really need to wear a mask when we are not transporting a patient?”
In general
The more closely you interact with others and the longer
that interaction, the higher the risk of COVID-19 spread
How well do you really know your partner?
• Family members with symptoms?
• Immunocompromised / elderly family members?
Asymptomatic transmission:
• Remember: Percentage of asymptomatic infections estimated to be 20-50% (ASPR and CDC)
• Are you or your partner:
• Asymptomatic spreaders? - OR - Pre-symptomatic spreaders?
In the ambulance:
•
•
Considered a “healthcare workplace”
Wear a mask if < 6 feet apart
•
•
Roll windows down
Vent on high – not ”Max AC” or recirculation
�QUESTION 10:
“Once I take my mask or other PPE off for a break, can I put the same stuff back on?
Where do I leave my mask or store it?”
Know when to discard
Hang used respirators in a designated storage area or keep them in a
clean, breathable container such as a paper bag between uses
Careful donning and doffing
Always perform a seal check when donning
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html#:~:text=Extended%20use%20is%20favor
ed%20over%20reuse%20because%20it,transmission%20and%20other%20risks%20involved%20in%20these%20practices.
https://www.youtube.com/watch?v=Cfw2tvjiCxM
�QUESTION 11:
“I see healthcare workers in the hospitals wearing less and less PPE.
Why do I still have to wear full PPE on every single patient encounter?”
Fatigue is not unique to first responders!
Full vs. Appropriate PPE
•
Agency rules vary
•
Different environmental conditions
may require PPE variances
Pre-hospital Responses
• Contaminants in home
• No controlled airflow
• One provider in “Full” PPE
performs an assessment
https://www.cochrane.org/CD013582/EPOC_factors-influence-whether-healthcare-workers-follow-infection-prevention-and-control-guidelines
�QUESTION 12:
“I like to follow the rules and support wearing a mask at the fire station, but my coworkers
tell me it’s not necessary, and none of them wear masks. My boss isn’t enforcing the mask
mandate when at the station. What can I do to deal with this situation?”
Be a good example:
• Always wear a mask if you’re going to ask others to comply
• Have extras to share
• Masks as a fashion statement / conversation starter
• Silently reinforce desired behavior through visual cues
• Step back when someone approaches you to talk without a mask
Educate with reliable sources (not social media):
• Boston hospital system (MGB) system study in JAMA
Photo credit: Dr. Carr
• CDC MMWR: C-19 positive hair stylists wore masks
Theme mask: Yellowstone National Park Buffalo mask
• Increasing acceptance based on survey data: 500 adults
• April 7: 62% would wear mask à May 13: 76% would wear mask
Escalate if necessary
• Supervisor’s responsibility to protect workers
• Encourage policy development within your workplace
• Consider anonymous reporting system
�QUESTION 13:
“Given we are in a truck and staged versus transporting a patient for most of the shift,
it is tough to follow handwashing guidelines like you would in the hospital. Do you
have suggestions on how pre-hospital providers can deal with this issue?”
ü Hand hygiene should be performed before and after all patient contact, contact
with potentially infectious material, and before donning and after doffing PPE,
including gloves. Hand hygiene after removing PPE is particularly important
ü Ideally, hands will be washed with soap and water for at least 20 seconds
ü When soap and water is not available, an alcohol-based hand sanitizer with
60-95% alcohol is recommended
ü It is very important to use soap and water anytime hands are visibly soiled
ü Wash hands prior to leaving the hospital
ü Stop at a local fire department (if allowed) to use restroom to wash hands
ü Always make sure you have plenty of alcohol-based hand sanitizer available in
cab of ambulance
https://www.washingtonpost.com/business/2020/09/24/face-masks-coworkers-workplace/
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Amanda Grindle, MSN, RN
�Resources: NETEC
NETEC is Here to Help
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and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
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�Contact
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Join the Conversation!
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Email
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��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, October 2, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/CJlbXaduIYY
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="PPE Compliance and Fatigue webinar" src="https://www.youtube.com/embed/CJlbXaduIYY?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-ppefatigue" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-ppefatigue</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (10/02/20)/Online Course: Got Masks? PPE Compliance and Fatigue in First Responder Realms.
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Are personnel getting less diligent with PPE? Is there a significant element of PPE fatigue? Do you know what the PPE requirements are when not actively providing patient care? What about PPE requirements in the office, ambulance, and firehouse? Join us for a Town Hall meeting and discuss the importance of PPE in the First Responder Environment and learn techniques to deal with PPE fatigue and improve compliance? Submit your questions for the panel during registration, and they will be answered during the Town Hall session.<br /><br />Webinar slides attached.<br /><br /><br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-ppefatigue" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-02
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM) - covid specific resource, relevancy for non covid environment
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-14
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
First Responder
Mask
Masks
N95
Occupational Exposure
Occupational Health
Online Course
Personal Protective Equipment (PPE)
Personnel Management
R-PM
R-PPE
Staffing
-
https://repository.netecweb.org/files/original/b35893762d0676f09efff4002d58c0ff.png
139537736afa6c039ac07bb4bd6a8122
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="N95 with Exhalation Valve animation" src="https://www.youtube.com/embed/5PJ0m9yQM1M?autoplay=0" frameborder="0"></iframe>
URL
https://youtu.be/5PJ0m9yQM1M
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
An N95 with Exhalation Valve: Is it Protective Against Virus?
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The use of exhalation valves with N95s can expose the people around you to a virus if you are an asympotamic or presymptomatic carrier.<br /><br />N95 respirators come in different brands and types. One of the key features is whether they have an exhalation valve. In this video, we focus on the exhalation valves without filters, the most common type in the market. Please contact the manufacturer to learn more about the safety of the specific respirator model you are using.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-27
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - Good to keep for now - topic that many people do not understand
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
2019-nCoV
Airborne Transmission
Coronavirus
COVID-19
Droplet Transmission
Filtering Facepiece Respirator
Flu
Healthcare Worker Safety
Influenza
Just in Time training (JIT)
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Respirator
Respiratory Pathogen
Respiratory Protection
-
https://repository.netecweb.org/files/original/c03601d488cb9a40022e24d9f47939a0.pdf
99f5f2f8bed2f9862793b82ff5fcff34
PDF Text
Text
Ciclo de descontaminación
de respiradores N95 UVGI*
La descontaminación UVGI ocurre
Pasos de preparación para la descontaminación
Pasos de preparación para el respirador N95
• Escribir nombre e información requerida en
el respirador N95 con pluma de punta fina.
• Colocar el respirador en un contenedor
transpirable, como una bolsa de papel, la
cual la deja secarse y previene la
acumulación de humedad.
• Colocar el contenedor en la zona designada
para ser colectada.
Durante la descontaminación UVGI:
• Cada respirador N95 es colgado
en una cuerda y separado
adecuadamente para evitar
contacto entre los respiradores
N95.
• Altos niveles de radiación
ultravioleta (300 mj/cm2)
desactivan los patógenos.
*Irradiación Germicida Ultravioleta
Recoger los respiradores N95 limpios
Inspeccionar antes de usar
Antes de ser reusados, inspeccionar los
respiradores para confirmar lo siguiente:
Recoger los respiradores N95
descontaminados.
• La información escrita en la N95 es correcta.
• La ausencia de residuos incluso de aceite
facial y maquillaje.
• El respirador N95 no esta dañado o
deformado.
• Las bandas elásticas se estiran.
• El respirador N95 ajusta de manera correcta.
• Es posible hacer una prueba de sellado.
• Los respiradores N95
serán colocados dentro de
un contenedor limpio.
• Es posible que el
contenedor sea distinto
que el usado antes de la
descontaminación.
Poner en el N95 usando una mano enguantada.
06-29-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ciclo de descontaminación de respiradores N95 UVGI
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
<a href="https://repository.netecweb.org/items/show/1188">UVGI* Decontamination Cycle for N95 Respirators</a> in Spanish. UVGI = Irradiación Germicida Ultravioleta
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-29
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Decontamination
Español
Filtering Facepiece Respirator
Healthcare Worker Safety
N95
Personal Protective Equipment (PPE)
R-PPE
Respirator
Respiratory Protection
Reuse
Spanish
-
https://repository.netecweb.org/files/original/871bb0691bd88a7149d6f968afadba57.pdf
fdc7319a8ce859017ff191e73015053e
PDF Text
Text
PRACTICA EL USO SEGURO DE EPP
MEDIDAS
CORRECTAS
MEDIDAS
INCORRECTAS
Reduce la carga biológica Ambiental
No te olvides de tu proprio estado
Mantenga todas las superficies limpias y evite
tocar el PPE o la cama / mostrador. Use
equipo de uso para un solo paciente.
Sean vigilante a cómo se siente y a
cualquier indicador de problemas de EPP,
como gafas empañadas.
Usen barreras adicionales según
sea necesario
Considere el uso de una toalla o almohadilla para
poder proteger su ropa y su EPP, sobre todo si
están a menos de 1 metro del paciente.
No toque a su piel o a su cabello
Ate el cabello largo y péinese con una cinta
para la cabeza o unos pasadores para
disminuir la tentación de tocar su cabello o su
cara.
No contamine a su EPP
Quitense el EPP con cuidado
Quítese la bata y
los guantes
Quítese las gafas / la careta
Quítese la mascara
Use el protocolo de su instalación en el orden y
ubicación especificada. Quítese la máscara / el
respirador al final.
Desinfecte los guantes con desinfectante
para manos
Evite inclinarse contra los rieles de la cama
y los mostradores. No toque su EPP.
No ajuste a sus gafas, su careta o su
mascara
Abroche a sus gafas, mascara o
respirador para evitar de ajustarlos
en el entorno del paciente.
Use desinfectante a base de alcohol
sobre los guantes frecuentemente y
antes de quitarse los guantes.
04-28-20 • Emory University, creado por Visual Medical Education.
�
https://repository.netecweb.org/files/original/3ac0946351fb3292db32ad07cfa080ea.pdf
3c94c5200bc540ac8d8d7982e93f4133
PDF Text
Text
PRACTICA EL USO SEGURO DE EPP
MEDIDAS
CORRECTAS
MEDIDAS
INCORRECTAS
Reduce la carga biológica Ambiental
No te olvides de tu proprio estado
Mantenga todas las superficies limpias y evite
tocar el PPE o la cama / mostrador. Use
equipo de uso para un solo paciente.
Sean vigilante a cómo se siente y a
cualquier indicador de problemas de EPP,
como gafas empañadas.
Usen barreras adicionales según
sea necesario
Considere el uso de una toalla o almohadilla para
poder proteger su ropa y su EPP, sobre todo si
están a menos de 1 metro del paciente.
No toque a su piel o a su cabello
Ate el cabello largo y péinese con una cinta
para la cabeza o unos pasadores para
disminuir la tentación de tocar su cabello o su
cara.
No contamine a su EPP
Quitense el EPP con cuidado
Quítese la bata y
los guantes
Quítese las gafas / la careta
Quítese la mascara
Use el protocolo de su instalación en el orden y
ubicación especificada. Quítese la máscara / el
respirador al final.
Desinfecte los guantes con desinfectante
para manos
Evite inclinarse contra los rieles de la cama
y los mostradores. No toque su EPP.
No ajuste a sus gafas, su careta o su
mascara
Abroche a sus gafas, mascara o
respirador para evitar de ajustarlos
en el entorno del paciente.
Use desinfectante a base de alcohol
sobre los guantes frecuentemente y
antes de quitarse los guantes.
04-28-20 • Emory University, creado por Visual Medical Education.
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PRACTICA EL USO SEGURO DE EPP
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
PRACTICA EL USO SEGURO DE EPP. Spanish language version of Practice PPE Safety. <br /><br />Go to the <a href="https://repository.netecweb.org/items/show/964">English language version</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-28
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Español
Personal Protective Equipment (PPE)
R-PPE
Spanish
-
https://repository.netecweb.org/files/original/d52997a4e88c8d262dee8d0375ec4d53.pdf
25147a0cee6a8b7d8fdfbfb659a7e725
PDF Text
Text
¡Elije correcto!
Infórmate sobre tu tipo de mascarilla. Úsala consistentemente.
Reduce tu riesgo de exposición.
Mascarilla quirúrgica
Respirador N95
Protección
Provee un nivel superior de protección en
contra de contaminantes forma aerosol y
liquida
• Retiene partículas pequeñas en
Retiene y protege de contaminantes
en forma liquida
• Retiene liquido y gotas tamaño
grande
• Proteje pacientes de tus mismas
emisiones respiratorias
• No protege en contra de partículas
provenientes del paciente en forma
aerosol.
forma aerosol y grandes en
forma liquida.
• Filtra un 95% o mas de partículas
pequeñas y grandes (tan
pequeñas como 0.3 de micrometro)
Razón: respiradores N95 proveen un nivel
superior de protección cuando el contagio es
trasmitido por medio de partículas en aerosol.
Razón: Las mascaras quirúrgicas son
adecuadas cuando el contagio no es por
medio aerosol. Conserva el inventario de
respiradores N95.
Ajuste
Sin prueba de ajuste
Prueba de ajuste
• Ajuste fijo.
• Prueba de sellado es requerida en cada uso.
• Previene fugas dúrate inhalación y
• Ajuste suelto.
• Prueba de sellado no requerida.
• Fuga presente alrededor de la
mascarilla durante inhalación y
exhalación.
Razón: el ajuste es suficiente para el
nivel de protección requerido.
exhalación mientras sea usada
apropiadamente y ajustada en cada uso.
Razón: El ajuste es imperativo para el nivel
de protección optimo.
Uso
Desechable
Reusables al ser desinfectadas
• Mediante que las mascarillas son
normalmente desechadas ante cada uso,
pueden ser reusadas en caso de crisis.
• Al ser desinfectadas pueden ser usadas en
múltiples encuentros con pacientes
• Recicle solo si instalaciones tiene
procedimientos apropiados de
descontaminación y preservación de función
de respiradores.
Desechables cuando:
• Visiblemente mojadas, excesivamente
húmedas, rotas, sucias o contaminadas con
secreciones respiratorias o corporales del
paciente.
Desechables cuando:
• Visiblemente mojadas, excesivamente
húmedas, rotas, sucias o contaminadas con
secreciones respiratorias o corporales del
paciente.
• incapaz de realizar la prueba de sellado
Razón: el reúso y el reciclaje conservan el
inventario de mascarillas quirúrgicas.
Razón: el reúso y el reciclaje conservan el
inventario de respiradores N95.
05-01-20
�
https://repository.netecweb.org/files/original/44fffec4338461339bb70aa1a15cf7db.pdf
34305deb429f7000b661f727dc162b16
PDF Text
Text
¡Elije correcto!
Infórmate sobre tu tipo de mascarilla. Úsala consistentemente.
Reduce tu riesgo de exposición.
Mascarilla quirúrgica
Respirador N95
Protección
Provee un nivel superior de protección en
contra de contaminantes forma aerosol y
liquida
• Retiene partículas pequeñas en
Retiene y protege de contaminantes
en forma liquida
• Retiene liquido y gotas tamaño
grande
• Proteje pacientes de tus mismas
emisiones respiratorias
• No protege en contra de partículas
provenientes del paciente en forma
aerosol.
forma aerosol y grandes en
forma liquida.
• Filtra un 95% o mas de partículas
pequeñas y grandes (tan
pequeñas como 0.3 de micrometro)
Razón: respiradores N95 proveen un nivel
superior de protección cuando el contagio es
trasmitido por medio de partículas en aerosol.
Razón: Las mascaras quirúrgicas son
adecuadas cuando el contagio no es por
medio aerosol. Conserva el inventario de
respiradores N95.
Ajuste
Sin prueba de ajuste
Prueba de ajuste
• Ajuste fijo.
• Prueba de sellado es requerida en cada uso.
• Previene fugas dúrate inhalación y
• Ajuste suelto.
• Prueba de sellado no requerida.
• Fuga presente alrededor de la
mascarilla durante inhalación y
exhalación.
Razón: el ajuste es suficiente para el
nivel de protección requerido.
exhalación mientras sea usada
apropiadamente y ajustada en cada uso.
Razón: El ajuste es imperativo para el nivel
de protección optimo.
Uso
Desechable
Reusables al ser desinfectadas
• Mediante que las mascarillas son
normalmente desechadas ante cada uso,
pueden ser reusadas en caso de crisis.
• Al ser desinfectadas pueden ser usadas en
múltiples encuentros con pacientes
• Recicle solo si instalaciones tiene
procedimientos apropiados de
descontaminación y preservación de función
de respiradores.
Desechables cuando:
• Visiblemente mojadas, excesivamente
húmedas, rotas, sucias o contaminadas con
secreciones respiratorias o corporales del
paciente.
Desechables cuando:
• Visiblemente mojadas, excesivamente
húmedas, rotas, sucias o contaminadas con
secreciones respiratorias o corporales del
paciente.
• incapaz de realizar la prueba de sellado
Razón: el reúso y el reciclaje conservan el
inventario de mascarillas quirúrgicas.
Razón: el reúso y el reciclaje conservan el
inventario de respiradores N95.
05-01-20
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
¡Elije correcto!
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
<span class="tlid-translation translation"><span>Versión en español de Make the Smart Choice.<br /><br /></span></span>Spanish language version of Make the Smart Choice - Procedure Mask vs. N95 Respirator selection printable flyer infographic - a flyer explaining the reasons to choose a procedure mask or n95 respirator. <a href="https://repository.netecweb.org/items/show/1023">Go to the English version.</a>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-01
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Español
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Spanish
-
https://repository.netecweb.org/files/original/34243d3a9fe410401150468e61b55255.pdf
09b4ec7ef701d3346d4b05475012a76b
PDF Text
Text
NETEC COVID-19 Webinar Series:
Supply Management and Inventory Control
During COVID-19 – Part Two
�Content Outline (TOC)
Welcome
Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
�Overview
Welcome: Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
Supply Management and Inventory Control During COVID-19:
Emory Healthcare: Kari Love, MS, RN, CIC, FAPIC, Program Director Infection Prevention
Supply Management and Inventory Control During COVID-19:
Nebraska Medicine / University of Nebraska Medical Center:
Brian Spencer, AIA, Director Facilities & Clinical Space Planning
NETEC Resources: Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Supply Management and Inventory Control
During COVID-19:
Emory Healthcare
Kari Love, MS, RN, CIC, FAPIC
Program Director Infection Prevention
�Supply Management and Inventory Control
During COVID-19
PPE and Donated Supplies
Articulate creative ways in managing reusable and disposable supplies
and how to approach the need for substitution amid the pandemic crisis
Describe vetting processes for supplies received including how to manage
donations while maintaining safety and infection control measures
�The First Needs
Hand Sanitizer was one of the first items we
felt like we had to scramble to procure
Worked with medical students to create hand
sanitizer in the chemistry lab
r
• Used WHO recipe
Seriously considered using
sheet protectors for face
shields as demonstrated
by Sharon Vanairsdale
�Supply Management and Inventory Control
During COVID-19
Develop a Process for Disinfecting CAPR Cuffs/Lenses
Developed disinfection protocol for the CAPR lens as part of the doffing
process so that it could be reused by a HCW
�Face Shields
Partnered with Georgia Tech (GT) to
develop multiple prototypes
Disposable
Disinfected and reused until the
headband disintegrated
Reusable
Headband and shield dedicated to each HCW
– shields can be replaced if damaged
r
�PPE Tailored to Fit
Reusable face shields created by
Georgia Tech had input from three
different health systems
Feedback from Emory - difficult to
hear and the shield was too long
The other two health systems
did not want to re-design the
shield
Created a pattern with feedback
from front line staff members
– it can be trimmed to fit
r
�Isolation Gowns
Purchased material made of 40 GSM polypropylene
Local companies took material, used an isolation gown pattern and made gowns
Since the material was not rated as AAMI Level 2 etc., we did some of our own testing
with diet coke, water and other fluids to determine fluid resistance
r
�Cloth Gowns, Surgical Gowns and Coveralls
Cloth isolation gowns
• Having cloth isolation gowns
laundered
• Good for 100 wash cycles
Disposable surgical gowns
• Laundered 3x and the
gowns were still intact
r
Coveralls
• Not optimal but were able to
use them at the testing centers
• Staff wore PAPRs and
coveralls for 4 hour shifts in
the drive-up testing clinic
�Donation Center
Amazing community response
Found a building on campus where donations could be
received
• Overwhelmed the dock and the supply warehouse
Took a full-time team just to manage rdonations
• VP of Performance Improvement utilized
management engineers to categorize, organize
and distribute
Developed and posted criteria for items that we could
accept
Also assisted with pulling supplies out of the
emergency management pods
�Reprocessing N95 Respirators and PAPR Hoods
UV disinfection of N95s
Bioquell – PAPR hoods
• Achieved > 6 log kill INSIDE the hood
Once EUA received – N95s reprocessed in sterile
processing
r
�Supply Management and Inventory Control
During COVID-19
Ready to Swab
Gowns sewn by Mohawk Flooring
Face shields produced by TSG
�Resources
r
https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html
�Resources
r
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html
�Content Outline (TOC)
Supply Management and Inventory Control
During COVID-19:
Nebraska Medicine
University of Nebraska Medical Center
Brian Spencer, AIA
Director Facilities & Clinical Space Planning
�Supply Management and Inventory Control
During COVID-19
Decision Making: Quick/Slow
Decision making in an organization under extreme stress often
resorts to one of two models:
Very quick and not always knowledge based
Very slow and very safe
HICS exists, in part, to help combat moving to these extremes
Our job as we continue to manage the pandemic is to help bring balance
Launch more than one balloon!
�Decision Making: Balloons
Example
Germicidal wipes burn rate was up, we were on allocation, shipments were
delayed, and it appeared we would run out in the short term and have long
term sustainability issues
The team quickly launched several balloons:
r
•
•
•
•
Infection Control team toured to
understand burn very deeply
Supply chain worked to see what WAS
available in the market – even parts
(tubs)
Pharmacy and Sterile Processing
began testing ‘home rolled’ solutions
Deployed home roll solutions to low
burn and low risk areas to test.
�Vetting
Phase 1
Emergency issues and shortages
Phase 2
This is going to last a while and we need to capture good
ideas and innovation
Phase 3
This is REALLY going tor last a while and we need to have a
framework for increasingly complex shortages
�Vetting Team
Phase 1
As we worked through Phase 1 it became clear we
needed a team….
qGrabbed a very small group – IC, ID, Safety, Legal, CIO, Logistics
qCommon inbox for all ideas
r
qMet almost daily in the beginning
and have settled to bi-weekly
�Vetting Process: Hand Sanitizer Example
Phase 1
Emergency deploy portable hand
sinks at entries, pull product from
office areas, send people home
Phase 2
Work with existing vendorsr and
local alternate folks (distillers,
college pharmacy department) to
get something coming
Phase 3
Worked with vendors to stabilize and
refill existing bags. Develop stands to
deploy more broadly for increased
hand sanitation based on available
materials, bags, dispensers, etc
�Vetting Process: Intubation Boxes Example
Phase 1
Emergency shortage of masks and
other PPE, put out word in
institution looking for safer way to
intubate for aerosol producing
procedures
Phase 2
Work with ‘weekend warriors’
to get
r
samples made and into test rotation.
Develop accepted standard and have
small batch made
Phase 3
Working with legal and innovation
groups on IP rights and bringing to
larger market
�Content Outline (TOC)
NETEC Resources
Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, August 7, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/knJfoS366TY
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Supply Management webinar" src="https://www.youtube.com/embed/knJfoS366TY?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="http://courses.netec.org/courses/20-web-supply2" target="_blank" rel="noreferrer noopener">http://courses.netec.org/courses/20-web-supply2</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (8/07/20)/Online Course: Supply Management & Inventory Control – Part 2
Subject
The topic of the resource
Physical Infrastructure
Description
An account of the resource
In this webinar, participants will discuss the principles of the Hospital Incident Command System (HICS) and other innovative approaches to assist with making informed decisions related to COVID-19 preparedness, mitigation, and response. Participants will also learn how to articulate creative ways to manage reusable and disposable supplies and how to approach the need for substitution during the pandemic crisis. The vetting processes for supplies received, including managing donations while maintaining safety and infection control measures, will also be discussed.<br /><br />Webinar slides attached.<br />
<h2>Get educational credit for this webinar through <a href="http://courses.netec.org/courses/20-web-supply2" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-07
Relation
A related resource
Y - PPE pos 82 qualtrics 303; PPE pos 88 qualtrics 309
Y - D0.1PPE/D0.2PPE Qualtrics # 303
Y - D0.1PPE/D0.2PPE Qualtrics # 309
Contributor
An entity responsible for making contributions to the resource
2023-08-31 by Shawn Gibbs - PhysInfr General Review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-08-31
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
CEU
CEUs
Contingency and crisis capacities
Coronavirus
COVID-19
Equipment and Supplies
Infection Prevention and Control
Online Course
Personal Protective Equipment (PPE)
R-PhIn
R-PPE
-
https://repository.netecweb.org/files/original/68201dc38aa9c032a12151769cdebbff.pdf
67d89c9f3b95180fdbdfd4b2b04430f6
PDF Text
Text
NETEC COVID-19 Webinar Series:
Supply Management and Inventory Control
During COVID-19 – Part One
�Content Outline (TOC)
Welcome
Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
�Overview
Welcome: Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
Supply Management and Inventory Control During COVID-19:
Providence Sacred Heart Medical Center:
Bethany White, Manager of Materials Management Supply Chain Operations
Christa Arguinchona, MSN, RN, CCRN
Supply Management and Inventory Control During COVID-19:
NYC H+H Bellevue: John Maharaj, Associate Executive Director of Support Services
Trish Tennill, RN, BSN
NETEC Resources: Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Supply Management and Inventory Control
During COVID-19:
Providence Sacred Heart Medical Center
Bethany White, Manager of Materials Management Supply Chain Operations
Christa Arguinchona, MSN, RN, CCRN
�Supply Management and Inventory Control
During COVID-19
Providence Sacred Heart Medical Center
Providence St. Joseph Health (PSJH)
• 51 hospitals in 7 states (WA, OR, MT, AK, CA, NM and TX)
Providence Health Care
• Providence Sacred Heart Medical Center (Region 10 RESPTC)
• 4 total hospitals
�Acquiring PPE
Challenges:
• Hoarding/stealing, fear-based, inappropriate usage
• Availability of PPE nationwide
• Vendor allocations
• Multiple planning meetings
Approaches:
• State Department of Health allocated PPE
r
• Donations from multiple sources
• Local purchases
• Providence St. Joseph System
• Central Planning Team distributed PPE resources
• PSHMC HUB for our region
• Hospitals, Clinics, Urgent Cares
• Pre-ordering for pandemic preparedness
• Sharing amongst all facilities
• Donated to local charities in need
�Supply Management and Inventory Control
During COVID-19
PPE Changes/Substitutions
New PPE (different/unfamiliar products)
• Approval process with Infection Prevention
• Develop new product number
• Develop “no-charge” purchase order for tracking
• Daily inventory counts/reporting of all PPE
Collaboration with nursing leadership
• Approaches/substitutions
• Flexibility and adaptability
Processes/policies
constantly changing
=
Daily changes
in PPE use
=
New headache every day!
�Innovative Approach to Inventory Control
Lock down of PPE
• Securely stored all bulk PPE in Supply Chain
• Removed PPE from unit stock carts
• Identified locked storage area in each unit
• Daily order for each unit
• Assigned daily PPE ordering levels rfor each unit
based off usage
• Staffed PPE room 24/7 to ensure it was secured and
departments got what they needed
• Items returned to supply carts based on availability
• Challenges:
• Supply chain staff = police
• Consistency of process
�Innovative Approach to Inventory Control
PAPR Management Plan
• Appointed a clear owner to develop and manage the plan
• PAPR tracking spreadsheet
• Share point
• Department, manager, inventory date, repair/reason, serial #,
inventory date, filter change date:
r
• Developed PAPR repair process
• Increase use = increase in needed repairs
• Innovative Clinical Engineering expert!
• Utilize online request for repair, allows tracking
• Allocation plan for prioritization of use
�Innovative Approach to Inventory Control
PAPR accessory conservation strategies:
•
•
•
•
No accessory orders filled for 7 months
Assigned shields and headbands for reuse
Unit responsibility to develop storage plan
Job aid developed and distributed
Strengths
r
Extended use, staff preference/comfort
It worked! No known staff acquired infections
Challenges
Which disinfectant?
Increased use from training
Decreased visualization from multiple cleanings
CAPR DISINFECTION PROCESS (MaxAir with Lens Cuff)
Lens cuff will be reused until its’ integrity is compromised. Care must be taken when applying and
removing to extend the life of the lens cuff. Lens cuff will be stored in a bag in designated location on
unit.
Comfort strip will be issued to each caregiver, name written on side that adheres to Velcro, removed after
use and stored in a bag with name on it in designated place on unit.
1. After doffing process occurs in patient room, caregiver will have clean gloves on and will use a
disinfectant wipe to proceed through the door into the hallway and proceed to CAPR doffing
area.
2. Doff CAPR
a. Remove disinfectant wipe and have ready
b. Remove CAPR by grabbing back knob and thoroughly disinfect all components with
wipe, including lens cuff and cord
c. Place on surface to have appropriate contact time dependent on disinfectant wipe used
d. Place in clear white bag, tie up bag and write name on bag with Sharpie to reuse CAPR
and lens cuff throughout shift (unless end of shift, then remove lens cuff and place in a
bag and label with name to be used during next shift. Place comfort strip in bag with
name to be reused.)
e. Doff belt and battery and disinfect with wipe
3. Perform hand hygiene
4. Doff gloves using glove in glove technique
5. Perform hand hygiene
6. Return bagged CAPR to cart to reuse throughout shift
7. Return belt and battery to cart and plug in battery to charge
P or
initials
�Supply Management and Inventory Control
During COVID-19
Supply Chain/Nursing Coordination
Approval needed for accessory item orders
• Able to identify departments needing more education
• Prioritized high risk departments
• Established clear request process
Constant Communication
• Awareness of inventory
• POC for supply chain staff
• Coordinated approach based on changing circumstances
• Improved collaboration amongst involved leadership
�Innovative Approach to Inventory Control
q CNO: 5 Things to Know this Week
q Huddle Highlights
q Safety Huddle Announcements
q Weekly system staff communications
q COVID Circle One communications
r
q Reassurance regarding changes in PPE pieces
q Different colored masks, gowns, gloves
q Focus on fact that we have PPE
Everyone needs to hear the rationale!!
Be transparent!!
�Content Outline (TOC)
Supply Management and Inventory Control
During COVID-19:
NYC H+H Bellevue
John Maharaj, Associate Executive Director of Support Services
Trish Tennill, RN, BSN
�Supply Management and Inventory Control
During COVID-19
NYC H+H Bellevue
Bellevue Hospital is part of the greater H+H
public health system
• Includes 11 acute care hospitals
• 5 post acute/long-term care facilities
• Shared supply chain
• Centralized ordering and storage
locations for PPE stores
�Supply Management and Inventory Control
During COVID-19
PPE Needs - In the Beginning
PPE
• PPE was in accordance to CDC COVID-19 guidelines
Initially
• PPE distribution started with three carts based on our
initial predictions - 1:1 patient to cart
• Using existing crash carts allowed the PPE to be portable
• Supplies were acquired from central stores, then taken to
satellite PPE room
• Labor
• Restocked during the day by central stores staff
• Three in-house staff members operated the night shifts
�PPE Needs – As the Pandemic Numbers Increase
PPE demands increased as:
• The number of patients increased
• There was an influx of outside staff
• Protocols changed
r
�Supply Management and Inventory Control
During COVID-19
PPE Supply
PPE changed from day to day:
• PPE varied from different supply chains
• Donations
All PPE was approved by either
• H+H Central Infection Control
• Bellevue Infection Control
�PPE Supply Chain and Delivery Services
Strengths
In house labor pool
Outside vendor support
Challenges
Hard to keep tight inventory control with the r
number of patients, care teams, and new staff
Could not keep up with burn rate
Sizing
Benefits
Could borrow from our sister facilities
Corporation had a large off-site warehouse
�Supply Management and Inventory Control
During COVID-19
State of Preparedness
Where do we go from here
• Low Covid census gives us a chance to
do inventory
Implementation of a 90-day supply of PPE
• This is across the corporation
Standardization of respiratory protection
• Will assure its availability
�Supply Management and Inventory Control
During COVID-19
State of Preparedness
Tracking of valuable resources
• N95 respirators
• PAPRs
• DLC lenses
Restructured PPE delivery
• From 24/7 delivery to M-F 7a-7p
�Supply Management and Inventory Control
During COVID-19
Conservation Strategies
Personal Protective Equipment:
qBundling care
Reuse of Respiratory Protection:
qN95 respirators
qPAPR DLC lenses
qFace shields
�Supply Management and Inventory Control
During COVID-19
Education Strategies
More is not better
Initial PPE training
• Reinforcement that gowns, gloves, and
respiratory protection may change
Making staff feel safe and secure
• Going into the room with them
More is not better
• Adding more can complicate donning
and doffing
�Content Outline (TOC)
NETEC Resources
Sharon Vanairsdale, DNP, APRN, ACNS-BC, NP-C, CEN, FAEN, FAAN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Wednesday, August 5, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/S3tzcp8yuJE
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Supply Management webinar" src="https://www.youtube.com/embed/S3tzcp8yuJE?autoplay=0" frameborder="0"></iframe>
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CEU online course: <a href="http://courses.netec.org/courses/20-web-supply1" target="_blank" rel="noreferrer noopener">http://courses.netec.org/courses/20-web-supply1</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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NETEC COVID-19 Webinar Series (8/05/20)/Online Course: Supply Management & Inventory Control – Part 1
Subject
The topic of the resource
Physical Infrastructure
Description
An account of the resource
In this webinar, participants will foster effective team strategies to assist in problem-solving to collectively control inventory and supply chain needs during the coronavirus pandemic, integrate approaches for optimizing PPE supply when caring for patients with COVID-19 including CAPRs/ PAPRs, masks, face shields, and other essential supplies and discuss options for product substitution while maintaining a safe clinical environment as derived from case-based scenarios.<br /><br />Webinar slides attached.<br />
<h2>Get educational credit for this webinar through <a href="http://courses.netec.org/courses/20-web-supply1" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-05
Relation
A related resource
Y - PPE pos 82 qualtrics 303; PPE pos 88 qualtrics 309
Y - D0.1PPE/D0.2PPE Qualtrics # 303
Y - D0.1PPE/D0.2PPE Qualtrics # 309
Contributor
An entity responsible for making contributions to the resource
2023-08-31 by Shawn Gibbs - PhysInfr General Review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-08-31
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
CEU
CEUs
Contingency and crisis capacities
Coronavirus
COVID-19
Equipment and Supplies
Mask
Masks
N95
Online Course
Personal Protective Equipment (PPE)
R-PhIn
R-PPE
-
https://repository.netecweb.org/files/original/21187d90d05bc0031a142c07a352b05a.pdf
50a07acec8b16cb0046a7588862261bf
PDF Text
Text
Conoce tu EPP
Guantes
Batas
Máscaras
N95 Respirador
ecuerda:
El virus del COVID-19 se transmite por secreciones
respiratorias – tos, estornudos e incluso hablando.
Utilizamos EPP y nos lavamos las manos para
romper la cadena de infección temprano, así se
cree una barrera entre los pacientes infectados y
usted.
Use estos carteles para obtener la mejor
información sobre cómo proteger a los prestadores
de servicios de la infección con COVID-19.
05-04-20
Gafas
Caretas
CDC Recomendaciones
�Guantes
Guantes
Batas
Máscaras
N95 Respirador
La gente se toca la cara 15 veces o mas cada hora. Sus
manos son una fuente primaria de transmisión por
contacto – si tocas a una personada o una superficie
infectada, y después te tocas la cara.
Los guantes son una barrera entre la contaminación y tus
manos. Pero los guantes solo limitan la transmisión,
entonces necesitas proteger a tus manos lavándolas antes,
después y mientras que usas los guantes.
• Inspeccione los guantes antes de ponérselos para
asegurarse de que estén intactos, sin agujeros ni
rasgaduras.
• Lávense las manos antes de ponerse los guantes y
después de quitárselos.
• Lávense las manos con guantes cuando se quite las
batas, máscaras y otros EPP
• Nunca se toque la cara o el pelo mientras usa guantes
• Nunca ajuste máscaras, respiradores o protección para
los ojos con las manos enguantadas, en un área de
cuidado al paciente o cerca de superficies
contaminadas.
05-04-20
Gafas
Caretas
CDC Recomendaciones
�Batas médicas
Guantes
Batas
Máscaras
N95 Respirador
Las batas protegen contra el contacto y la
transmisión de gotas al crear una barrera
entre la contaminación y su piel y ropa.
El tipo de batas que use (reutilizables o
desechables) dependerá de su tarea, las
reservas y protocolos de su instalación,
también dependerá de la cantidad de sangre y
fluidos corporales que encontrará en una
situación de cuidado al paciente.
• Inspeccione su bata antes de ponérsela
para asegurarse de que este intacta, sin
agujeros ni rasgaduras.
• Lávense las manos con los guantes
puestos cuando se quite la bata.
• Las batas siempre deben usarse con
guantes.
05-04-20
Gafas
Caretas
CDC Recomendaciones
�Máscaras
Guantes
Batas
Máscaras
N95 Respirador
Las máscaras quirúrgicas o de procedimiento lo protegen
contra la transmisión de gotas al crear una barrera entre
las membranas mucosas de la nariz y la boca, y un
paciente o área contaminada: las gotas de COVID-19
pueden permanecerse en el aire alrededor de un paciente
por un período de tiempo después de haber tozado o
estornudado.
Pero las mascaras no protegen contra la transmisión aérea,
por esa razón se prefieren los respiradores (si están
disponibles) para el tratamiento de pacientes con
COVID-19.
• Inspeccione su máscara antes de ponérsela para
asegurarse de que esté intacta, sin agujeros ni
rasgaduras.
• Lávense las manos con los guantes puestos cuando
se quite la máscara quirúrgica o de procedimiento.
• Nunca ajuste su máscara con las manos enguantadas,
en un área de cuidado al paciente o alrededor de
superficies contaminadas.
05-04-20
Gafas
Caretas
CDC Recomendaciones
�N95 Respirador
Guantes
Batas
Máscaras
N95 Respirador
El respirador con filtro N95 lo protege contra las gotas y la
transmisión por el aire. Como una máscara, crea una
barrera entre las membranas mucosas de la nariz y la boca,
y la fuente de la contaminación, pero, con su sello hermético,
también filtra las partículas infecciosas del aire que respira.
Aunque todavía estamos descubriendo la ruta de transmisión
en el aire para el virus del COVID-19, el Centros para el
Control y la Prevención de Enfermedades recomienda
protección contra las gotas, el contacto y la transmisión
por el aire cuando sea posible.
• Inspeccione su respirador antes de ponérselo para
asegurarse de que esté intacto, sin agujeros, roturas o
rasgaduras. Realizar una verificación de fugas, también
conocida como verificación de sellado.
• Lávense las manos con los guantes puestos cuando se
quite el respirador.
• La integridad del ajuste del respirador puede verse
reducida por las actividades normales de cuidado del
paciente, pero NUNCA debe ajustar su respirador con
las manos enguantadas, en un área de cuidado del
paciente o alrededor de superficies contaminadas.
05-04-20
Gafas
Caretas
CDC Recomendaciones
�Gafas de protección
Guantes
Batas
Máscaras
N95 Respirador
Las gafas te protegen contra la transmisión de
gotas al crear una barrera que evita que la
sangre y los fluidos corporales entren en tus ojos.
Las gafas deben usarse siempre con una
máscara quirúrgica, una máscara de
procedimiento o un respirador para evitar que la
infección ingrese a los ojos, la nariz y la boca.
• Inspeccione sus gafas protectoras antes de
ponérselas para asegurarse de que no haya
grietas en los descansos y de que pueda ver
a través de ellas con claridad.
• Lávense las manos con sus guantes cuando
se ponen las gafas.
• Nunca ajuste sus gafas con las manos
enguantadas, en un área de cuidado al
paciente o alrededor de superficies
contaminadas.
05-04-20
Gafas
Caretas
CDC Recomendaciones
�Caretas
Guantes
Batas
Máscaras
N95 Respirador
Las caretas lo protegen contra la transmisión de
gotas al crear una barrera que mantiene la
sangre y los fluidos corporales lejos de los ojos y
la cara. Sirven para el mismo propósito que las
gafas pero protegen un área más grande.
Las caretas siempre deben usarse con una
máscara quirúrgica, una máscara de
procedimiento o un respirador para evitar que la
infección entre en los ojos, la nariz y la boca.
• Inspeccione su protector facial antes de
ponérselo para asegurarse de que no haya
grietas o roturas, y que pueda ver
claramente
• Lávense las manos con sus guantes al
ponerse la careta.
• Nunca ajuste su careta con las manos
enguantadas, en un área de cuidado al
paciente o alrededor de superficies
contaminadas.
05-04-20
Gafas
Caretas
CDC Recomendaciones
�Recomendaciones del CCPE (CDC)
Guantes
Batas
Máscaras
N95 Respirador
Gafas
Los Centros para el Control y la Prevención de
Enfermedades recomiendan precauciones estándar, de
contacto y en el aire cuando interactúa con pacientes que han
estado o podrían estar infectados con COVID-19. Esto incluye:
•
•
•
•
Guantes
Batas médicas
N95 Respirador*
Protección para los ojos
El equipo de protección personal específico que usará estará
determinado por su instalación, la tarea que está realizando y
la disponibilidad del equipo.
Aunque todavía estamos descubriendo la ruta de transmisión de la
columna de aire para COVID-19, los Centros para el Control y la
Prevención de Enfermedades recomiendan N95 o protección
respiratoria superior para la atención del paciente siempre que sea
posible. El uso de máscaras quirúrgicas / de procedimiento puede ser
aceptable si el nivel de protección recomendado no está disponible.
05-04-20
Caretas
CDC Recomendaciones
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Conoce tu EPP
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
Spanish version guide with information about different types of PPE (Personal Protective Equipment) and COVID-19.<br /><br />View the <a href="https://repository.netecweb.org/items/show/1053">English version</a>.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-04
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Español
Gloves
Gown
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Spanish
-
https://repository.netecweb.org/files/original/4880856dddff504317e0db9f6d5fdc88.pdf
6bd8280c95fa803d631d1815472340a5
PDF Text
Text
NETEC COVID-19 Webinar Series:
Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
�Content Outline (TOC)
Welcome
Amanda Grindle, MSN, RN
�Overview
Welcome: Amanda Grindle, MSN, RN, NETEC Staff
Infection Control Precautions in Dentistry
During the COVID-19 Pandemic: Eve Cuny, MS
Jill Morgan, RN, BSN
NETEC Resources: Amanda Grindle, NETEC
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Eve Cuny, MS
Jill Morgan, RN BSN
�CDC Interim Guidelines for Dentistry June 17, 2020
r
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
CDC Framework for Healthcare Systems
Provide Care in the Safest Way Possible
• Telehealth
• Follow infection prevention recommendations
Consider that services may need to expand gradually
• Local epidemiology
• Prioritize procedures that may cause harm if further delayed
• Prioritize at-risk patients that would benefit most from care
www.cdc.gov/coronavirus/2019-ncov/hcp/framework-non-COVID-care.html
�OSHA Risk Pyramid
Aerosol generating procedures on known or
suspected COVID-19 patient
Aerosol generating procedures on well patients
Any procedure on COVID-19 patient
Very
High
High
r
Urgent or emergency care without
aerosols
Administrative duties
Medium
Low
U.S. Department of Labor. OSHA.
Guidance on preparing workplaces for COVID-19.
COVID-19 - Control and Prevention /Dentistry Workers and Employers
�Hierarchy of Controls
MOST
EFFECTIVE
ELIMINATION
PHYSICALLY REMOVE THE HAZARD
SUBSTITUTION
ENGINEERING
CONTROLS
ADMINISTRATIVE
CONTROLS
PPE
REPLACE THE HAZARD
r
ISOLATE PEOPLE FROM THE HAZARD
CHANGE THE WAY PEOPLE WORK
PROTECT THE WORKER WITH
PERSONAL PROTECTIVE EQUIPMENT
LEAST
EFFECTIVE
https://www.cdc.gov/niosh/topics/hierarchy/default.html
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Engineering Controls
MOST EFFECTIVE
ISOLATE PEOPLE FROM THE HAZARD
LEAST EFFECTIVE
Enhanced HVAC filtration
Use of supplemental HEPA ventilation
Increase air changes per hour (ACH)
Placement of patients near return vents for AGPs
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Administrative Controls
MOST EFFECTIVE
CHANGE THE WAY PEOPLE WORK
LEAST EFFECTIVE
Limiting personnel in the treatment room
Altering the patient schedule
Use of hand instruments instead of ultrasonic scaler
Prioritizing most urgent treatment
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Personal Protective Equipment
MOST EFFECTIVE
PROTECT THE WORKER WITH PPE
LEAST EFFECTIVE
Isolation gown
Face shield or goggles
Surgical mask or respirator (N95 or higher)
Exam gloves or surgical gloves
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Waiting Area Preparation
Remove toys, books, magazines
Remove or securely cover any non-wipeable furniture
Consider labeling, “X-ing” or placing signage on chairs to create appropriate distance
Reduce use of the waiting area by:
• Clients call or text upon arrival to parking lot, or when outside
• Utilize a doorbell with instructions to ring and wait outside
• Staff call or text clients when exam space available
• Limit or restrict accompanying family members
Create job lists for the scheduled cleaning of waiting area, registration desk, restrooms
• Emphasize high-touch surfaces – door handles, counter edges, arms of chairs
�Waiting Area Preparation
Many of these surfaces were not designed with frequent wiping in mind
Beware of degradation of finishes that may leave surfaces porous or splintered
- First Discourage use of
the waiting room
r
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Screening
Where will screening occur? What screening will occur?
• Can be outside, if area available and protected from elements
• Waiting room
• Electronic? Paper? Consider verbal questioning to avoid paper handled by clients
• Instruct clients to wear a mask until they are seated in the exam area and are
instructed to remove by dental staff
What plans are in place in the event client screens positive?
• If screening was done outside, no cleaning needed except to PPE of screener
• If exam needed is deemed an emergency?
• Consider exam space zones based on proximity, disruption to work-flow,
airflow and isolation
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Workspace Planning
Work-flow
• Minimize cross-traffic
• Consider zones by risk category
• Each work-space should include a space for donning, doffing and storage of PPE
• Alternate clients and chair spaces to allow for cleaning/decontamination time
HVAC, airflow
• Intake and out-flow mapping – tissue test
• Increase air exchanges, mix of outside air if possible
• Upgrade filter—check MERV rating
• Ensure that staff spaces and supply areas are ‘clean’ spaces to the extent possible
• Consider supplemental ventilation, such as free-standing HEPA filter units
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Workspace Planning
Break rooms, shared office and registration spaces should be cleaned regularly
If space allows for staff to be sequestered, i.e. in their own office with a door or
sufficiently isolated from others, they can be in that space without masking
Supply and storage rooms should only be entered or accessed by clean staff
• Mask on
• Clean hands or clean gloves
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Exam Space
Alternate the use of spaces to allow for cleaning/drying time
Do not use adjacent chair space at the same time if in areas without walls/doors
Make clinical space easily cleaned – nothing on counters except supplies to be
used for that client
Remove curtains or treat as contaminated by avoiding contact
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Staff
Screening of staff is two-fold
• Self reporting of symptoms that would prevent them from presenting to work,
done each work-day before arrival
• On-site screening for temperature and symptoms
Staff should wear masks, even cloth masks, as Source Control at all times
Consider assigning or reassigning staff to clients based on risks to each – if you have
staff who are in a high-risk category (age, medical condition, etc) prioritize them to
clients who are at the lowest risk
Consider maintaining a searchable database of staff members in contact with
specific clients
�PPE Donning
Considerations BEFORE Donning
any type of respiratory protection:
Donning should occur in a CLEAN space
Gather necessary PPE equipment
Hand sanitizer, trash bin
Tie long hair back
Secure hair away from face, eyes
Secure eyeglasses so they do not slide
Remove any jewelry that might be a hazard in your PPE
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
PPE: Surgical / Procedure Masks
Metal or plastic formable nose piece
“cascading waterfall” effect of
pleats – make sure they are
going the right direction!
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
PPE: How Masks are Evaluated
BFE – Bacterial Filtration Efficiency
For medical/surgical masks, must filter out 95% of bacterial sized
particles, tested with real bacteria.
PFE – Particle Filtration Efficiency, medical/surgical masks must
be able to filter out particles of about 0.1 micron in size
Delta P – airflow resistance across the filter, equates to work
of breathing
Fluid Resistance – Levels 1 - 3 for ability to repel synthetic
blood at increasing pressure
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
PPE: Respirators
Surgical N95’s act as both
PPE and source control
Masks with exhalation
valves CANNOT be used
as source control
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
What Makes an N95 Respirator Work
Filtration Mechanisms
Inertial impaction
Interception
Diffusion
Electrostatic attraction
https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Respirators: Tight-fitting Seal
Tight-fitting respirators need a tight seal between the respirator and
the face and/or neck of the respirator user in order to work properly
A user seal check is a quick check performed by
the wearer each time the respirator is put on
• This determines if the respirator is properly
seated to the face or needs to be readjusted
https://www.osha.gov/video/respiratory_protection/resptypes_transcript.html
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Face Shields as Protectors of the Protection
During testing of an influenza-laden cough aerosol with a volume
median diameter (VMD) of 8.5 μm, wearing a face shield reduced
the inhalational exposure of the worker by 96% in the period
immediately after a cough
• The face shield also reduced the surface contamination
of a respirator by 97%
Increasing the distance between the patient and worker
to 183 cm (72 inches) reduced the exposure to influenza
that occurred immediately after a cough by 92%
https://oeh.tandfonline.com/doi/full/10.1080/15459624.2013.877591
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Train DHCP in Proper Use of PPE
FOLLOW
The recommended sequences
for PPE donning and removal
www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html
�Before Entering a Patient Room
q Perform hand hygiene
q Put on a clean gown or protective clothing that covers personal clothing and skin (e.g.,
forearms) likely to be soiled with blood, saliva, or other potentially infectious materials
q Gowns and protective clothing should be changed if they become soiled
q Put on a surgical mask or respirator
q Mask ties should be secured on the crown of the head (top tie) and the base of the neck
r
(bottom tie). If mask has loops, hook them appropriately around your ears
q Respirator straps should be placed on the crown of the head (top strap) and the base of the
neck (bottom strap). Perform a user seal check each time you put on the respirator
q Put on eye protection
q Personal eyeglasses and contact lenses are NOT considered adequate eye protection
q Put on clean, non-sterile gloves
q Gloves should be changed if they become torn or heavily contaminated
q Enter the procedure area
�After Completion of Dental Care
q Remove gloves
q Remove gown or protective clothing and discard the gown in a dedicated container for waste or
linen
q Discard disposable gowns after each use
q Collect cloth gowns or protective clothing to be laundered after each use
q Exit the patient room or care area
q Perform hand hygiene
r
q Remove eye protection
q Carefully remove eye protection by grabbing the strap and pulling upwards and away from head
q Do not touch the front of the eye protection
q Clean and disinfect reusable eye protection according to manufacturer’s reprocessing instructions
q Discard disposable eye protection after use
q Remove and discard surgical mask or respirator – or store in a breathable container for re-use
q Hand hygiene
�PPE and Behavior
Additional safety
measures:
Face shield protects:
• Eyes
r
• Suction
• Front of mask
• Dental dam
• Un-intact skin
on face, neck
• 4-hand procedures
https://oeh.tandfonline.com/doi/full/10.1080/15459624.2015.1095302 - .XuD-Mi85SqB
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
PPE and Physical Distancing
�PPE Process
Extended Use: Masks and face shields
may be worn multiple times throughout
the day
Care must be taken to remove carefully,
wipe face shield
Perform hand hygiene
Store in clean area where they can dry
Label with name and day or date
CDC guidelines for reuse:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html
r
�PPE Process
The elastic of the mask or respirator
can be looped over the bag handle to
allow the mask to hang and air dry
Each staff member can keep their bag
and PPE in a convenient location for
reuse during their workday
Store bags between workdays in a
clean, well-ventilated space
Always handle PPE you are reusing with
gloved hands, then sanitize or change
gloves
r
�Infection Control Precautions in Dentistry
During the COVID-19 Pandemic
Decontamination of Filtering Facepiece Respirators (FFRs)
Crisis Capacity Standards of Care
• Ultraviolet germicidal irradiation
(UVGI), vaporous hydrogen peroxide
(VHP), and moist heat
• These FFRs should not be worn by
healthcare providers (HCPs) when
performing or present for an aerosolgenerating procedure
• Do not attempt to decontaminate
KN95 respirators allowed under FDA
EUA
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
�Environmental Cleaning
Do not manually compact trash, avoid aerosolization of waste
COVID-19 waste can be handled as normal waste
Look for cleaning products that list “human corona viruses” on the list of what they
kill, or see the list of approved EPA disinfectants (will not be COVID-specific)
Make sure to allow for the appropriate contact time for surfaces
r
Encourage frequent hand hygiene with ABHR or soap and water
Make sure ABHR have a minimum of 70% isopropyl or 60% ethanol
Use special care to:
• Not combine cleaners, directly or indirectly
• Use proper dilutions
• Aliquot carefully, date and discard
�Risk Reduction
Patient follow up: one to two week recheck via phone or text to verify no
presentation of symptoms
Request notification if key symptoms appear, patient receives positive test results
Some offices have chosen to see patients in family units – i.e., multiple family
members (who have been quarantined together) be seen in sequence so that the
exam space and waiting area can be cleanedr once that group has been seen
Encourage staff members to continue to reduce their own risks – maintaining
distance, use of masks when distance is not possible, or wearing a mask whenever
around others; encouraging the same in their household members
Remember, antibody testing does not imply immunity to COVID-19; a negative
screening test may miss early cases
Establishing good habits around PPE use, cleaning and disinfection, will serve us all
well moving forward!
�Resources
CDC - Guidance for Dental Settings:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
CDC Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19
Pandemic: https://www.cdc.gov/coronavirus/2019-ncov/hcp/framework-non-COVID-care.html
CDC - NIOSH Hierarch of Controls:
https://www.cdc.gov/niosh/topics/hierarchy/default.html
CDC - N95 Respirators and Surgical Masks: https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/
U.S. Department of Labor - Transcript for the OSHA Training Video Entitled Respiratory Types:
https://www.osha.gov/video/respiratory_protection/resptypes_transcript.html
Efficacy of Face Shields Against Cough Aerosol Droplets from a Cough Simulator
https://oeh.tandfonline.com/doi/full/10.1080/15459624.2013.877591
CDC - Using Personal Protective Equipment (PPE):
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
�Resources
Face Shields for Infection Control: A Review:
https://oeh.tandfonline.com/doi/full/10.1080/15459624.2015.1095302#.XuD-Mi85SqB
CDC - Strategies for Optimizing the Supply of N95 Respirators:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html
CDC – Decontamination and Reuse of Filtering Facepiece Respirators:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
AIHA Returning to Work: Dental Settings:
https://www.backtoworksafely.org/
OSAP/DQA Best Practices for Infection Control in Dental Clinics During COVID-19 Pandemic:
https://cdn.ymaws.com/www.osap.org/resource/resmgr/dentaquest/INC-1353_Best_Practices_for_.pdf
ADA – Return to Work Interim Guidance Toolkit, COVID-19 Hazard Assessment, and Patient
Education Center: https://www.ada.org/en
�Content Outline (TOC)
NETEC Resources
Amanda Grindle, MSN, RN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Wednesday, July 29, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/AkLR0PpGqXE
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Infection Control Precautions in Dentistry webinar" src="https://www.youtube.com/embed/AkLR0PpGqXE?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-dentistry" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-dentistry</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (7/29/20)/Online Course: Infection Control Precautions in Dentistry During the COVID-19 Pandemic
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This webinar will discuss infection control precautions in Dentistry during the COVID-19 pandemic. Objectives include: defining standard and transmission-based precautions, applying the proper sequence for donning and doffing PPE, and describing the characteristics of surgical masks, filtering facepiece respirators, and face shields.<br /><br />Webinar slides attached.<br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-dentistry" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-29
Type
The nature or genre of the resource
Webinar and Online Course
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - recommend archive - submitted asset update/review form
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
2019-nCoV
Airborne Transmission
CEU
CEUs
Coronavirus
COVID-19
Donning and Doffing
Droplet Transmission
Infection Prevention and Control
Mask
Masks
N95
Online Course
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/b0ac0ade688107db764f45823b5be06e.png
30d15b8d8679ca020a427e17f7871c8f
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Exercise
Exercise templates for training and education.
URL
https://www.cdc.gov/coronavirus/2019-ncov/hcp/training.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Training for Healthcare Professionals: Coronavirus Disease 2019 (COVID-19)
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Training materials on: Clinical Care & Infection Control, Personal Protective Equipment (PPE), Nonpharmaceutical Interventions (NPIs), Emergency Preparedness and Response, and Additional Topics.
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-26
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
2023-03-30 by Jill Morgan - General Asset Review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-03-30
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Emergency Management
Exercises and Drills
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-PPE
Therapeutics
Training
-
https://repository.netecweb.org/files/original/0f4284f44e20d5dfa7674908f3dbdcc9.pdf
de176f4341bc7b979ecbe30d5dc5d434
PDF Text
Text
putting
PPE
ON
1/1
Contact gown
N95
respirator
Face shield
Gloves
Gown
1
Remove any personal
items and jewelry and
put in secure location,
not in pockets.
3
2
Put on contact
gown outside room.
Sanitize
hands.
Open-end faces
your back.
Tie the back of
the gown.
4
Put on
gloves to
handle
reused N95
and face
shield.
N95, Eye Protection
6
8
7
Remove
gloves.
Put on
face shield.
9
5
Put on
N95.
Sanitize
hands.
Fit N95 to nose, make
sure no air is escaping.
Entry, Gloves
11
10
ENTER
room
12
Sanitize
hands.
Put on gloves
(over the cuffs
of the gown if
worn).
13
Do not touch face or readjust N95 or face shield
inside room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 4, 2020
�taking
PPE
OFF
1/1
N95, face shield, contact gown, gloves
1
Gown
2
Sanitize
gloves.
3
Roll the gown towards
your hands.
Remove the gloves
with the gown.
Cross arms and
grip gown on
shoulders.
Pull and break
gown in controlled
fashion.
Sanitize
gloves.
9
6
Place wipe
on table.
EXIT patient room
Eye Protection, Gloves
7
13
Wipe
front and
back of
shield.
Wipe
elastic band.
Pinch
bottom strap
and pull far
over head.
Do not let
straps touch
your face.
Remove eye
wear and
place on
wipe.
Pinch top strap
and pull far
over head. Do
not let straps
touch your face
as you remove
the N95.
12
4
Dispose of
gloves and
gown.
EXIT patient room
5
Sanitize
gloves.
Store
N95
in
bag.
10
8
11
Put on
mask.
Sanitize gloves.
14
15
Wipe
foam band.
Place
shield in
bag to dry.
16
17
Wipe
table.
19
Sanitize
gloves.
18
Remove
gloves.
Sanitize hands or
wash with soap and
water.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 4, 2020
�
https://repository.netecweb.org/files/original/b57e52efe49ab162989288a4200e2ec9.pdf
7cec21569ccdc6b138f432427bb0159b
PDF Text
Text
putting
PPE
ON
1/1
Contact gown
N95
respirator
Face shield
Gloves
Gown
1
2
Remove any
personal items and
jewelry and put in
secure location, not
in pockets.
3
If you already have a mask on:
Sanitize
hands.
Remove
mask.
Store
mask.
Sanitize
hands.
Put on contact gown outside room.
Open-end faces your back.
Tie the back of the gown.
N95, Eye Protection
4
5
Put on
gloves to
handle reused
N95 and face
shield.
Put on
N95.
6
7
8
Remove
gloves.
Put on
face shield.
9
Sanitize
hands.
Fit N95 to nose, make
sure no air is escaping.
Entry, Gloves
10
11
ENTER
room
Sanitize
hands.
12
Put on gloves
(over the cuffs
of the gown if
worn).
13
Do not touch face or readjust N95 or face shield
inside room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated September 4, 2020
�taking
PPE
OFF
1/1
N95, face shield, contact gown, gloves
Gown
1
2
Sanitize
gloves.
3
Cross arms and
grip gown on
shoulders.
4
Roll the gown towards your
hands.
Sanitize
gloves.
Remove the gloves
with the gown.
Pull and break
gown in controlled
fashion.
Dispose of gloves
and gown.
EXIT patient room
EXIT patient room
Eye Protection, Gloves
5
Sanitize
gloves.
9
6
Place wipe
on table.
7
8
Pinch bottom
strap and pull
far over head.
Do not let
straps touch
your face.
Remove
eye wear
and place
on wipe.
10
Pinch top strap
and pull far over
head. Do not
let straps touch
your face as you
remove the N95.
11
Store
N95
in
bag.
Put on
mask.
Sanitize gloves.
12
13
14
Place
shield in
bag to dry.
Wipe shield. Sanitize in the following
order:
15
Wipe
table.
17
Back of
shield.
Elastic
band.
Foam
band.
Sanitize
gloves.
16
Remove
gloves.
Wash hands with
soap and water
or sanitize hands.
Front of
shield.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated September 4, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/ambulatory-ppe.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Ambulatory PPE Resources: Aerosol Generating Procedure
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<h3>N95 Respirator (reuse)</h3>
<h3>Face shield or goggles (reuse)</h3>
<h3>Contact gown</h3>
<h3>Single gloves</h3>
<p>Instructions for aerosol generating procedures. Please follow reuse protocols for N95 and gowns.<br /><br />Putting ON PPE, Taking OFF PPE</p>
<p>These instructions are useful when you are...</p>
<ul><li>...<span style="text-decoration:underline;">performing an aerosol generating procedure</span> with a symptomatic patient who has a mask off.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-04
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Donning and Doffing
Example
Face shield
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/b122e0e50b4bda8d3b1ffde5ff84981a.pdf
44eafd1a27407da14b6e4fdae89c4e60
PDF Text
Text
putting
PPE
ON
1/1
Contact gown
Procedure
mask
Eye protection
Gloves
Gown
1
Remove any personal
items and jewelry and
put in secure location,
not in pockets.
2
3
Sanitize
hands.
Put on contact
gown outside room.
Open-end faces
your back.
Tie the back of
the gown.
Mask, Eye Protection
4
5
6
Put on
mask.
Put on face
shield or
other eye
protection.
Fit mask to nose.
Entry, Gloves
7
8
Sanitize
hands.
9
ENTER
room
10
Sanitize
hands.
11
Put on gloves
(over the cuffs
of the gown if
worn).
Do not touch face or readjust mask or face shield
inside room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated September 4, 2020
�taking
PPE
OFF
1/1
Procedure mask, eye protection, contact gown, gloves
Gown
1
Sanitize
gloves.
2
3
4
Cross arms and
grip gown on
shoulders.
Roll the gown towards
your hands.
Pull and break
gown in controlled
fashion.
Sanitize
gloves.
Dispose of
gown.
EXIT patient room
EXIT patient room
Eye Protection, Gloves
5
6
Place
wipe on table.
Sanitize gloves.
7
8
Remove
eye
protection
and place
on wipe.
Sanitize
gloves.
10
9
Wipe shield. Sanitize in the following
order:
Place
shield in
bag to dry.
11
12
Wipe
table.
14
Back of
shield.
Elastic
band.
Foam
band.
Sanitize
gloves.
13
Remove
gloves.
Wash hands with
soap and water or
sanitize hands.
Front of
shield.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated September 4, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/ambulatory-ppe.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Ambulatory PPE Resources: Throat/sinus exam
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p><strong>Procedure mask</strong></p>
<p><strong>Face shield or goggles (reuse)</strong></p>
<p><strong>Contact gown</strong></p>
<p><strong>Single gloves</strong></p>
<p>Instructions for throat/sinus exam PPE. Standard instructions for putting on and taking off <span style="text-decoration:underline;">D</span>roplet <span style="text-decoration:underline;">C</span>ontact Precautions with <span style="text-decoration:underline;">E</span>yewear (DICE) level PPE. This is the level of PPE which is <em><span style="text-decoration:underline;">acceptable</span></em> for COVID care <a href="https://www.cdc.gov/coronavirus/2019-ncov/downloads/COVID-19_PPE_illustrations-p.pdf" target="_blank" rel="noreferrer noopener">according to CDC</a>. Please refer to <a href="https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/general-ppe-guidance.html" target="_blank" rel="noreferrer noopener">our instructions on reuse of PPE</a>. Talk with your supervisor if you have any questions about reuse in your area.<br /><br />Putting ON PPE, Taking OFF PPE</p>
<p>These instructions are useful when you are...</p>
<ul>
<li>...<span style="text-decoration:underline;">performing a physical exam</span> with a symptomatic patient who has a mask off.</li>
<li>...<span style="text-decoration:underline;">NOT</span> performing aerosolizing procedures.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-04
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-01
2019-nCoV
Coronavirus
COVID-19
Donning and Doffing
Example
Face shield
Gloves
Goggles
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/3e6858b16a29a0869ebf972f677f4c21.png
ef18c9a2914fbbc2b289d3c544d7cd3a
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="N95 User Seal Check Animation" src="https://www.youtube.com/embed/DPa1nlU9Vfg?autoplay=0" frameborder="0"></iframe>
URL
https://youtu.be/DPa1nlU9Vfg
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
N95 User Seal Check Animation
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This video covers how to perform a user seal check on an N95 respirator. This is NOT a fit test that is performed by qualified fit-test personnel. Talk to your supervisor if you do not achieve a proper seal. <br /><br />Who produced this? These materials have been developed by the Serious Communicable Diseases Program Team in collaboration with Emory's Visual Medical Education team, which is comprised of certified medical illustrators.<br /><br />©2020 Emory University <br /><br />med.emory.edu/PPE
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control; PPE
2019-nCoV
Coronavirus
COVID-19
Donning and Doffing
Just in Time training (JIT)
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/47d77d74633abc4a1e48bb3fbffa4546.pdf
32db8d7004339420e61c25c50566d0d8
PDF Text
Text
Extended
wear
1
EW
View the PPE video at
med.emory.edu/PPE
Eyes and Mask
Exit patient room.
2
4
Get a new gown.
Sanitize hands.
3
Keep eyewear and
face protection if
they are not visibly
soiled.
Gown
5
6
Tear the neck
at center.
Protect the
seams.
Tie the gown
at the neck.
7
Tie the gown
at the waist.
Entry
8
Put on fresh
gloves.
9
Sanitize gloves.
10
Enter
NEXT
patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated May 5, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/general-ppe-guidance.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Reusing Face and Eye PPE - Extended Wear - Flyer
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Extended wear/Cohort reuse protocol for face and eye protection when supplies are low and the provider is treating only COVID-19 patients.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-05
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Relation
A related resource
Y - PPE pos 100 qualtrics 320
Y - D0.1PPE/D0.2PPE Qualtrics # 320
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Donning and Doffing
Example
Extended wear
Face shield
Gloves
Goggles
Gown
Hand Hygiene
Mask
Masks
One Page Flyer
Personal Protective Equipment (PPE)
R-PPE
Reuse
-
https://repository.netecweb.org/files/original/4d0406d4eeab57b84d805ac5a986d81c.pdf
b90b521d08890d694d998629f2749d65
PDF Text
Text
Setup
CONSERVE
PPE
1
Sanitize
hands.
2
View the PPE videos at
med.emory.edu/PPE
3
Put on fresh
gloves.
Place
wipe
on table.
After
gown
and
glove
removal...
4
N95
Remove eyewear and
place on wipe.
5
6
Sanitize
gloves.
or
9
10
Wipe
elastic band.
13
12
11
Wipe
foam band.
Sanitize
gloves.
Remove
procedure
mask,
lower strap
and then
upper.
Store mask.
Face Shield
8
Wipe
front and
back of
shield.
7
Sanitize
gloves.
14
Remove
gloves.
Place shield
upside down
to dry.
Wipe
table.
15
Wash hands
with soap
and water.
Goggles
8
Wipe front
and back of
lens.
9
Wipe both
ear pieces.
10
Wipe
table.
11
12
Sanitize
gloves.
13
Place goggles
on clean table
to dry.
14
Wash hands
with soap
and water.
© 2020 Emory University, created by Visual Medical Education. Updated April 7, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
Remove
gloves.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/general-ppe-guidance.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Conserve PPE: Reusing face shield, eyewear, and N95
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 Flyer: These instructions are only meant to be used when supplies are low.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-07
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Relation
A related resource
Y - PPE pos 100 qualtrics 320; PPE row 31 score 0
Y - D0.1PPE/D0.2PPE Qualtrics # 320
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Example
Face shield
Gloves
Goggles
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
Reuse
-
https://repository.netecweb.org/files/original/efd923ba18989fdcc37ac5a459723aed.pdf
3e7ba9505d7a86b79c5802ef01670358
PDF Text
Text
Get The Most Out of
Wearing Your
What to do when...?
MASK
N95
Surgical
Cloth
This feels uncomfortable on my skin
Wash up
Moisturize
Au naturel
Drink up!
Roll it in
Get crafty
Drink water to
help moisturize
your skin.
Use a chafe stick, often
used by runners, to
reduce skin chafing.
Create handmade
ear savers. Go
online for ideas :)
Wash your face
before and after
wearing a mask.
Apply lotion or vaseline
after washing your face
to protect your skin.
Avoid wearing
makup under
the mask.
I’m hot, thirsty, or hungry
Cool down
If you feel hot,
properly doff your
mask, store in paper
bag and take a break.
Really hydrate
Eat enough
Drink plenty of water
before entering the
patient room.
Eat enough in
one sitting to stay
energized.
I need to make/answer this call
Volume up
Batch emails
Use ear buds
Turn up the
volume or put on
speaker phone.
Batch and answer
emails while you
are taking a break.
Hold your phone away
from your face and
mask.
Don’ts
Pull below
chin
Leave
straps
hanging
Pull below
nose
Leave hair
down on face
Hang
around
neck
Cross
straps in
the back
Touch
nose
bridge
Touch
front of
mask
Remove
mask to
cough or talk
Reach
under
mask
Pull mask
out to eat
or drink
Hang
from one
ear
Touch
phone to
mask
Wear on
forehead
Wear wet
mask
Emory University, created by Visual Medical Education. Updated April 22, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19) and have not been subject to review that typically would occur in a nonemergent situation. The materials do not constitute the provision of medical, legal or other professional advice. EMORY UNIVERSITY AND EMORY HEALTHCARE MAKE NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIALS, INCLUDING, WITHOUT
LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/general-ppe-guidance.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Getting the most from your mask
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 - Flyer: Getting the most out of wearing your mask, for healthcare providers and hospital staff.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-22
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
COVID-19
Example
Mask
Mask Education
Mask Rules
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/37fdac0758066860a410b0182ab515a8.pptx
b7842b20700eb3815e65fb164ab3d39d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Create your own PPE Flyers
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/general-ppe-guidance.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Create your own PPE figure
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 Resources: General PPE Guidance - If you are in charge of creating PPE signage or communications for your institution, we have created a simple way for you to dress a figure in different pieces of PPE and export for your own use. These are not meant to communicate the complex process of donning and doffing, but should be helpful for a general "here is the level of PPE you should wear".
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-29
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Communications
Contingency and crisis capacities
Coronavirus
COVID-19
Example
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/2707db7bc7fe151d51a0cc4b577bab91.pdf
fc48d6aee37f4185f831b443298951cd
PDF Text
Text
N95
User
Seal Check
N95
Important notes
1
2
With any N95, you should always
perform a seal check each time it
is donned. Follow the manufacturer’s
manual for best practice.
If you are reusing
the mask, use
gloved hands.
Each time, Every time.
Your Safety Depends on it.
Positive pressure user seal check
1
2
Ensure that the
face piece is slightly
pressurized before
pressure causes
outward leakage.
Exhale gently
while blocking the
paths for air to
exit the face piece.
Negative pressure user seal check
1
2
Ensure that the
face piece collapses
slightly under negative
pressure that is
created with this
procedure.
Inhale sharply
while blocking
the paths for air
to enter the face
piece.
1
If you can’t achieve a proper seal...
2
If the air leaks out between
your face and the respirator,
the respirator does not fit
your face properly.
4
3
DO NOT ENTER
a hazardous
area.
Readjust the
respirator and check
the seal again.
If you are still unable
to get a good seal, talk
to your supervisor for a
new N95.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 30, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/general-ppe-guidance.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
N95 User Seal Check
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<br />COVID-19 Resources: General PPE Guidance -When wearing an N95 to care for COVID patients, you need to perform a user seal check <span style="text-decoration:underline;">EVERYTIME</span> you don your PPE. This flyer instructs you on how to perform your own user seal check. Your safety depends on it.<br /><br />User seal checks do NOT replace initial fit testing done by your institution to ensure that your particular piece of equipment fits properly to your specific face shape.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-30
Contributor
An entity responsible for making contributions to the resource
2022-02-04 by Jill Morgan
2022-02-07 by Lisa Stone (needed for old blog post)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
Do not review - outdated - needed for old blog post.
2019-nCoV
Archived
Coronavirus
COVID-19
N95
Personal Protective Equipment (PPE)
R-PPE
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Chu, Derek K., Elie A. Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, Holger J. Schünemann, Derek K. Chu, Elie A. Akl, Amena El-harakeh, Antonio Bognanni, Tamara Lotfi, Mark Loeb, Anisa Hajizadeh, Anna Bak, Ariel Izcovich, Carlos A. Cuello-Garcia, Chen Chen, David J. Harris, Ewa Borowiack, Fatimah Chamseddine, Finn Schünemann, Gian Paolo Morgano, Giovanna E. U. Muti Schünemann, Guang Chen, Hong Zhao, Ignacio Neumann, Jeffrey Chan, Joanne Khabsa, Layal Hneiny, Leila Harrison, Maureen Smith, Nesrine Rizk, Paolo Giorgi Rossi, Pierre AbiHanna, Rayane El-khoury, Rosa Stalteri, Tejan Baldeh, Thomas Piggott, Yuan Zhang, Zahra Saad, Assem Khamis, Marge Reinap, Stephanie Duda, Karla Solo, Sally Yaacoub, and Holger J. Schünemann. 2020. "Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis." The Lancet.
Abstract
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.</div>
<h3>Methods</h3>
<div class="section-paragraph">We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047.</div>
<h3>Findings</h3>
<div class="section-paragraph">Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; <em>p</em><sub>interaction</sub>=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; <em>p</em><sub>interaction</sub>=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.</div>
<h3>Interpretation</h3>
<div class="section-paragraph">The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance.</div>
<h3>Funding</h3>
<div class="section-paragraph">World Health Organization.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31142-9/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.<br /><br />A response to this publication was published:<br /><ul><li>MacIntyre, C. Raina, and Quanyi Wang. "<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31183-1/fulltext">Physical distancing, face masks, and eye protection for prevention of COVID-19.</a>" The Lancet.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Chu, Derek K., Elie A. Akl, Stephanie Duda, Karla Solo, Sally Yaacoub, Holger J. Schünemann, Derek K. Chu, Elie A. Akl, Amena El-harakeh, Antonio Bognanni, Tamara Lotfi, Mark Loeb, Anisa Hajizadeh, Anna Bak, Ariel Izcovich, Carlos A. Cuello-Garcia, Chen Chen, David J. Harris, Ewa Borowiack, Fatimah Chamseddine, Finn Schünemann, Gian Paolo Morgano, Giovanna E. U. Muti Schünemann, Guang Chen, Hong Zhao, Ignacio Neumann, Jeffrey Chan, Joanne Khabsa, Layal Hneiny, Leila Harrison, Maureen Smith, Nesrine Rizk, Paolo Giorgi Rossi, Pierre AbiHanna, Rayane El-khoury, Rosa Stalteri, Tejan Baldeh, Thomas Piggott, Yuan Zhang, Zahra Saad, Assem Khamis, Marge Reinap, Stephanie Duda, Karla Solo, Sally Yaacoub, and Holger J. Schünemann.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
2019-nCoV
Coronavirus
COVID-19
Droplet Transmission
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/1f0b576bedf711a4a566adfb53282c12.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
<p><strong>Date</strong>: Wednesday, June 3, 2020</p>
<p><strong>Time</strong>: 2:00–3:00 P.M. ET</p>
Event Type
COCA Call webinar, will be recorded.
URL
https://emergency.cdc.gov/coca/calls/2020/callinfo_060320.asp
Alternate URL
Other URLs if necessary.
https://youtu.be/CtOThtxtqvg
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Guidance for Dental Settings During the COVID-19 Response" src="https://www.youtube.com/embed/CtOThtxtqvg?autoplay=0" frameborder="0"></iframe>
Objectives
Information for dentists, dentist, dentistry.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Guidance for Dental Settings During the COVID-19 Response
Subject
The topic of the resource
Infection Control
Description
An account of the resource
During this COCA call, presenters will provide an overview of the updated guidance for dental settings, including recommendations for resuming non-emergency dental care during the COVID-19 pandemic. Presenters also will discuss strategies for dental healthcare facilities to optimize personal protective equipment (PPE).
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-03
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Example
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/7ba460618e1bdd8a33a50a10ec8d96ce.png
700012660d4898bcf6c588d95d719479
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/respprotect/CA-2020-1028.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NIOSH Respiratory Protective Device Information
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Information regarding damaged or degraded head straps on previously stockpiled NIOSH-approved filtering facepiece respirators
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-18
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change to R-PPE)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
2019-nCoV
Coronavirus
COVID-19
N95
Personal Protective Equipment (PPE)
R-PPE
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Ortega, Rafael, Mauricio Gonzalez, Ala Nozari, and Robert Canelli. 2020. "Personal Protective Equipment and Covid-19." New England Journal of Medicine.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM
URL
https://www.nejm.org/doi/full/10.1056/NEJMvcm2014809
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMvcm2014809
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Personal Protective Equipment and Covid-19
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Given the threat of coronavirus disease 2019, or Covid-19, it is important to emphasize the use of proper precautions for infection control in health care settings.
Creator
An entity primarily responsible for making the resource
Ortega, Rafael, Mauricio Gonzalez, Ala Nozari, and Robert Canelli.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-19
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
2019-nCoV
Coronavirus
COVID-19
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/c195b3bb1f42215df9fa5f41327574e5.pdf
f7b3ecadf32c40b49557dd5c15cac883
PDF Text
Text
putting
PPE
ON
1/1
N95
respirator
Contact gown
Face shield
Gloves
Gown, Gloves
1
2
Remove any
personal items and
jewelry and put in
secure location, not
in pockets.
3
If you already have a mask on:
Sanitize
hands.
Remove
mask.
Store
mask.
Sanitize
hands.
4
Put on contact gown outside
room.
Open-end faces your back.
Tie the back of the gown.
Put on gloves
over the cuffs
of the gown.
N95
5
6
Put on N95,
ensuring proper
seal.
Ensure straps
are not crossing.
7
Place hands over
the front of the
N95. Breathe an
easy deep breath
in and out.
Sanitize gloves.
If you feel air
escape the
edges, refit
and repeat.
Face Shield, Entry
8
10
9
Put on face
shield.
Sanitize
gloves.
ENTER
room
DO NOT enter the room if
you do not achieve a proper
respirator seal.
11
Do not
touch
face or
re-adjust
N95 or
face shield
inside
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated September 4, 2020
�taking
PPE
OFF
1/2
N95, face shield, contact gown, gloves
Gown, Gloves
1
Sanitize
gloves.
2
Cross arms and
grip gown on
shoulders.
Pull and break
gown in controlled
fashion.
3
Roll the gown
towards your hands.
Remove the gloves
with the gown.
Dispose of
gloves and gown.
4
Sanitize
hands.
Exit
5
Exit
operating
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated September 4, 2020
�taking
PPE
OFF
2/2
N95, face shield, contact gown, gloves
Gloves, Setup
1
After outer
glove removal
in the patient
room,
exit and...
2
Put on new
gloves.
3
Sanitize
gloves.
Place wipe on
table.
N95
4
Remove eye wear
and place on wipe.
5
6
7
Sanitize
gloves.
Do not touch face.
Do not let straps touch your
face as you remove the N95.
Do not let straps touch
your face.
8
10
9
Sanitize
gloves.
Store N95.
Pinch
top
strap
and pull
far over
head.
Pinch
bottom
strap and
pull far
over head.
Put on mask.
Face Shield
11
12
Wipe shield. Sanitize in the following
order:
13
Place
shield in
bag to dry.
14
Wipe
table.
16
Back of
shield.
Elastic
band.
Foam
band.
Sanitize
gloves.
15
Remove
gloves.
Wash hands with
soap and water
or sanitize hands.
Front of
shield.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Donning Airborne Contact precautions with Eyewear (ACE) Printable Instructions for non-sterile OR staff.<br /><div class="element-text five columns omega">
<p>Doffing Airborne Contact precautions with Eyewear (ACE) Printable Instructions for non-sterile OR staff.</p>
</div>
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/surgery-dept-ppe.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Non-Sterile - Airborne Contact precautions with Eyewear (ACE) Printable Instructions
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Operating Room (Non-Sterile) Printable PDFs <br /><br />Putting ON PPE, Taking OFF PPE<br /><br />These PDF's depict the the use of PPE for non-sterile OR staff for the protection against COVID-19 that is currently in use at Emory University. Created by Emory's Visual Medical Education team.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-04
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
Coronavirus
COVID-19
Donning and Doffing
Example
Face shield
Gloves
Gown
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/465ae324618fd07e5f392e32d9c0a86e.pdf
b632db6123d583aacbec5b89646ab08b
PDF Text
Text
putting
PPE
ON
1/2
Launderable gown
CAPR
system
Inner gloves
Outer gloves
Gloves
1
Batch work and plan
ahead, having items
available
outside each
patient room.
3
2
If you
already
have a
mask on:
Put on
first pair of
gloves.
Sanitize
hands.
Remove
mask.
Store
mask.
Sanitize
hands.
Lens Cuff
4
7
Remove the
lens protector
liner from the
front side of the
lens cuff.
5
6
Secure the
lens cuff by
aligning the
center hole
over the center
attachment
post on the
helmet.
Lift the cuff
flappers to
rest against
the foam
pads at the
ends of the
comfort strip.
Attach the left and
right side lens cuff
mounting holes over
the left and right
side attachment
posts of the helmet.
Tip: The lens cuff
will click when it is
properly secured.
8
9
Insert
the power
cord
connecter
into the
battery.
Check the LED lights
to ensure the battery
is fully charged.
10
Adjust fan
speed to
comfort.
Battery, Belt
11
12
Secure the battery
to the belt using the
battery clip.
Secure the belt
around the waist.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�putting
PPE
ON
2/2
CAPR, launderable gown, double gloves
Helmet
13
14
Turn ratchet knob
counterclockwise
to loosen the
headband.
15
18
16
Place the chin
into the lens cuff
while pulling
the helmet over
and down on the
head.
Check for proper fit, ensure:
The cuff flappers
are perpendicular
to the head.
Hold the helmet near
the rear headband with
one hand, pull down on
top of the lens cuff with
the other.
17
Turn the
ratchet knob
counterclockwise to
tighten the
headband.
Slide the
fingers around
the cuff under
the chin to
ensure slight
tension.
19
LED indicators
The cuff flappers
are in your
are 1/4 inch from
peripheral vision. the temples.
The bottom of
the headband
rests 1/2
inch from the
eyebrows.
Tip: If the headband
is not in an
appropriate height,
doff, adjust the
headband height
position, and redo.
Gown, Gloves
20
Put on gown outside room.
Open-end faces your back.
21
Pull cuffs half way
over palm of the
inner glove.
Tie the back of the gown.
23
24
Sanitize
second
pair of
gloves.
ENTER room
DO NOT enter the room if
you do not achieve a proper
fit of the CAPR system.
22
Put on
second
pair of
gloves.
25
Do not touch or
re-adjust CAPR
system inside the
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�extended
wear
EW
INSIDE
room
1/2
CAPR, launderable gown, double gloves
Next patient:
COVID+
Gloves
1
Sanitize outer gloves.
2
Remove outer gloves.
Exit
3
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�extended
wear
EW
OUTSIDE
room
2/2
CAPR, launderable gown, double gloves
Next patient:
COVID+
Gloves
1
After outer
glove removal
in the patient
room,
exit and...
Pull cuffs half way
over palm of the
inner glove.
2
Put on fresh
outer gloves.
Walking
3
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
4
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
5
Sanitize outer
gloves.
7
6
Enter
next
COVID-19
patient
room or
area.
Do not touch face or
re-adjust CAPR system
inside room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�taking
PPE
OFF
INSIDE
1/3
room
CAPR, launderable gown, double gloves
Next patient:
NOT COVID+
Gown, Gloves
1
Sanitize outer gloves.
4
2
Remove outer gloves.
Reach back and release
the neck portion.
5
6
Sanitize inner gloves.
Untie the waist.
7
Remove
the gown
into the
designated
bin.
3
Sanitize inner gloves.
Exit
8
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�taking
PPE
OFF
OUTSIDE
2/3
room
CAPR, launderable gown, double gloves
Next patient:
NOT COVID+
Lens Cuff
1
After coveralls
and outer glove
removal...
2
Sanitize
gloves.
4
Place first
wipe on table.
3
Grab lens cuff at
the left and right
side attachments.
Remove by pulling
outward and forward.
5
Place
lens
cuff
on
wipe.
6
Wipe front
and back of
lens cuff.
Allow to
dry.
Store lens
cuff in a gallon
sized bag
labeled with
your name.
Helmet
7
8
Sanitize
gloves.
9
Place
second
wipe on
table.
13
10
Grasp outer-shell of
helmet and take off.
Ensure that
the helmet cord
doesn’t touch
your body.
14
Wipe inside of the
helmet.
15
Sanitize
gloves.
11
Place
helmet on
first wipe.
Sanitize
gloves.
12
Put on
mask.
16
Hold inside
of the
helmet and
flip onto
second
wipe.
Wipe outside of the
helmet.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�taking
PPE
OFF
OUTSIDE
3/3
room
CAPR, launderable gown, double gloves
Next patient:
NOT COVID+
Battery, Belt
17
18
Wipe helmet
cord.
Sanitize
gloves.
19
20
Remove and
wipe battery.
Sanitize
gloves.
21
22
Remove belt
and wipe.
Sanitize
gloves.
Gloves
24
23
Remove
gloves.
25
Wash
hands.
Sanitize
gloves.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Use these instructions for donning, or putting on your PPE, if you are caring for a COVID-19 positive patient next and are reusing CAPR, and gown.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/conserving-ppe.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Unit Resources: Donning and Doffing with CAPR and double gloves, PPE
Subject
The topic of the resource
Infection Control
Description
An account of the resource
CAPR, RE-USE GOWN, DOUBLE Gloves - ACE Printable PDFs<br /><br />Putting ON PPE, Extended Wear, Taking OFF PPE
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-13
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
CAPR
Coronavirus
COVID-19
Example
Extended wear
Gloves
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/ff7be9009a14dba23ec23460872d5f4f.pdf
5481da6849ec1a9739ca9ac12f139ba5
PDF Text
Text
putting
PPE
ON
1/1
Launderable gown
N95
respirator
Face
shield
Inner gloves
Outer gloves
Gown, Gloves
1
2
Batch work and plan
ahead, having items
available
outside each
patient room.
3
Put on
first pair of
gloves.
If you
already
have a
mask on:
Sanitize
hands.
4
5
Put on gown outside room.
Open-end faces your back.
Remove
mask.
Store
mask.
Sanitize
hands.
6
Pull cuffs half way
over palm of the
inner glove.
Put on second
pair of gloves
over the cuffs
of the gown.
Tie the back of the gown.
N95
7
8
Put on N95,
ensuring proper
seal.
Ensure straps
are not crossing.
9
Place hands over
the front of the
N95. Breathe an
easy deep breath
in and out.
Sanitize gloves.
If you feel air
escape the
edges, refit
and repeat.
Face Shield, Entry
10
Put on face
shield.
11
Sanitize
gloves.
12
13
ENTER
room
Do not touch face or readjust N95 or face shield
inside room.
DO NOT enter the room if
you do not achieve a proper
respirator seal.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�extended
wear
EW
INSIDE
room
1/2
N95, face shield, launderable gown, double gloves
Next patient:
COVID+
Gloves
1
Sanitize outer gloves.
2
Remove outer gloves.
Exit
3
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�extended
wear
EW
OUTSIDE
room
2/2
N95, face shield, launderable gown, double gloves
Next patient:
COVID+
Gloves
1
After outer
glove removal
in the patient
room,
exit and...
Pull cuffs half way
over palm of the
inner glove.
2
Put on fresh
outer gloves.
Walking
3
4
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
5
Sanitize outer
gloves.
6
7
Enter
NEXT
COVID-19
patient
room or
area.
Do not touch face or readjust N95 or face shield
inside room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�taking
PPE
OFF
INSIDE
1/2
room
N95, face shield, launderable gown, double gloves
Next patient:
NOT COVID+
Gown, Gloves
1
Sanitize outer gloves.
4
2
Remove outer gloves.
Reach back and release
the neck portion.
5
6
Sanitize inner gloves.
Untie the waist.
7
Remove
the gown
into the
designated
bin.
3
Sanitize inner gloves.
Exit
8
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�taking
PPE
OFF
OUTSIDE
2/2
room
N95, face shield, launderable gown, double gloves
Next patient:
NOT COVID+
Gloves, Setup
1
After outer
glove removal
in the patient
room,
exit and...
Sanitize
gloves.
2
Place
wipe on
table.
N95
3
4
Remove eye wear and
place on wipe.
5
Sanitize
gloves.
6
Remove
N95,
lower strap
and then
upper.
Store N95.
Sanitize
gloves.
7
Put on
mask.
Face Shield
8
10
9
Place
shield in
bag to dry.
Wipe shield. Sanitize in the following
order:
11
Wipe
table.
13
Back of
shield.
Elastic
band.
Foam
band.
Sanitize
gloves.
12
Remove
gloves.
Wash hands with
soap and water
or sanitize hands.
Front of
shield.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Use these instructions for donning, or putting on your PPE, if you are caring for a COVID-19 positive patient next and are reusing the mask, faceshield, and gown.<br /><div class="element-text five columns omega">
<p>Post these inside and outside COVID-19 patient rooms, use to doff. Two options, one if your next patient is COVID-19 positive (pages 2 and 3 of this pdf), the other if your next patient COVID-19 status is negative or uncertain, or if you are finished seeing patients (pages 4 and 5 of this pdf).</p>
</div>
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/conserving-ppe.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE (ACE) double gloves
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 Unit Resources: COVID-19 Unit - COVID-19 ACE Printable PDFs (RE-USE GOWN). <br />RE-USE GOWN, DOUBLE Gloves - COVID-19 Unit - ACE Printable PDFs <br /><br />Putting ON PPE, Extending Wear, Taking OFF PPE<br /><br />These PDFs reflect the current supply shortage in which N95 masks and face shields and gowns may be conserved and reused. Created by Emory's Visual Medical Education team.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-28
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
Coronavirus
COVID-19
Donning and Doffing
Example
Extended wear
Face shield
Gloves
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/b9826859ec95cd923f67a6d34d70bf4f.pdf
769764272610d00e7849b8de80628911
PDF Text
Text
putting
PPE
ON
1/1
CAPR
system
Coveralls
Inner gloves Outer gloves
Gloves
2
1
Batch work and plan
ahead, having items
available
outside each
patient room.
If you already have a mask on:
Sanitize
hands.
Remove
mask.
Store
mask.
3
Sanitize
hands.
Put on first
pair of gloves.
Lens Cuff
4
Remove the
lens protector
liner from the
front side of the
lens cuff.
5
6
Secure the lens cuff by
aligning the center hole
over the center attachment
post on the helmet.
Attach the left and
right side lens cuff
mounting holes over
the left and right
side attachment
posts of the helmet.
Tip: The lens cuff
will click when it is
properly secured.
7
Lift the cuff
flappers to
rest against
the foam
pads at the
ends of the
comfort strip.
8
9
Insert
the power
cord
connecter
into the
battery.
Check the LED lights
to ensure the battery
is fully charged.
10
Adjust fan
speed to
comfort.
Battery, Belt
11
12
Secure the battery
to the belt using the
battery clip.
Secure the belt
around the waist.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�putting
PPE
ON
2/2
CAPR, coveralls, double gloves
Helmet
13
14
Hold the helmet near
the rear headband with
one hand, pull down on
top of the lens cuff with
the other.
Turn ratchet knob
counterclockwise
to loosen the
headband.
15
18
16
Place the
chin into the
lens cuff while
pulling the
helmet over
and down on
the head.
17
Turn the
ratchet knob
counter
clockwise to
tighten the
headband.
Slide the fingers
around the cuff
under the chin
to ensure slight
tension.
19
Check for proper fit, ensure:
The cuff flappers
are perpendicular
to the head.
LED indicators
are in your
peripheral vision.
The cuff
flappers are 1/4
inch from the
temples.
The bottom of
the headband
rests 1/2 inch
from eyebrows.
Tip: If the headband
is not in an
appropriate height,
doff, adjust the
headband height
position, and redo.
Entry
20
21
Put on coveralls outside room.
Open-end faces your front.
22
Sanitize
first pair
of gloves.
Put on second
pair of gloves.
Zip up the front of the coveralls.
23
24
Sanitize
second
pair of
gloves.
ENTER room
DO NOT enter the room if
you do not achieve a proper
fit of the CAPR system.
25
Do not touch or
re-adjust CAPR
system inside the
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�extended
wear
EW
INSIDE
room
1/2
CAPR, coveralls, double gloves
Next patient:
COVID+
Gloves
1
Sanitize outer gloves.
2
Remove outer gloves.
3
Sanitize inner gloves.
Exit
4
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�extended
wear
EW
OUTSIDE
room
2/2
CAPR, coveralls, double gloves
Next patient:
COVID+
Gloves
1
After outer
glove removal
in the patient
room,
exit and...
2
Sanitize
inner
gloves.
Put on fresh
outer gloves.
Walking
3
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
4
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
5
6
Sanitize outer
gloves.
7
Enter NEXT
COVID-19
patient
room or
area.
Do not
touch
face or
re-adjust
CAPR
system
inside
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
INSIDE
1/3
room
CAPR, coveralls, double gloves
Next patient:
NOT COVID+
Gloves, Coveralls
1
5
2
Sanitize
outer gloves.
Sanitize
inner gloves.
9
Remove
outer gloves.
6
3
Sanitize
inner gloves.
7
10
Wipe
down
torso,
arms, and
legs.
8
Grasp
coveralls
around
lower back
area and
pull down.
Zip
down
coveralls.
Remove and
step out of the
coveralls by
marching and
stomping on
the arms of the
coveralls.
4
Remove
into bin
for reuse
without
touching
outside of
coveralls.
11
Remove
coveralls
from
shoulders
and pull
down below
knees.
Sanitize
gloves.
Exit
12
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
OUTSIDE
2/3
room
CAPR, coveralls, double gloves
Next patient:
NOT COVID+
Lens Cuff
1
After coveralls
and outer glove
removal...
4
2
Sanitize
gloves.
Place first wipe
on table.
3
Grab lens cuff at
the left and right
side attachments.
Remove and by
pulling outward and
forward.
5
Place lens
cuff on wipe.
6
Wipe front and
back of lens cuff.
Allow to dry.
Store lens
cuff in a gallon
sized bag
labeled with
your name.
Helmet
7
Sanitize
gloves.
8
Place
second
wipe on
table.
13
9
Grasp outer-shell of helmet
and take off.
Ensure that
the helmet
cord doesn’t
touch your
body.
14
Wipe inside of the
helmet.
15
Sanitize
gloves.
11
10
Place helmet
on first wipe.
12
Sanitize
gloves.
Put on
mask.
16
Hold inside
of the
helmet and
flip onto
second
wipe.
Wipe outside of the
helmet.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
OUTSIDE
3/3
room
CAPR, coveralls, double gloves
Next patient:
NOT COVID+
Battery
17
18
Wipe
helmet
cord.
Sanitize
gloves.
19
20
Remove
and wipe
battery.
Sanitize
gloves.
21
22
Remove
belt and
wipe.
Sanitize
gloves.
Gloves
24
23
25
Remove
gloves.
Wash
hands.
Sanitize
gloves.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Donning CAPR system PPE for contact precautions.<br /><div class="element-text five columns omega">
<p>Doffing CAPR system PPE for contact precautions, inside room, for extended wear or terminal doffing.</p>
<div class="element-text five columns omega">
<p>Doffing CAPR system PPE for contact precautions, outside room for extended wear.</p>
<div class="element-text five columns omega">
<p>Doffing CAPR system PPE for contact precautions, outside room for terminal doffing when next patient is NOT COVID-19 positive.</p>
</div>
</div>
</div>
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/emergency-dept-ppe.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
CAPR - Airborne – PPE
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Contact precautions with eyewear (ACE) Printable instructions. From CAPR (ACE) Emergency Department Printable PDFs. These PDF's depict the Emergency Department use of CAPR for protection against COVID-19 that is currently in use at Emory University. This configuration may also be useful outside of the ED context. Created by Emory's Visual Medical Education team.<br /><br />Putting ON PPE, Extended Wear, Taking OFF PPE
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-17
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
CAPR
Coronavirus
Coveralls
COVID-19
Donning and Doffing
Example
Extended wear
Gloves
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/5170d8055a728534503f192465da2386.pdf
96c36b2d5cd689ec646d29116b7d5121
PDF Text
Text
putting
PPE
ON
1/1
Coveralls
PAPR
system
Inner gloves Outer gloves
Gloves
1
2
Batch work and plan
ahead, having items
available
outside each
patient room.
If you already have a mask on:
Sanitize
hands.
Remove
mask.
Store
mask.
3
Put on first
pair of gloves.
Sanitize
hands.
Helmet
4
Secure the
belt around the
waist.
5
Secure the
battery on the left
side of the belt.
6
7
Check the LED lights
to ensure the battery
is fully charged.
Connect
the helmet
to the
battery.
8
Put helmet on head
and size to fit by
turning ratchet knob to
adjust the headband.
9
Adjust fan
speed to
comfort.
10
Disconnect
the battery.
11
Take off the helmet and place
it inside the PAPR hood.
Ensure the white
HEPA filter is on
top, the helmet is
inside filter pouch,
and the adjustable
knob is outside of
filter pouch.
Hood
12
13
Slide the helmet into the hood
until it snaps in the center
hole. Snap helmet into the
hood on the left and right side
snaps of the face shield.
Set the
assembled PAPR
hood aside.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�putting
PPE
ON
2/2
PAPR, coveralls, double gloves
Coveralls, Gloves, PAPR
14
15
Sanitize
first pair
of gloves.
Put on coveralls outside room.
Open-end faces your front.
16
17
Insert PAPR
power cord
connector into
the battery.
Put the helmet on,
letting the hood drape
around your shoulders
over the coveralls.
18
19
Zip up the front
of the coveralls.
Straighten the
hood draping and
tie it down.
21
20
Put on
second pair
of gloves.
Sanitize
second
pair of
gloves.
Entry
22
23
ENTER
room
DO NOT enter the
room if you do not
achieve a proper fit of
the PAPR system.
Do not touch or
re-adjust PAPR
system inside the
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�extended
wear
EW
INSIDE
room
1/2
PAPR, coveralls, double gloves
Next patient:
COVID+
Gloves
1
Sanitize outer gloves.
2
Remove outer gloves.
3
Sanitize inner gloves.
Exit
4
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�extended
wear
EW
OUTSIDE
room
2/2
PAPR, coveralls, double gloves
Next patient:
COVID+
Gloves
1
After outer
glove removal
in the patient
room,
exit and...
2
Sanitize
inner
gloves.
Put on fresh
outer gloves.
Walking
3
4
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
5
6
Sanitize outer
gloves.
7
Enter NEXT
COVID-19
patient
room or
area.
Do not touch face or readjust PAPR system inside
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
INSIDE
1/2
room
PAPR, coveralls, double gloves
Next patient:
NOT COVID+
Gloves, Coveralls
1
5
2
Sanitize
outer gloves.
Sanitize
inner gloves.
9
Remove
outer gloves.
6
3
Sanitize
inner gloves.
7
10
Wipe
down
torso,
arms, and
legs.
8
Grasp
coveralls
around
lower back
area and
pull down.
Zip
down
coveralls.
Remove and
step out of the
coveralls by
marching and
stomping on
the arms of the
coveralls.
4
Remove
into bin
for reuse
without
touching
outside of
coveralls.
11
Remove
coveralls
from
shoulders
and pull
down below
knees.
Sanitize
gloves.
Exit
12
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�taking
PPE
OFF
OUTSIDE
2/2
room
PAPR, coveralls, double gloves
Next patient:
NOT COVID+
Hood
1
After gown
and outer
glove
removal...
5
2
Sanitize
gloves.
Place
wipe on
table.
6
Pull face
shield
forward
and
release
helmet pin.
3
4
Untie
the
PAPR
hood.
7
Grab hood
top, pull back,
then pull
forward to
remove hood,
avoiding your
face.
Grasp face
shield at the
sides and
pull out
snaps.
If reusing,
place
hood in
designated
bin.
Helmet, Belt, Battery
8
Sanitize
gloves.
9
Remove
helmet motor,
DO NOT touch
your face.
13
10
Put on
mask.
14
Remove
and wipe
belt.
11
Sanitize
gloves.
Wipe
helmet.
15
12
Remove
gloves.
Remove
and
wipe
battery.
16
Wash
hands.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 17, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Donning PAPR system PPE for airborne contact.<br /><div class="element-text five columns omega">
<p>Doffing PAPR system PPE for airborne contact in room.</p>
<div class="element-text five columns omega">
<p>Doffing PAPR system PPE for airborne contact, outside room, for extended wear.</p>
<div class="element-text five columns omega">
<p>Terminal Doffing PAPR system PPE for airborne contact when the next patient is NOT COVID-19 positive.</p>
</div>
</div>
</div>
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/emergency-dept-ppe.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PAPR - Airborne – PPE
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Contact precautions with eyewear (ACE) Printable instructions. From PAPR (ACE) Emergency Department Printable PDFs. These PDF's depict the Emergency Department use of PAPR for protection against COVID-19 that is currently in use at Emory University. This configuration may also be useful outside of the ED context. Created by Emory's Visual Medical Education team.<br /><br />Putting ON PPE, Extended Wear, Taking OFF PPE
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-17
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Coronavirus
Coveralls
COVID-19
Donning and Doffing
Example
Extended wear
Gloves
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Canelli, Robert, Christopher W. Connor, Mauricio Gonzalez, Ala Nozari, and Rafael Ortega. 2020. "Barrier Enclosure during Endotracheal Intubation." New England Journal of Medicine 382 (20):1957-8.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM
URL
https://www.nejm.org/doi/full/10.1056/NEJMc2007589
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMc2007589
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Barrier Enclosure during Endotracheal Intubation
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Clinicians with inadequate access to standard personal protective equipment (PPE) have been compelled to improvise protective barrier enclosures for use during endotracheal intubation.<br /><br />See a response to this article:<br /><ul><li><a href="https://www.nejm.org/doi/full/10.1056/NEJMc2012960"> More on Barrier Enclosure during Endotracheal Intubation </a>(May 5, 2020)</li>
</ul>
Creator
An entity primarily responsible for making the resource
Canelli, Robert, Christopher W. Connor, Mauricio Gonzalez, Ala Nozari, and Rafael Ortega.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-03
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
2019-nCoV
Airborne Transmission
Coronavirus
COVID-19
Occupational Exposure
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/8a4e0ca69136f087ca297dafa15d1760.pdf
f489d46eb03c38158b63541d20d00ffd
PDF Text
Text
05-04-20
�05-04-20
�05-04-20
�05-04-20
�05-04-20
�05-04-20
�05-04-20
�05-04-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Know Your PPE
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guide with information about different types of PPE (Personal Protective Equipment) and COVID-19.<br /><br />View the <a href="https://repository.netecweb.org/items/show/1236">Spanish version / versión en español</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-04
Relation
A related resource
Y - PPE pos 81 qualtrics 302; PPE pos 83 qualtrics 304
Y - D0.1PPE/D0.2PPE Qualtrics # 302
Y - D0.1PPE/D0.2PPE Qualtrics # 304
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - needs updating - submitted asset review form - CDC Recomendations needs to be reviewed and updated
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
2019-nCoV
Coronavirus
COVID-19
Gloves
Gown
Infection Prevention and Control
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free, Online First
URL
https://jamanetwork.com/journals/jama/fullarticle/2765377
Read Online
Online location of the resource.
https://jamanetwork.com/journals/jama/fullarticle/2765377
Citation
Citation information for the publication itself.
Feldman, Oren, Michal Meir, Danielle Shavit, Ravit Idelman, and Itai Shavit. 2020. "Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment." JAMA.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Exposure to a Surrogate Measure of Contamination From Simulated Patients by Emergency Department Personnel Wearing Personal Protective Equipment
Subject
The topic of the resource
Infection Control
Description
An account of the resource
A major challenge with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is the effective protection of health care workers.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-27
Type
The nature or genre of the resource
Publication
Creator
An entity primarily responsible for making the resource
Feldman, Oren, Michal Meir, Danielle Shavit, Ravit Idelman, and Itai Shavit.
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-10 (2 years)
2019-nCoV
Coronavirus
COVID-19
Gloves
Gown
Infection Prevention and Control
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/21e5bd19e2ac9c329118341d37c85266.pdf
688c6bcf402157a27aa9fae2ec49053b
PDF Text
Text
05-01-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Make the Smart Choice - Procedure Mask vs. N95 Respirator selection flyer
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Printable flyer infographic explaining the reasons to choose a procedure mask or n95 respirator.<br /><br />Go to the <a href="https://repository.netecweb.org/items/show/947">NETEC COVID-19 webinar on Healthcare Workers and Masks</a>.<br /><br /><a href="https://repository.netecweb.org/items/show/1252">Go to the Spanish Language version</a> of this flyer.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-01
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
2019-nCoV
Airborne Transmission
Coronavirus
COVID-19
Droplet Transmission
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
<div class="col-md-8">
<div class="card border-0 mb-3">
<div class="card-body bg-gray-l2">
<p><strong>Who this guidance is for: </strong>Federal, state, and local public health officials, respiratory protection program managers, occupational health service leaders, infection prevention and control program leaders, and other leaders in healthcare settings who are responsible for developing and implementing policies and procedures for preventing pathogen transmission in healthcare settings.</p>
<p><strong>Purpose: </strong>This webpage offers guidance for the use of reusable elastomeric particulate respirators to provide respiratory protection to healthcare practitioners (HCP) against pathogens as a component of a formally developed and implemented written respiratory protection program.</p>
</div>
</div>
</div>
URL
https://www.cdc.gov/niosh/npptl/respirators/elastomeric/default.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Elastomeric Respirators: Strategies During Conventional and Surge Demand Situations
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance document: Conventional, Contingency, and Crisis Strategies
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-20
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
2024-02-05 by J Mundy, updated URL
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-19
2019-nCoV
Coronavirus
COVID-19
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/f227e6c708549b770225b9883e686403.pdf
ffd42416e21c574ebd04860757b7fbb4
PDF Text
Text
04-28-20 • Emory University, created by Visual Medical Education.
�
Dublin Core
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Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
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Title
A name given to the resource
Practice PPE Safety
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Printable flyer infographic with Do's and Don'ts of PPE Safety.<br /><br />Go to the <a href="https://repository.netecweb.org/items/show/1253">Spanish language version</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-28
Source
A related resource from which the described resource is derived
Emory University, created by Visual Medical Education.
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - recommend update - submitted asset update form
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control; PPE
2019-nCoV
Coronavirus
COVID-19
Donning and Doffing
Gloves
Gown
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
Dublin Core
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Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online
URL
https://www.nationalacademies.org/our-work/standing-committee-on-emerging-infectious-diseases-and-21st-century-health-threats
Read Online
Online location of the resource.
https://www.nap.edu/read/25776/chapter/1
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Rapid Expert Consultation on the Effectiveness of Fabric Masks for the COVID-19 Pandemic (April 8, 2020)
Subject
The topic of the resource
Infection Control
Description
An account of the resource
In response to a request from the Office of Science and Technology Policy (OSTP), the National Academies of Sciences, Engineering, and Medicine convened a standing committee of experts to help inform OSTP on critical science and policy issues related to emerging infectious diseases and other public health threats. The standing committee includes members with expertise in emerging infectious diseases, public health, public health preparedness and response, biological sciences, clinical care and crisis standards of care, risk communication, and regulatory issues. This publication responds to questions concerning the effectiveness of homemade fabric masks worn by the general public to protect others, as distinct from protecting the wearer.
Creator
An entity primarily responsible for making the resource
Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-08
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-10 (2 years)
2019-nCoV
Coronavirus
COVID-19
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/bbed6597510fdd475dca0ddce1c4ed05.pdf
8b7c63d6a540f24dcff28df11ff73733
PDF Text
Text
NETEC COVID-19 Webinar Series:
Healthcare Workers and Masks
The What, How and Why of masks for
healthcare workers caring for patients
during the COVID-19 outbreak
�Content Outline (TOC)
Welcome
Angie Vasa, RN, BSN, CCN
�Overview of the Webinar
Welcome: Angie Vasa, RN, BSN, CCN
The What: Kate Boulter, RN, BAN, MPH
The How: Kate Boulter, RN, BAN, MPH
The Why: Jill Morgan, RN, BSN
Innovations: Angie Vasa, RN, BSN, CCN
Decontamination Strategies: Kate Boulter, RN, BAN, MPH
Jennifer Garland RN_BC, PhD, CIC
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical Assistance
Research Network
Empower hospitals to gauge
their readiness using
Provide self-paced education
through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker readiness
using
Metrics
Meet Fred
Online Trainings
Deliver didactic and hands-on
simulation training via
In-Person Courses
Compile
Online Repository
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback to
hospitals via
On-Site Assessment
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Built for rapid implementation
of clinical research protocols
Develop Policies,
Procedures and Data
Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
The What
Kate Boulter, RN, BAN, MPH
�Healthcare Workers and Masks: The What
CDC Guidelines
Preferred: N95 or higher respirator
Acceptable: Facemask
https://www.cdc.gov/coronavirus/2019-ncov/downloads/A_FS_HCP_COVID19_PPE.pdf
�Healthcare Workers and Masks: The What
What is an N95 Respirator
Filtering Facepiece Respirators
Reduce exposure to inhaled particles
Several styles, filtering efficiency and designations
• N - indicates not resistant to oil
• R - Somewhat resistant to oil
• P - Strongly resistant to oil
• 95 - 95% of airborne particles
• 99 - 99% of airborne particles
• 100 - 99.97% of airborne particles
https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html
�Healthcare Workers and Masks: The What
N95 Respirators
�Healthcare Workers and Masks: The What
What Makes an N95 Respirator Work
Filtration Mechanisms
Inertial impaction
Interception
Diffusion
Electrostatic attraction
https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/
�Healthcare Workers and Masks: The What
N95 Respirators
Annual N95 fit testing is vital to ensure
that personnel is wearing the correct
N95 style and size
�Healthcare Workers and Masks: The What
Surgical / Procedure Masks
�Content Outline (TOC)
The How
Kate Boulter, RN, BAN, MPH
�Healthcare Workers and Masks: The How
Preparing to Don a N95 or Medical Mask
Donning should occur in a CLEAN space
Gather necessary PPE equipment
Hand sanitizer, trash bin
Tie long hair back
Secure hair away from face, eyes
Secure eyeglasses so they do not slide
Remove any jewelry that might be a hazard to you and your PPE
�Healthcare Workers and Masks: The How
What about Facial Hair
The CDC has a guide to facial hair and respirator compatibility
RESPIRATOR SEALING SURFACE
(Careful! Chin hair may
easily cross the seal)
https://www.cdc.gov/niosh/npptl/pdfs/FacialHairWmask11282017-508.pdf
�Healthcare Workers and Masks: The How
Donning an N95
N95 Respirators
Check to ensure the N95 is free from defects
Perform hand hygiene
Cover nose, mouth and chin
Top strap on crown of head
Bottom strap at the nape of the neck under
the ears
ü Mold the nose piece
ü Perform a seal check
ü
ü
ü
ü
ü
�Healthcare Workers and Masks: The How
How to Remove an N95
�Healthcare Workers and Masks: The How
How to Don and Doff a Surgical or Procedure Mask
Mask should cover nose
Mask should cover mouth
Mask should cover chin
Surgical Mask
Procedure Mask
�Healthcare Workers and Masks: The How
How NOT to Wear an N95 Respirator
NO DOUBLE CROWN
NO CRISS-CROSS
NO DOUBLE NECK
�Healthcare Workers and Masks: The How
How NOT to Behave When Wearing an N95 Respirator
NO
NO
NO
DO NOT
DO NOT
ADJUST RESPIRATOR
EAT OR DRINK
DO NOT
PRESS OBJECTS AGAINST
THE RESPIRATOR
�Healthcare Workers and Masks: The How
How NOT to Wear Your Procedure Mask
NO
NO
NO
NO
NO
�Healthcare Workers and Masks: The How
Protecting the Mask and Respirator
�Content Outline (TOC)
The Why
Jill Morgan, RN, BSN
�CDC Understanding the Difference Between Masks and Respirators
https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf
�Healthcare Workers and Masks: The Why
How Masks are Evaluated
BFE – Bacterial Filtration Efficiency
For medical/surgical masks, must filter out 95% of bacterial sized
particles, tested with real bacteria.
PFE – Particle Filtration Efficiency, medical/surgical masks must
be able to filter out particles of about 0.1micron in size
Delta P – airflow resistance across the filter, equates to work
of breathing
Fluid Resistance – Levels 1 - 3 for ability to repel synthetic
blood at increasing pressure
�Healthcare Workers and Masks: The Why
!
!
?
N95, N99 and N100: All tight-fitting respirators
Tight-fitting respirators need a tight seal between the respirator and the face
and/or neck of the respirator user in order to work properly
Tight-fitting respirators must be fit tested with the respirator selected for
your use, this is not one-size-fits-all!
• A user seal check is a quick check performed by the wearer each
time the respirator is put on. It determines if the respirator is
properly seated to the face or needs to be readjusted
What about the relaxation of the OSHA rules?
?
https://www.osha.gov/video/respiratory_protection/resptypes_transcript.html
�Healthcare Workers and Masks: The Why
Temporary Change to OSHA Guidelines
Perform initial fit tests with the same model, style, and size respirator that the worker will be required
to wear for protection against COVID-19
Inform workers that the employer is temporarily suspending the annual fit testing of N95 filtering facepiece
respirators to preserve and prioritize the supply of respirators for use in situations where they are required
to be worn;
Explain to workers the importance of performing a user seal check (i.e., a fit check) at each donning
Workers should visually inspect the N95 respirator to determine if the structural and functional integrity of the
respirator has been compromised. Over time, components such as the straps, nose bridge, and nose foam
material may degrade, which can affect the quality of the fit and seal. If the structural and functional integrity
of any part of the respirator is compromised, or if a successful user seal check cannot be performed, discard the
respirator and try another respirator
https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit
�Coughing and Aerosolization
Coughs move quickly!
You have probably heard a lot about aerosol generating procedure lately – that really
means “things that make people cough”
Without any cover over a mouth and nose, droplets and particles can move toward an
observer faster than we can react
This is why having SOURCE CONTROL in place is such an important first step
A schlieren optical study of the human cough with and without wearing masks for aerosol infection control, Volume: 6, Issue: suppl_6, Pages: S727-S736, DOI: (10.1098/rsif.2009.0295.focus)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843945/
�Coughing and Aerosolization
Cough directed downward at
30 degree angle
Cough when covered by surgical mask,
air disturbance above and below mask
where air escapes
You can see the airflow being diverted by the loose-fitting mask upward and downward ,
meaning less is likely to directly impact someone standing right in front of them
A schlieren optical study of the human cough with and without wearing masks for aerosol infection control, Volume: 6, Issue: suppl_6, Pages: S727-S736, DOI: (10.1098/rsif.2009.0295.focus)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843945/
�Healthcare Workers and Masks: The Why
If possible, have the patient wear a mask
�Healthcare Workers and Masks: The Why
Universal Masking
Reduce risk from asymptomatic shedders
Everyone entering the facility
Instructions to keep a distance
Perform hand hygiene
Don a mask
�Healthcare Workers and Masks: The Why
Cloth Masks
Ok, let’s talk about cloth masks…
When is something better than nothing?
Better option for general public, anyone when they must be out in public
especially where social distancing may be impossible or unpredictable – leave
the surgical/isolation and N95’s for HCW’s
SUGGESTIONS
•
•
•
•
•
Closely woven (180 thread count or higher) cotton outside (Wake Forest research)
Flannel inside
Multiple layers are important
Check strong light source through mask
Filtration becomes academic if fit allows air to enter all around the mask
�Healthcare Workers and Masks: The Why
Crisis Capacity Strategy
HCP use of homemade masks:
In settings where facemasks are not available, HCP might use homemade masks (e.g.,
bandana, scarf) for care of patients with COVID-19 as a last resort.
However, homemade masks are not considered PPE, since their capability to protect HCP
is unknown. Caution should be exercised when considering this option. Homemade
masks should ideally be used in combination with a face shield that covers the entire
front (that extends to the chin or below) and sides of the face.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
�Healthcare Workers and Masks: The Why
A cluster randomized trial of cloth masks compared
with medical masks in healthcare workers
Objective The aim of this study was to compare the efficacy of cloth masks to medical masks in hospital
healthcare workers Setting 14 secondary-level/tertiary-level hospitals
Participants 1607 hospital HCWs aged ≥18 years working full-time in selected high-risk wards.
Intervention Hospital wards were randomised to: medical masks, cloth masks or a control group (usual
practice, which included mask wearing). Participants used the mask on every shift for 4 consecutive weeks.
Main outcome measure Clinical respiratory illness (CRI), influenza-like illness (ILI) and laboratory-confirmed
respiratory virus infection.
Results The rates of all infection outcomes were highest in the cloth mask arm, with the rate of ILI statistically
significantly higher in the cloth mask arm (relative risk (RR)=13.00, 95% CI 1.69 to 100.07) compared with the
medical mask arm. Cloth masks also had significantly higher rates of ILI compared with the control arm. An
analysis by mask use showed ILI (RR=6.64, 95% CI 1.45 to 28.65) and laboratory-confirmed virus (RR=1.72, 95%
CI 1.01 to 2.94) were significantly higher in the cloth masks group compared with the medical masks group.
Penetration of cloth masks by particles was almost 97% and medical masks 44%.
https://bmjopen.bmj.com/content/5/4/e006577.short
�Healthcare Workers and Masks: The Why
Aerosol Penetration Thru Various Cloth Masks
The Annals of Occupational Hygiene, Volume 54, Issue 7, October 2010, Pages 789–798, https://doi.org/10.1093/annhyg/meq044
�https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
�Healthcare Workers and Masks: The Why
How to Wear a Cloth Face Mask
A cloth face mask should:
• Fit snugly but comfortably against the side of the face
• Be secured with ties or ear loops
• Include multiple layers of fabric
• Allow for breathing without restriction
• Be able to be laundered and machine dried
without damage or change to shape
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
�Coughing and Aerosolization
While wearing – DO NOT TOUCH the mask or respirator
You don’t want to help any particles to make it thru the
filter.
You don’t want to contaminate your hands or to get
even gloved hands that close to your eyes/nose/mouth
That means – NO pulling it down to talk, or to scratch
your nose, or to take a drink
No wearing it on your chin, under your nose or on top of
your head
Credit: Corri Levine – UTMB - https://twitter.com/CBLevineMS/status/1249740489454161920
�Healthcare Workers and Masks: The Why
Other Strategies to Protect Our PPE and Ourselves
Increasing the distance between the patient and worker to 183 cm (72
inches) reduced the exposure to influenza that occurred immediately
after a cough by 92%.
https://oeh.tandfonline.com/doi/full/10.1080/15459624.2013.877591
Results show that cough-generated aerosol particles spread rapidly
throughout the room, and that within 5 min, a worker anywhere in the
room would be exposed to potentially hazardous aerosols.
https://www.tandfonline.com/doi/abs/10.1080/15459624.2012.725986
�Healthcare Workers and Masks: The Why
Face Shields as Protectors of the Protection
During testing of an influenza-laden cough aerosol with a volume median diameter
(VMD) of 8.5 μm, wearing a face shield reduced the inhalational exposure of the
worker by 96% in the period immediately after a cough. The face shield also
reduced the surface contamination of a respirator by 97%
When a smaller cough aerosol was used (VMD = 3.4 μm), the face shield was less
effective, blocking only 68% of the cough and 76% of the surface contamination
Increasing the distance between the patient and worker to 183 cm (72 inches)
reduced the exposure to influenza that occurred immediately after a cough by 92%.
https://oeh.tandfonline.com/doi/full/10.1080/15459624.2013.877591
�Healthcare Workers and Masks: The Why
Other Means of Decreasing HCW Exposure
Have patient hold tissue or towel over their mouths when coughing
Drape an absorbent pad over vent connections when you must break the circuit
Turn the patient’s head away from you when performing close tasks
Hold a child facing away from you
Leave the room after instructing a patient to perform pulmonary toilet, if possible
Keep patient room door shut when possible
Do not use portable fans in patient room
Ask maintenance about in-room airflow, have staff stand when possible between
air output and patient
�Content Outline (TOC)
Innovations
Angie Vasa, RN, BSN, CCN
�Healthcare Workers and Masks: Innovations
New Uses for Old Materials
Hospitals that have excess supplies of surgical drapes are
using them to create masks
Research and patterns for masks that have been
noted to pass fit tests and claim to offer 99.9%
filtration are available online
Surgical draping is tested for bacteria and fluid
penetration but not typically viruses which are notably
smaller than bacteria
Surgical drape manufacturers do not endorse the use of
their material for this purpose at this time
�Healthcare Workers and Masks: Innovations
Innovations to Help with Comfort
�Potential Strategies to Protect the Skin
During Respirator Extended Use
No skin breakdown
Skin breakdown
CAVILON
Allkare
MEPILEX LITE
No Sting Barrier Film
Protective barrier wipe
This can be used if you have skin breakdown
or to prevent skin breakdown
This is applicable if you do not already have skin
breakdown
This is applicable if you do not already have skin
breakdown
• Apply to skin of nose and cheeks
• Apply to skin of nose and cheeks
* Caution: Do not get near eyes
* Caution: Do not get near eyes
• Allow at least 1 minute to dry before
application of a mask
• Allow at least 1 minute to dry before application
of a mask
• Benefits:
•
* Little or no smell
* Smells like alcohol
* Doesn’t sting (sensitive skin)
* Stings slightly with application
* Not as tacky feeling
•
* The film will wear off the skin and does not
require removal
Important!
Drawbacks:
• Cut & place a piece of Mepilex Lite foam where
the mask will be touching on your nose and
cheeks
• Make sure you press down your mask and have
a good seal between the mask and Mepilex
foam
Share the Mepilex Lite with coworkers or save
remaining pieces for next shifts- DO NOT waste
The film will wear off the skin and does not
require removal
Ensure that any prevention or treatment strategy you
use does not compromise the fit and seal of your mask
�Healthcare Workers and Masks: Innovations
More Innovations to Enhance HCW Protection
3D printed face shield
Custom made intubation box
�Healthcare Workers and Masks: Innovations
A Phoenix-based toy company designed
a prototype intubation shield for doctors
to use while treating COVID-19 patients.
(Photo: Kim Van Der Deen)
Photo credit: azcentral.com
Credit: https://www.syracuse.com/coronavirus/2020/03/coronavirus-demand-soars-for-central-new-york-companys-air-purifiers-amid-pandemic.html
�Healthcare Workers and Masks: Innovations
https://now.nebraskamed.com/news/innovative-device-contains-exhaled-virus-particles/
�PPE Extenders
Staff Support
The role of the PPE extender is to coach and mentor all
staff working in departments providing care to patients
suspected or confirmed to have COVID-19
PPE extenders should be used to observe and coach staff on:
• Proper use of PPE to include donning and doffing
(techniques and proper sequence)
• Extended use and reuse of N95s
• Observe IPC practices and reinforce concepts of clean and
dirty spaces
• PAPR use, cleaning, disinfection and storage
�Content Outline (TOC)
Decontamination Strategies
Jennifer Garland RN_BC, PhD, CIC
Kate Boulter, RN, BAN, MPH
�Decontamination Strategies
How to Remove a Surgical or Procedure Mask
Reuse after Decontamination
Hydrogen Peroxide
Ultraviolet Light Germicidal Irradiation
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
�Decontamination Strategies
Hydrogen Peroxide for N95 Reprocessing
Background:
• Vaporized hydrogen peroxide for disinfection was first developed in the late 1980s and patented in the early
1990’s for sterilization of surgical equipment.
• Uses for hydrogen peroxide disinfection are intended for materials that cannot tolerate high temperatures
and humidity (plastics, electrical devices, and metal alloys susceptible to corrosion.
• Hydrogen peroxide H2O2 decomposes into non-toxic byproducts: water (H2O) and oxygen (O).
• Ionized Hydrogen Peroxide: EPA listed as a Binary Ionization Technology (BIT) solution.
• This reprocessing method is currently one of three (VHP, UVGI, moist heat) methods described by the Centers
for Disease Control and Prevention under its crisis standards of care decontamination recommendations.
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/hydrogen-peroxide-gas.html
Ezra Linley, Stephen P. Denyer, Gerald McDonnell, Claire Simons, Jean-Yves Maillard, Use of hydrogen peroxide as a biocide: new consideration of its
mechanisms of biocidal action, Journal of Antimicrobial Chemotherapy, Volume 67, Issue 7, July 2012, Pages 1589–1596, https://doi.org/10.1093/jac/dks129
�Ionized Hydrogen Peroxide vs. Vaporized Hydrogen Peroxide
Ionized Hydrogen Peroxide
Vaporized Hydrogen Peroxide
Concentration
7.8%
30-35%
Particle size
1-2 microns
8-12 microns
Humidity Monitoring Required
No
Yes, dehumidifying required if higher than 70%
Temperature Monitoring Required
No
Yes, must occur at > 70 degrees F
Contact Time
15 minutes
30 minutes
Biological Indicator
Recommended for initial
validation but not required
Yes, usually Geobacillus stearothermophilus spores
(7-day incubation period)
Chemical Indicator
Yes
No
Enzyme Indicator
Yes, Adenylate kinase with
rapid luminescence assay
Yes
Special Shipping or Storage
Requirements
No
Yes, Hazardous material shipping and storage
required
�STERAMIST N-95 DISINFECTION
This Activity would be performed by trained EVS Tech
Start Process
Complete
documentation
for each batch
in disinfection
log.
Sanitize hands, don PPE
to include gown, mask,
face shield and gloves
Begin inspection of
Steramist equipment
Remove N-95 masks from
soiled transport cart. Take
inside processing room
Check fill level of solution; MUST
be above red line (1000ML)
Inspect condition of each
mask; dispose if
damaged or visibly soiled
Confirm USB
drive is inserted
Exit room, zip-up door, close
Check fogger units and fans are set-up Turn on Steramist system
door, seal bottom of door with
and begin programming
in opposing directions. Do not point
tape and activate system once
( See page 2 for operation ) outside
fans directly at the N-95 masks
Mark bottom of mask
with notch on upper
right corner. Dispose
after third notch
Check scrubber outlet is
fully inserted
Once hydrogen peroxide
has reached <1.0 PPM it is
safe to enter the room
Fully open each mask
and display with open
side down on rack
Check each scrubber
dial is set to #5 setting
Collect disinfected
masks and place in clean
paper bag.
Repeat Process
�Decontamination Strategies
N95 Reuse after Decontamination
UVGI
�Guidance for Respiratory and Eye Protection:
Extended Use, Reuse & Reuse After Decontamination
• First Initial and Last Name
• Department/Unit Location
• Date of First use
1
2
• Tally Marks for Decontamination Cycles
• These Marks are Added by the UVGI Staff
ü Write name and date on N95
3
4
ü Prepare brown bag
ü Remove N95
ü Place in brown bag
�Guidance for Respiratory and Eye Protection:
Extended Use, Reuse & Reuse After Decontamination
1
2
3
aa
4
�Content Outline (TOC)
NETEC Resources
Angie Vasa, RN, BSN, CCN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC
SMEs
Submit a Technical Assistance request at NETEC.org
�Resources
Slide 7: CDC - Use Personal Protective Equipment When Caring for Patients with Confirmed or Suspected
COVID-19:
https://www.cdc.gov/coronavirus/2019-ncov/downloads/A_FS_HCP_COVID19_PPE.pdf
Slide 8: CDC - NIOSH - Approved Particulate Filtering Facepiece Respirators:
https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/default.html
Slide 10: CDC - N95 Respirators and Surgical Masks:
https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/
Slide 15: CDC - Facial Hairstyles and Filtering Facepiece Respirators:
https://www.cdc.gov/niosh/npptl/pdfs/FacialHairWmask11282017-508.pdf
Slide 24: CDC - Understanding the Difference Between Surgical Masks and N95 Respirators:
https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf
Slide 26: U.S. Department of Labor – Transcript for the OSHA Training Video Entitled Respirator Types:
https://www.osha.gov/video/respiratory_protection/resptypes_transcript.html
�Resources
Slide 27: U.S. Department of Labor – Healthcare Respiratory Protection Annual Fit-Testing for N95
Filtering Facepieces During the COVID-19 Outbreak:
https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit
Slide 28 & 29: A Schlieren Optical Study of the Human Cough With and Without Wearing Masks for
Aerosol Infection Control:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843945/
Slide 33: CDC – Strategies for Optimizing the Supply of Facemasks:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html
Slide 34: BMJ - A Cluster Randomized Trial of Cloth Masks Compared with Medical masks in
Healthcare Workers:
https://bmjopen.bmj.com/content/5/4/e006577.short
Slide 35: Oxford Academic – Performance of Cloth Masks and Common Fabric Materials Against
20-1000nm Size Particles:
https://doi.org/10.1093/annhyg/meq044
Slide 36 & 37: CDC – Use of Cloth Face Coverings to Help Slow the Spread of COVID-19:
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html
�Resources
Slide 39: Efficacy of Face Shields Agaist Cough Aerosol Droplets From a Cough Similator:
https://oeh.tandfonline.com/doi/full/10.1080/15459624.2013.877591
Slide 40: Efficacy of Face Shields Against Cough Aerosol Droplets From a Cough Similator:
https://oeh.tandfonline.com/doi/full/10.1080/15459624.2013.877591
Slide 48: University of Nebraska / Nebraska Medicine: Innovative Device Contains Exhaled Virus Particles
https://now.nebraskamed.com/news/innovative-device-contains-exhaled-virus-particles/
Slide 51: CDC - Decontamination and Reuse of Filtering Facepiece Respirators:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html
Slide 52: EPA – Disinfectants for Use Against SARS-CoV-2
https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2
Slide 52: CDC - Decontamination and Reuse of Filtering Facepiece Respirators:
https://www.cdc.gov/infectioncontrol/guidelines/disinfection/sterilization/hydrogen-peroxide-gas.html
UNMC Universal Mask Policy and FAQs:
https://www.nebraskamed.com/sites/default/files/documents/covid-19/surgical-mask-policy-and-faq-nebraska-med.pdf
�Resources
U.S. Food & Drug – Code of Federal Regulations Title 21:
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=878.4040
CDC - N95 Respirators and Surgical Masks:
https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/
CDC/NIOSH – Respirator Filtor Classes
https://www.cdc.gov/niosh/npptl/pdfs/N95RespirClassesInfographic-508.pdf
Mask Protection Standards and Medical Face Mask Information for Use
https://www.primed.ca/clinical-resources/astm-mask-protection-standards/
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
YouTube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, April 17, 2020 | 11:00 AM CDT
Event Type
Webinar, register below
URL
https://youtu.be/gcc8kVb7n_Y
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Healthcare Workers and Masks webinar" src="https://www.youtube.com/embed/gcc8kVb7n_Y?autoplay=0" frameborder="0"></iframe>
Objectives
Self-paced, 1 credit
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-masks" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-masks</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (4/17/20)/Online Course: Healthcare Workers and Masks
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The what, how and why of masks for healthcare workers caring for patients during the COVID-19 outbreak. <br /><br />Webinar slides attached.<br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-masks" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
<br />Go to a <a href="https://repository.netecweb.org/items/show/1023">flyer explaining choices between Procedure Mask vs. N95 Respirator</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-17
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM) - covid specific resource, relevancy for non covid environment
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-14
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
CEU
CEUs
Coronavirus
COVID-19
Mask
Masks
N95
Occupational Exposure
Occupational Health
Online Course
Personal Protective Equipment (PPE)
R-PM
R-PPE
-
https://repository.netecweb.org/files/original/5de2a11171b93b4755253783d682b9c9.pdf
aeb0c76a794cce027a23ab1ce1c7bfb0
PDF Text
Text
Infection Control and PPE Recommendations for ED, Inpatient, and Surge Settings
Setting
Scenario
All areas,
including
ED waiting
areas
All patients
presenting with ILI
are suspected to
have COVID-19,
unless indicated
otherwise
ED/ICU/
Med/Surge
Wards
Initial evaluation of
patient with COVID19 like illness1
Or
Admitted patient
with mild-moderate
symptoms
Testing
Area/Tents/
Clinic/
Drive Thru
Critically ill patient
Or
Anticipation of
aerosolizing
procedures2
Or
Designated Hot
Zone3
Specimen collection
only (testing
tents/drive through
testing)
Patient
Immediately
provide surgical
mask. Encourage
hand hygiene.
Separate from
others by 6ft if
possible.
Surgical mask
Surgical mask when
possible, only
remove when
necessary for
treatment
Healthcare Worker PPE
Wear surgical mask and gloves if within
6 ft of patient.
Surgical mask (Extended)
Isolation gown (Extended)
Eye Protection (Extended)
Gloves (1 pair)
N95 (Extended)
Isolation gown (Extended)
Eye Protection (Extended)
Gloves (double gloves optional)
Non-Clinical Staff
PPE
Wear surgical mask
and gloves if within
6 ft of patient.
Transmission Based
Precautions
Droplet
Avoid entering the
room.
Droplet +
Contact +
Eye Protection
N95/Surgical Masks:
Surgical mask and
gloves if entry is
necessary. Avoid
close contact.
Do not enter room.
Extended Use
Strategies
Airborne +
Contact +
Eye Protection
Surgical mask;
only remove for
specimen collection
Surgical mask (Extended)
Isolation gown (Extended)
Eye Protection (Extended)
Gloves (1 pair)
Wear surgical mask
and gloves if within
6 ft of patient.
Droplet +
Contact +
Eye Protection
All Areas
Environmental
Cleaning
Room cleaning after
patient discharge
--
Surgical mask (Extended)
Isolation gown (Extended)
Gloves (1 pair)
Eye protection if splash risk (Extended)
1 - COVID-19 Like Illness: new onset subjective or measured fever OR cough OR shortness of breath OR sore throat that cannot be attributed to
anything else.
2 - Aerosol generating procedure: Examples include intubation, extubation, bronchoscopy, bag mask ventilation, sputum induction, chest PT,
non-invasive ventilation (BiPAP), CPR, suctioning, nebulization
3 – Hot Zone: Cohorted area with COVID-19 suspected/confirmed cases as designated by departmental leadership
Surgical mask and
gloves if entry is
necessary.
Droplet +
Contact +
Eye Protection
To extend the use
of an N95, don a
barrier (face shield
or surgical mask)
over the N95.
Discard N95 or
surgical mask when
visibly wet,
contaminated or
damaged.
Eye Protection
Using gloves, clean
eye protection with
a facility approved
disinfectant wipe.
Disinfect with a
second wipe,
allowing for
appropriate contact
time. Perform hand
hygiene.
Store the eye
protection
appropriately
labeled.
Gown*
To extend the use
of the isolation
gown, wear an
apron on top for
care activities
where splashes and
sprays are
anticipated.
*Applies to any
color isolation
gown.
4 – HCW: refers to all persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body
substances; contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air (EVS, MD, RN, PA, etc)
5 – Eye Protection: Includes face shield, goggles or other approved protective eyewear
6 – Non-clinical staff include receptionists, front desk staff, hospital police, etc.
�Personal Protective Equipment Recommendations for Ancillary Staff
Setting
Non-clinical Areas
(boiler rooms,
hallways; café,
break rooms)
PPE
Comment
Public Patient
Facing Area
(waiting rooms;
lobbies;
registration;
pharmacies)
In addition to the above:
Limit glove use.
Always perform hand hygiene after
removing gloves.
Wear appropriate PPE based on the
specific transmission-based isolation
precautions indicated by the isolation
signage.
Do not enter room or areas during an
aerosolizing procedure.
Doff PPE appropriately and cautiously.
Clinical Areas
(hot zone; isolation
rooms, patient
care areas)
Clean hands before & after touching mask.
Expand mask fully to cover nose and chin.
Ensure metal nose piece is molded to face.
Avoid touching outer area of mask.
Store mask safely and in a clean paper bag
or container if planned for reuse
throughout the shift.
Discard mask if it becomes wet or
contaminated.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE by location and task
Subject
The topic of the resource
Infection Control
Description
An account of the resource
PPE guide grid, organized by location and task
Creator
An entity primarily responsible for making the resource
NYC Health + Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-06
Contributor
An entity responsible for making contributions to the resource
2022-02-08 by Trisch - PPE group - NYC general asset review - Archive
2022-11-16 - by Jill/Britton - on SPORSA - mark active
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-11-16
Relation
A related resource
Y - PPE row 7 score 1; PPE pos 101 qualtrics 321;
Y - D0.1PPE/D0.2PPE Qualtrics # 321
2019-nCoV
Coronavirus
COVID-19
Gloves
Gown
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/1e3e4162a9e0eb20ce74541e8059e11b.pdf
d294b9a584de39a8e1302c4bec48d182
PDF Text
Text
EMERGENCY DEPARTMENT
taking
PPE
OFF
(ACE)
Is your next patient COVID+ ?
COVID+ = “Extended Wear”
1
2
3
Sanitize gloves.
NO = “Terminal doffing”
1
6
Remove gloves.
10
Sanitize hands.
2
Sanitize
gloves.
7
Take off
the first
glove.
Sanitize
hands.
11
3
Wipe
down
torso,
arms,
and legs.
Pull the bare
hand into the
sleeve of the
coverall.
8
Touch inside
of coverall
along inseam
to push down
and step
out of
coverall.
Zip down
coverall.
4
Using the hand in
the sleeve, remove
the other glove.
12
Remove
into bin for
reuse
without
touching
outside of
coveralls.
5
Pull down
and
remove
from
shoulders.
9
Sanitize
gloves.
Use hands inside
the coveralls to
scrunch or
pull
sleeves
off.
13
Sanitize
hands.
2020 Emory University, created by Visual Medical Education. Updated April 4, 2020
EXIT patient room
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Contact precautions with eyewear (ACE) Printable instructions
URL
https://med.emory.edu/ppe
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
ED - Taking OFF Airborne (In Room)
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 ED Resources: COVID-19 ACE Emergency Department CONSERVE Printable PDFs.
Taking OFF PPE, Doffing Only
These one-page PDF's depict the Emergency Department use of PPE for protection against COVID-19 that is currently in use at Emory University. Created by Emory's Visual Medical Education team.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-05
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
Contingency and crisis capacities
Coronavirus
Coveralls
COVID-19
Doffing
Emergency Department
Example
Extended wear
Face shield
Gloves
Hand Hygiene
N95
One Page Flyer
Personal Protective Equipment (PPE)
R-PPE
Terminal Clean
-
https://repository.netecweb.org/files/original/5aa8b32c6d2ab0c72e8f5e5fff76e071.pdf
9840ba3d952c95bb64190a292df41fdf
PDF Text
Text
EMERGENCY DEPARTMENT
putting
PPE
ON
What You Need
(ACE)
Coveralls
1
Batch work and plan
ahead, having items
available outside each
patient room.
N95 Respirator
Clean face shield
Gloves
Coveralls + Gloves
2
Sanitize
hands.
4
Put on
coveralls
outside room.
3
Put on gloves
over the cuffs
of the coveralls.
Open-end
faces your
front.
Zip up the front
of the coveralls.
5
Respirator
6
Put on N95,
ensuring proper
seal.
Ensure straps
are not crossing.
7
Sanitize gloves.
Place hands over
the front of the
N95. Breathe an
easy deep breath
in and out.
If you feel air
escape the
edges, refit
and repeat.
8
Put on face
shield.
9
Eyes + Entry
Sanitize
gloves.
10
ENTER
room
11
Do not touch face or readjust N95 or face shield
inside room.
DO NOT enter the room if
you do not achieve a proper
respirator seal.
2020 Emory University, created by Visual Medical Education. Updated April 4, 2020
Creative Commons Attribution-NonCommercial-NoDerivs
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Contact precautions with eyewear (ACE) Printable instructions
URL
https://med.emory.edu/ppe
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
ED - Putting ON Airborne
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 ED Resources: COVID-19 ACE Emergency Department CONSERVE Printable PDFs. <br /><br />Putting ON PPE, Donning Only <br /><br />These one-page PDF's depict the Emergency Department use of PPE for protection against COVID-19 that is currently in use at Emory University. Created by Emory's Visual Medical Education team.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-05
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
Coronavirus
Coveralls
COVID-19
Donning
Emergency Department
Example
Face shield
Gloves
N95
One Page Flyer
R-PPE
-
https://repository.netecweb.org/files/original/b5bf6d6d74f6c3b867097722cd6fda12.pdf
132319ea27659a927ddc974958d45952
PDF Text
Text
AMBULATORY CLEANING PROTOCOL
Cleaning room after suspected COVID-19 patient
Did
Patient
have mask on
no
entire time?
yes
Room to remain vacant
after patient leaves for
1 hour prior to cleaning.
Don PPE:
Gloves & Mask
Don PPE:
Gloves Only
Do not lean on surfaces until clean
Do not lean on surfaces until clean
Clean high touch surfaces with approved disinfectant*
High Touch Surface Areas:
High Touch Surface Areas:
• Door knobs
• Blood Pressure cuff
• Exam table
• Otoscope
• Cabinet handles
• Sink faucet handle
• Keyboard
• Countertop
• Computer mouse
• Thermometer
• Patient Chair
Your clinic may have additional high touch surfaces
based on your clinical setting or layout (i.e. I.V.
Pumps)
*Approved Cleaning Agents include:
1. Clorox Healthcare Hydrogen peroxide
or Bleach Wipes
2. PDI Wipes: Purple top, gray top, and
yellow/gold top
Observe kill time on
the label of the wipe
container
Trash should be disposed
of as you normally would
Emory Infection Prevention on call:
1. EHConnec PIC #94428
2. 404‐686‐5500 enter 94428 followed by #
Version 1.0 Emory University, created by Visual Medical Education. Updated March 26, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
Objectives
Emory's protocol for cleaning room after suspected COVID-19 patient.
URL
https://med.emory.edu/ppe
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 Ambulatory PPE Resources: Cleaning
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 Ambulatory ACE / DICE Printable PDFs.
These one-page PDF's depict Emory's use of PPE for protection against COVID-19 in the ambulatory setting. Created by Emory's Visual Medical Education team.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-04-03
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change R-PPE)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
2019-nCoV
Cleaning
Coronavirus
COVID-19
Disinfection
Gloves
Mask
Masks
R-PPE
Waste
-
https://repository.netecweb.org/files/original/8757ca23e986f916e4579fb686cae51a.pdf
d54b9e8f2f09a91f88a581bf548d7f3d
PDF Text
Text
Ambulatory PPE and Room
Cleaning Selection Protocol
Providers as a baseline should be wearing
procedure mask.
What are you doing
with patient?
Patient
Patient
interview
Physical
exam
Mask &
face
shield or
goggles1
Provider
Throat/sinus
exam
Mask &
face
shield or
goggles1
Gloves
Mask &
face
shield or
goggles1
Aerosol
generating
procedure
N95 &
face
shield1
Gown
Gown
Gloves
Gloves
High touch surfaces need to be cleaned between every patient.
Room
Cleaning
No down
time
15
minutes
No down
time
1 hour2
Follow the reuse protocols for N95 and eye protection.
1
Or other time period approved by Infection Prevention.
2
Emory Infection Prevention on call:
1. EHConnect PIC #94428
2. 404-686-5500 enter 94428 followed by #
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 13, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
Objectives
Selecting the proper PPE in an Emory ambulatory / outpatient setting.
URL
https://med.emory.edu/ppe
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Selecting PPE - Ambulatory PPE and Cleaning Selection Protocol
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 Ambulatory PPE Resources: COVID-19 Ambulatory ACE / DICE Printable PDFs.
These one-page PDF's depict Emory's use of PPE for protection against COVID-19 in the ambulatory setting. Created by Emory's Visual Medical Education team.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-13
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
Cleaning
Coronavirus
COVID-19
DICE
Example
Face shield
Gloves
Goggles
Gown
Mask
Masks
N95
Personal Protective Equipment (PPE)
PPE Selection
R-PPE
Terminal Clean
-
https://repository.netecweb.org/files/original/1b2587b9cf1311201d5f008a41636e87.pdf
05f893f7b7e13ffdffb5ff8b7a571c86
PDF Text
Text
putting
PPE
ON
1/1
Launderable gown
N95
respirator
Face
shield
Gloves
Gown, Gloves
1
Batch work and
plan ahead, having
items available
outside each patient
room.
2
If you already have a mask on:
3
4
Put on gown
outside room.
Open-end
faces your
back.
Sanitize Remove
hands.
mask.
Store
mask.
Sanitize
hands.
Put on
gloves
over the
cuffs of
the gown.
Tie the back
of the gown.
N95
5
6
Put on N95,
ensuring proper
seal.
Ensure straps
are not crossing.
7
Sanitize gloves.
Place hands over
the front of the
N95. Breathe an
easy deep breath
in and out.
If you feel air
escape the
edges, refit
and repeat.
Face Shield, Entry
8
Put on face
shield.
9
Sanitize
gloves.
10
ENTER
room
DO NOT enter the room if
you do not achieve a proper
respirator seal.
11
Do not
touch
face or
re-adjust
N95 or
face shield
inside
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�extended
wear
EW
INSIDE
room
1/2
N95, face shield, launderable gown, gloves
Next patient:
COVID+
Gloves
1
Sanitize gloves.
2
Remove gloves.
3
Sanitize hands.
Exit
4
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�extended
wear
EW
OUTSIDE
room
2/2
N95, face shield, launderable gown, gloves
Next patient:
COVID+
Gloves
1
After glove
removal in the
patient room,
exit and...
2
Sanitize
hands.
Put on fresh
gloves.
Walking
3
4
Walk to next
patient with
confirmed
COVID-19
(marked) while
remaining in
marked zone.
Do not touch
your face, the
walls, rails, or
anybody else
until reaching
the next room.
Entry
5
Sanitize gloves.
6
7
Enter
NEXT
COVID-19
patient
room or
area.
Do not
touch
face or
re-adjust
N95 or
face
shield
inside
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�taking
PPE
OFF
INSIDE
1/2
room
N95, face shield, launderable gown, gloves
Next patient:
NOT COVID+
Gown, Gloves
1
4
2
Sanitize gloves.
Take off the first glove.
7
5
Untie the waist.
6
Pull the bare hand into
the sleeve of the gown.
Using the hand in the
sleeve, remove the
other glove.
9
8
Remove
with gloves
into bin for
reuse without
touching
outside of
gown.
Use hands
inside the
gown to
scrunch or
pull sleeves
off.
3
Reach back and release
the neck portion.
Sanitize hands.
Exit
10
Exit patient
room.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�taking
PPE
OFF
OUTSIDE
2/2
room
N95, face shield, launderable gown, gloves
Next patient:
NOT COVID+
Gloves, setup
1
After glove and
gown removal
in the patient
room,
exit and...
2
Sanitize
hands.
3
Put on fresh
gloves.
Place wipe
on table.
N95
4
5
Remove eye wear and
place on wipe.
6
Sanitize
gloves.
7
Remove
N95,
lower strap
and then
upper.
Store N95.
Sanitize
gloves.
8
Put on
mask.
Face Shield
9
10
11
Place
shield in
bag to dry.
Wipe shield. Sanitize in the following
order:
12
Wipe
table.
14
Back of
shield.
Elastic
band.
Foam
band.
Sanitize
gloves.
13
Remove
gloves.
Wash hands with
soap and water
or sanitize hands.
Front of
shield.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
Use these instructions for donning, or putting on your PPE, if you are caring for a COVID-19 positive patient next and are reusing the mask, faceshield, and gown. <br /><div class="element-text five columns omega">
<p>Print and hang "Inside" page up inside the COVID-19 patient rooms near the bin where reusable gowns are going. Two options (page 2 or 4 of this pdf), based on COVID-19 status of next patient.</p>
</div>
<div class="element-text five columns omega">
<p>Post "Outside" outside COVID-19 patient rooms, use to doff. Two options, if your next patient is COVID-19 positive (page 3 of this pdf) and if your next patient COVID-19 status is negative or uncertain (page 5 of this pdf).</p>
</div>
URL
https://med.emory.edu/ppe
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Putting On PPE (ACE)
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 Unit Resources: COVID-19 Unit - COVID-19 ACE Printable PDFs (RE-USE GOWN). <br /><br />RE-USE GOWN, SINGLE Gloves - COVID-19 Unit - COVID-19 ACE Printable PDFs. <br /><br />Putting ON PPE, Extended Wear, Taking OFF PPE<br /><br />This combined PDF reflects the current supply shortage in which N95 masks and face shields and gowns may be conserved and reused. Created by Emory's Visual Medical Education team.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-28
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
Airborne Transmission
Coronavirus
COVID-19
Donning and Doffing
Example
Extended wear
Face shield
Gloves
Gown
N95
Personal Protective Equipment (PPE)
R-PPE
Reuse
-
https://repository.netecweb.org/files/original/383625c4f0377fe535cd6460ce6dfbcb.pdf
65c2b3e6a1f1ccef2e9c1752f3827b74
PDF Text
Text
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Decontamination and Reuse of N95 Respirators with Hydrogen Peroxide Vapor
to Address Worldwide Personal Protective Equipment Shortages During the
SARS‐CoV‐2 (COVID‐19) Pandemic
Antony Schwartz1,5, Matthew Stiegel1,5, Nicole Greeson1, Andrea Vogel2, Wayne Thomann1,5,
Monte Brown6, Gregory D. Sempowski3, Thomas Scott Alderman3, James Patrick Condreay3,
James Burch3, Cameron Wolfe4, Becky Smith4, and Sarah Lewis4
1
Occupational & Environmental Safety Office, Duke University & Health System; 2National
Biosafety & Biocontainment Training Program, National Institutes of Health; 3Duke Human
Vaccine Institute, Duke School of Medicine; 4Division of Infectious Diseases, Duke School of
Medicine; 5Division of Occupational & Environmental Medicine, Family Medicine & Community
Health, Duke School of Medicine; 6Duke University Health System
16
Abstract
17
The SARS‐CoV‐2 (COVID‐19) pandemic has placed a tremendous amount of strain on resources
18
in the healthcare setting. One of the most pressing issues is the rapid depletion of personal
19
protective equipment (PPE) used in the care of patients. This is a significant concern for
20
healthcare workers’ health and safety. Many entities have depleted or soon will exhaust their
21
stockpile of PPE despite adopting PPE sparing practices as the number of COVID‐19 cases in the
22
U.S. increases at an almost exponential rate and manufacturers struggle to keep up with the
23
worldwide demand. This potential shortage is particularly concerning for commonly used N95
24
respirators and Powered‐Air Purifying Respirators (PAPRs). Recently, the U.S. Occupational
25
Safety and Health Administration (OSHA)1 even temporarily suspended the requirement to
26
perform annual fit testing of respirators to allow entities to conserve respirators and preserve
27
them for patient care. These measures are unprecedented and highlight the urgent need for
28
entities to develop solutions to proactively address what could be potentially a grave
29
occupational health issue.
�
30
At Duke University and Health System, we have evaluated and will begin utilizing Hydrogen
31
Peroxide Vapor to decontaminate and reuse N95 respirators. In this communication, we briefly
32
discuss the decontamination validation process and post‐decontamination performance
33
validation conducted at Duke. This validation, which is supported by previous laboratory
34
testing, funded by the FDA, demonstrated that N95 respirators still met performance
35
requirements even after decontamination with Hydrogen Peroxide Vapor in the laboratory
36
setting for over 50 times2. While previous studies have shown the applicability of the Hydrogen
37
Peroxide Vapor process, we have also confirmed that the respirator still functions as designed,
38
using our standardized human N95 fit testing methodology. We will now use this internally
39
validated and Duke Institutional Biosafety Review Committee (IBRC) approved laboratory
40
decontamination process in the clinical setting to dramatically extend the life of our N95
41
respirators. We hope that sharing our processes through this brief communication can help
42
other entities with access to Hydrogen Peroxide Vapor to evaluate the potential applicability of
43
this technology at their facility or partner with those who may already have this capability
44
including other private sector life science organizations.
45
46
47
Process/Method
48
We, like others, have implemented many CDC‐approved N95 reuse practices including
49
employees reusing their own N95s for the duration of their shifts. However, this alone may not
50
be adequate to meet our anticipated need, with various centers reporting multiple fold higher
�
51
use of PPE as their case load increases. In the interest of our workforce safety, the goal was
52
thus to extend the life of our existing supply.
53
54
Duke University houses one of the NIAID Regional Biocontainment Laboratories (RBL) as part of
55
a nationwide network of high containment laboratories and has extensive experience with the
56
use of Hydrogen Peroxide Vapor decontamination. In addition, Duke University Health System
57
had past experience with Hydrogen Peroxide Vapor in the clinical setting as part of previous
58
high‐consequence pathogen preparedness exercises. The Duke RBL, a BSL3 facility, contains a
59
room specifically designed to use Hydrogen Peroxide Vapor to decontaminate laboratory
60
equipment and has been operational for over a decade. This room currently utilizes a Bioquell
61
Clarus™ C system with a 35% hydrogen peroxide solution and distribution system to disperse
62
Hydrogen Peroxide Vapor into the room in a uniform fashion. In addition, we are evaluating
63
the new Bioquell Z‐2 and Bioquell ProteQ systems that will provide increased capacity and
64
flexibility to our reprocessing needs.
65
66
The FDA‐funded project, referenced previously, validated the decontamination of N95
67
respirators with Hydrogen Peroxide Vapor for over 50 cycles, with the reuse limiting factor
68
being the elastic straps that started to show degradation.2 To address this, we plan to
69
decontaminate and reuse N95s up to 30 cycles, with a Quality Assurance (QA) step to ensure
70
both qualitative and quantitative degradation has not occurred. A cohort of respirators will be
71
decontaminated with every cycle and will be used in standardized quantitative fit testing to
72
ensure the integrity of the respirators is maintained over many decontamination cycles.
�
73
74
75
Procedures
76
Approximately 100 3MTM 1860 N95s, previously used in quantitative employee fit testing, were
77
collected and hung from stainless steel wire racks in our Hydrogen Peroxide Vapor processing
78
room in the RBL. The Hydrogen Peroxide Vapor run consisted of the following five stages:
79
Conditioning, Pre‐gassing, Gassing, Gassing Dwell and Aeration. The existing RBL Hydrogen
80
Peroxide Vapor standard operating procedure (SOP) was employed and requires that the
81
processing room attain 480+ ppm level of Hydrogen Peroxide Vapor with a “Gassing” time of 25
82
minutes and a “Gassing Dwell” time of 20 minutes. At the end of a cycle, during the aeration
83
stage, fresh air is introduced into the room to increase the rate of catalytic conversion of
84
hydrogen peroxide vapor into oxygen and water. This procedure leaves no residue other than
85
water. When sufficient time had passed, we used a PortaSens II™ sensor to ensure hydrogen
86
peroxide levels were below the OSHA Permissible Exposure Limit3 (PEL) of 1.0 ppm prior to
87
entering the room. In addition, we validated the efficacy of the decontamination process by
88
using eight individual 6‐log biological indicators (Geobacillus stearothermophilus spores). See
89
Figure 1 for representation of the decontamination setup and placement of biological indicators.
90
91
Based on our previous experience with Hydrogen Peroxide Vapor and porous materials, we
92
anticipated the possibility of off‐gassing of H2O2 from the respirators at the end of the run. For
93
this reason, in our initial tests, we performed a quantitative and qualitative assessment for
94
H2O2. For the quantitative assessment, the PortaSens II™ was used to detect H2O2 levels over a
�
95
4 hour time frame taking readings at regular intervals by placing the probe close to the
96
respirators. At approximately 4 hours, the levels decreased below the PortaSens IITM level of
97
detection (0 ppm). In the qualitative test, three individuals did a qualitative smell test to
98
determine if there were any noticeable odors. None were detected. After complete aeration,
99
the respirators went through a quality assurance (QA) process to ensure that there was no
100
physical or performance degradation. The decontaminated respirators then underwent our
101
normal quantitative fit testing process to ensure their continued performance and were tested
102
on two individuals with differing facial structures with no loss of fit or seal, thereby ensuring
103
that N95s decontaminated using this method can be placed back into circulation.
104
105
106
Conclusion
107
Using Hydrogen Peroxide Vapor is a proven method of decontamination. Previous studies have
108
shown that N95 respirators retain their filtering capability even after 50 cycles in a laboratory
109
environment. We have taken this one step further to show it can be done in the real world
110
environment using commercially available equipment and performing fit testing on humans
111
rather than “human forms.” We believe that N95 sparing and reuse practices are important but
112
not sufficient given the current situation and thus will begin reuse after decontamination on a
113
large scale. While this alone will not solve the problem, it will allow us to process and reuse a
114
significant number of N95 respirators or other critical items. As healthcare facilities operate in
115
uncharted territories while dealing with a plethora of unanticipated day‐to‐day issues, solving
116
issues that directly impact the health and safety of our healthcare workers is of utmost
�
117
importance. Healthcare workers must be equipped with the appropriate personal protective
118
equipment (PPE) that they need to do their jobs with confidence. In times of global shortages,
119
we have to improvise and adapt existing technologies for new uses. We believe that
120
decontamination of N95 respirators with Hydrogen Peroxide Vapor is one such solution that
121
affords us better ability to protect our healthcare workers as we continue to tackle this
122
monumental issue. We will continue to validate this process with other PPE and reusable
123
Hydrogen Peroxide Vapor‐compatible medical equipment. We recommend validating this
124
procedure with the respirator used at your facility. This manuscript has been accepted to
125
Applied Biosafety, publication forthcoming.
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
References
1. Temporary Enforcement Guidance ‐ Healthcare Respiratory Protection Annual Fit‐
Testing for N95 Filtering Facepieces During the COVID‐19 Outbreak. March 14, 2020.
https://www.osha.gov/memos/2020‐03‐14/temporary‐enforcement‐guidance‐
healthcare‐respiratory‐protection‐annual‐fit
2. Final Report for the Bioquell Hydrogen Peroxide Vapor (HPV) Decontamination for
Reuse of N95 Respirators. Prepared by Battelle Columbus, Ohio. Prepared under
Contract No. HHSF223201400098C. Study Number 3245. Prepared for the FDA. July
2016. Accessed, March 4, 2020
3. 29 CFR 1910.1000 TABLE Z‐1 ‐ TABLE Z‐1 Limits for Air Contaminants.
https://www.osha.gov/laws‐
regs/regulations/standardnumber/1910/1910.1000TABLEZ1
Acknowledgement
142
143
144
145
Decontamination testing and activities were performed in the Duke Regional Biocontainment
Laboratory, which received partial support for construction from the National Institutes of
Health, National Institute of Allergy and Infectious Diseases (UC6‐AI058607) and the Duke
School of Medicine.
�Run 1
Run 2
1
2
2
3
1
Hydrogen
Peroxide
Vapor
Hydrogen
Peroxide
Vapor
1. Inside PAPR in bag
2. Inside Respirator,
on plastic clamshell box
3. Inside PAPR, in bag
1. Inside Respirator
2. Inside Respirator
Run 3
Run 4
1
2
2
1
Hydrogen
Peroxide
Vapor
Hydrogen
Peroxide
Vapor
1. Inside PAPR, no bag
2. Under Respirator
Biological Indicator
Exhaust to Hydrogen Peroxide Vapor Unit
Rotating Dispersion Nozzle
1. Under Respirator
2. Under Respirator
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
URL
https://absa.org/decontamination-and-reuse-of-n95-respirators-with-hydrogen-peroxide-vapor-to-address-worldwide-personal-protective-equipment-shortages-during-the-sars-cov-2-covid-19-pandemic/
Citation
Citation information for the publication itself.
Decontamination and Reuse of N95 Respirators with Hydrogen Peroxide Vapor to Address Worldwide Personal Protective Equipment Shortages During the SARS-CoV-2 (COVID-19) Pandemic(PDF 175k) Antony Schwartz et al. Duke University, Applied Biosafety: Journal of ABSA International
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Title
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Decontamination and Reuse of N95 Respirators with Hydrogen Peroxide Vapor 1 to Address Worldwide Personal Protective Equipment Shortages During the 2 SARS‐CoV‐2 (COVID‐19) Pandemic
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The process uses vaporized hydrogen peroxide to kill germs without degrading the masks. Duke Regional Biocontainment Laboratory.
Creator
An entity primarily responsible for making the resource
Antony Schwartz et al. Duke University,
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-26
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-10 (2 years)
2019-nCoV
Coronavirus
COVID-19
Decontamination
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/ecebf05d8ea1004bbdaea314be68a5e4.png
3f501528330a5195fcab9cad4e0bb714
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Pompeii, Lisa A., Colleen S. Kraft, Erik A. Brownsword, Morgan A. Lane, Elisa Benavides, Janelle Rios, and Lewis J. Radonovich, Jr. 2020. "Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators." JAMA.
Accessibility
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Free online on JAMA
URL
https://jamanetwork.com/journals/jama/fullarticle/2763841
Read Online
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https://jamanetwork.com/journals/jama/fullarticle/2763841
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The demand for disposable respiratory protective devices needed to protect health care personnel may exceed supply during large outbreaks of respiratory infectious diseases.
Creator
An entity primarily responsible for making the resource
Pompeii, Lisa A., Colleen S. Kraft, Erik A. Brownsword, Morgan A. Lane, Elisa Benavides, Janelle Rios, and Lewis J. Radonovich, Jr.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-25
Type
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Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
Relation
A related resource
Y - PPE pos 88 qualtrics 309
Y - D0.1PPE/D0.2PPE Qualtrics # 309
2019-nCoV
Coronavirus
COVID-19
Infection Prevention and Control
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/6b3901379387e694e96a37954a0d9c69.png
71e4faf666f87142cbf181d942268d24
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Mills, Devin, Delbert A. Harnish, Caryn Lawrence, Megan Sandoval-Powers, and Brian K. Heimbuch. 2018. "Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators." American journal of infection control 46 (7):e49-e55.
Abstract
<div>
<h4>BACKGROUND:</h4>
<p>Safe and effective decontamination and reuse of N95 filtering facepiece respirators (FFRs) has the potential to significantly extend FFR holdings, mitigating a potential shortage due to an influenza pandemic or other pandemic events. Ultraviolet germicidal irradiation (UVGI) has been shown to be effective for decontaminating influenza-contaminated FFRs. This study aims to build on past research by evaluating the UVGI decontamination efficiency of influenza-contaminated FFRs in the presence of soiling agents using an optimized UVGI dose.</p>
<h4>METHODS:</h4>
<p>Twelve samples each of 15 N95 FFR models were contaminated with H1N1 influenza (facepiece and strap), then covered with a soiling agent-artificial saliva or artificial skin oil. For each soiling agent, 3 contaminated FFRs were treated with 1 J/cm<sup>2</sup> UVGI for approximately 1 minute, whereas 3 other contaminated FFRs remained untreated. All contaminated surfaces were cut out and virus extracted. Viable influenza was quantified using a median tissue culture infectious dose assay.</p>
<h4>RESULTS:</h4>
<p>Significant reductions (≥3 log) in influenza viability for both soiling conditions were observed on facepieces from 12 of 15 FFR models and straps from 7 of 15 FFR models.</p>
<h4>CONCLUSIONS:</h4>
<p>These data suggest that FFR decontamination and reuse using UVGI can be effective. Implementation of a UVGI method will require careful consideration of FFR model, material type, and design.</p>
<p class="copyright">Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.</p>
</div>
<div class="keywords">
<h4>KEYWORDS:</h4>
<p>Decontamination; Disinfection; Reuse; Soiling; UVGI; Ultraviolet</p>
</div>
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Free online
URL
https://www.ncbi.nlm.nih.gov/pubmed/29678452
Read Online
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https://www.ajicjournal.org/article/S0196-6553(18)30140-8/pdf
Dublin Core
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Title
A name given to the resource
Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Safe and effective decontamination and reuse of N95 filtering facepiece respirators (FFRs) has the potential to significantly extend FFR holdings, mitigating a potential shortage due to an influenza pandemic or other pandemic events.
Creator
An entity primarily responsible for making the resource
Mills, Devin, Delbert A. Harnish, Caryn Lawrence, Megan Sandoval-Powers, and Brian K. Heimbuch.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-04-17
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-10 (2 years)
Decontamination
N95
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/232e8831da21e20abee22db8db8f0c19.png
387ae336a32395087f238da7bd53e3c2
Dublin Core
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Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Video
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<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/2zN6oyvvaHU" title="YouTube video player" frameborder="0"></iframe>
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/conserving-ppe.html#title_3
Dublin Core
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Title
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Reusing Face and Eye PPE - Extended Wear for COVID-19 Care
Subject
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Infection Control
Description
An account of the resource
For more videos <br />visit med.emory.edu/PPE <br />https://youtu.be/j57qqjNCrck<br /><br />Extended reuse protocol for face and eye protection when supplies are low and the provider is treating a cohort of confirmed or suspected COVID-19 patients. This was created March 19, 2020 and updated March 23, 2020. Protocols are subject to change. If you are a provider be sure to clear with your leadership before use. <br /><br />Created by Visual Medical Education team at Emory University School of Medicine with video produced by Steve Bransford with Emory Center for Digital Scholarship. <br /><br />NOTE: THESE VIDEOS ARE FOR WHEN PPE SUPPLIES MUST BE CONSERVED DURING SUPPLY SHORTAGES. TALK TO YOUR SUPERVISOR TO FIND OUT WHETHER THIS IS PROPER PROCEDURE FOR YOU. <br /><br />Who is producing these? <br />These materials have been developed by the Serious Communicable Diseases Program Team in collaboration with Emory's Visual Medical Education team, which is comprised of certified medical illustrators. We also want to thank Emory Center for Digital Scholarship for their video expertise (when we weren't shooting on an iPhone!). <br /><br />Sharing<br />Intellectual property: We are using Creative Commons for all COVID-19 content unless otherwise indicated: Just give appropriate credit and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests Emory endorses you or your use. <br /><br />Disclaimer <br />The website is intended solely for general educational and information purposes, and is not intended to provide advice to healthcare professionals. EMORY MAKES NO WARRANTIES, EXPRESS OR IMPLIED AS TO THE MATERIAL DISCUSSED ON THIS WEBSITE WHATSOEVER, INCLUDING, WITHOUT LIMITATION, COMPLIANCE WITH QUALITY, REGULATORY, ACCREDITATION OR NATIONAL STANDARDS OF CARE. EMORY EXPRESSLY DISCLAIMS ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE RELATED TO THE MATERIAL PRESENTED ON THIS WEBSITE.
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Emory
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2020-03-23
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Emory VME
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2022-03-29 by Josia Mamora
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2024-01-01
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Y - PPE row 31 score 0
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Donning and Doffing
Example
Eye Protection
Eye/Ocular Health
Gloves
Goggles
Gown
Hand Hygiene
Mask
Personal Protective Equipment (PPE)
R-PPE
Reuse
-
https://repository.netecweb.org/files/original/fe9a813e5643ab774a62b4b1778117e0.pdf
a7b4cd9149e9e1bbd26c59b73e6ff76e
PDF Text
Text
N95 Filtering Facemask Respirator
Ultraviolet Germicidal Irradiation (UVGI)
Process for Decontamination and Reuse
John J Lowe, Katie D Paladino, Jerald D Farke, Kathleen Boulter, Kelly Cawcutt, Mark Emodi, Shawn
Gibbs, Richard Hankins, Lauren Hinkle, Terry Micheels, Shelly Schwedhelm, Angela Vasa, Michael
Wadman, Suzanne Watson, and Mark E Rupp
�Contents
Table of Figures ............................................................................................................................... 2
Introduction .................................................................................................................................... 3
Rationale and Method: ............................................................................................................... 3
UVGI Room Setup ........................................................................................................................... 4
Process Map .................................................................................................................................... 5
Roles ................................................................................................................................................ 6
Healthcare Professional (HCP) .................................................................................................... 6
Upon doffing: .......................................................................................................................... 6
Upon Completion of Decontamination Process: .................................................................... 6
UVGI Associate ............................................................................................................................ 7
Appendix ......................................................................................................................................... 9
Process Photos ............................................................................................................................ 9
Courier .................................................................................................................................... 9
UVGI Associate ...................................................................................................................... 11
1
�Table of Figures
Figure 1 – Room Setup (Overhead View). The lines holding the N95 respirators are 13 feet long
and hold 30 respirators per line (3 across the room); the UV “torches” are located 4 feet from
the center of the line and are 8 feet apart. .................................................................................... 4
Figure 2 – Process flow diagram by role ......................................................................................... 5
Figure 3 - Required respirator markings. ........................................................................................ 9
Figure 4 – Deposit brown bags containing respirators on rack in soiled utility room.................... 9
Figure 5 – Perform hand hygiene. ................................................................................................ 10
Figure 6 – Log respirator drop-off (must note contact for pickup of respirators when
decontaminated). ......................................................................................................................... 10
Figure 7 – Place bags with respirators on cart and transport to UVGI Room. ............................. 11
Figure 8 – Indicate name of respirator owner on new white bag, and number of respirators to
return. ........................................................................................................................................... 11
Figure 9 – Wipe cart thoroughly with Oxivir® 1 wipes. Doff at threshold and exit room. Perform
hand hygiene................................................................................................................................. 12
Figure 10 – Do not block UVGI arc from light to respirators. ....................................................... 12
Figure 11 – Shut off lights and close door. ................................................................................... 13
Figure 12 – Start cycle on remote. Start logging on touchscreen. ............................................... 13
Figure 13 – While cycle runs, write name on new brown bag and place in corresponding labeled
white bag. ..................................................................................................................................... 14
Figure 14 – Run cycle until dose is not less than 60 mJ/cm2. ....................................................... 14
Figure 15 – Stop cycle on remote as soon as possible after minimum required dose................. 15
Figure 16 – Enter room with gloves and procedure mask............................................................ 15
Figure 17 – Add tally to respirator to indicate number of UVGI cycles. ....................................... 16
Figure 18 – Carefully place respirator one at a time in corresponding bag for each owner........ 16
Figure 19 – Staple shut clean white bag with decontaminated respirators................................. 17
Figure 20 – Place stapled bags with decontaminated respirators in totes. ................................. 17
Figure 21 – Contact staff indicated on drop-off log to communicate respirators are ready for
pickup. ........................................................................................................................................... 18
2
�Introduction
Rationale and Method:
The ongoing pandemic of SARS-CoV-2 resulting in COVID-19 has severely stressed the
worldwide healthcare system and has created dangerous shortages of personal protective
equipment (PPE) including N95 filtering facepiece respirators (N95 FFRs). In an effort to extend
the stockpile of N95 FFRs at our institution, we developed a decontamination procedure
involving the delivery of ultraviolet germicidal irradiation (UVGI) to used N95 FFRs. The
evidence base supporting this program includes: 1) UVGI has been shown to effectively
inactivate a wide range of human pathogens including coronaviruses and other human
respiratory viruses; 2) UVGI has been demonstrated to inactivate human respiratory viruses,
including coronaviruses, on various models of N95 FFRs; 3) levels of UVGI needed to inactive
human respiratory viruses are well below the level of irradiation that adversely affects the fit
and filtration characteristics of N95 FFRs; and 4) UVGI can be safely administered when
appropriate safeguards are in place. Herein, we briefly describe our procedure to
decontaminate and reuse N95 FFRs.
Used N95 FFRs are subjected to UVGI at an exposure of 60 mJ/cm2. Single-stranded RNA
viruses, such as SARS-CoV-2, are generally inactivated by UVGI exposure of 2-5 mJ/cm2 (1).
Thus, the UVGI exposure we have chosen exceeds, by at least several fold, the amount of
exposure needed to inactivate SARS-CoV-2 and provides a wide margin of safety. Respirators
are secured on wires that are strung across a room with two UVGI towers (ClorDiSys UVGI Light
System, https://www.clordisys.com/products.php) on either side. These UVGI towers are
equipped with eight 254 nm bulbs, thesebulbs are routinely used in biosafety cabinets and
produce 200 μw/cm2 at 10 feet distance for a dosage of 12 mJ/minute. We monitor the
delivered UVGI exposure dose with a UVGI meter that can be initiated and monitored from
outside the room to verify that the desired exposure has been achieved. As UVGI can cause
damage to eyes and skin, this protects oru UVGI associate’s safety. We plan to decontaminate
and reuse the N95 FFRs multiple times until respirator fit is impacted (2-4). Prior to initiating
the decontamination program, the walls and ceiling were covered with a UV-reflective coating
(https://lumacept.com) with which our group had experience (5). Our program initially involved
the units with high N95 FFR use such as the emergency department and our COVID-19 ward,
but we plan to rapidly expand to ambulatory settings. We believe a variety of UV light sources
could be used in a similar fashion including UV equipped biosafety or sterilization cabinets or
other UV disinfection systems and that this method can be applied to a variety of other critical
items such as procedure masks. The method described below is a result of multiple tests, a
review of the scientific literature, and incorporation of current institutional practice.
3
�UVGI Room Setup
UV Torch
Y ft
N95
X ft
UV Torch
Figure 1 – Room Setup (Overhead View). The lines holding the N95 FFRs are 13 feet long and hold 30 respirators per line (3
across the room); the UVGI “torches” are located 4 feet from the center of the line and are 8 feet apart.
4
�Process Map
Figure 2 – Process flow diagram by role
5
�Roles
Healthcare Professional (HCP)
Healthcare Professional retrieves new N95 FFR from secure Omnicell storage or other
storage location
• Using a permanent marker, HCP writes needed information on front of respirator
including first initial and last name, department/unit location*, and date of first use*.
(This ensures correct respirator is returned to correct HCP and to the correct location;
Date of first use is requested to monitor duration of use as well as number of
decontamination cycles)
• HCP dons N95 FFR per policy ensuring integrity of respirator and proper fit
• HCP uses N95 FFR following extended use guidelines per policy
(https://www.nebraskamed.com/sites/default/files/documents/covid-19/COVIDExtended-Use-Reuse-of-PPE-and-N95.pdf?date03212020)
Upon doffing:
• Remove N95 FFR following appropriate doffing guidelines
• Place used N95 FFR in brown paper bag ensuring brown bag is correctly labeled with
HCP full name, and Department/Unit return location
• When ready to send brown bag, with used respirators, for decontamination, the HCP
brings bag to department/unit designated “dirty” drop off location. This is separate from
the department/unit “clean” location.
Specific to In-House Staff
• Donning gloves only, staff courier collects all used respirators (in brown bags) in a cart or
tote.
• Staff courier takes cart/tote to Decontamination Unit. Only gloves need to be worn for
this process.
• Staff courier places department/unit supply of brown bags (containing used respirators)
in the Decontamination Unit’s Dirty Storage area. Staff courier places tote or individual
bags on the shelf designated for specific unit.
• Staff courier removes gloves and performs hand hygiene
• Staff courier logs requested information onto the drop off log sheet (name of individual
dropping off, contact number, department/unit location, name of person to contact for
pick up, pick up contact number)
Specific to Ambulatory Clinic and Immediate Care Clinic Staff
• Lidded tote, with brown bags containing used respirators, is picked up by courier from
clinic site’s designated location. Pick-ups are done at times specific to clinic site. Any
used respirators, needing decontaminated, must be placed in tote prior to the specified
pick up time.
•
Upon Completion of Decontamination Process:
Specific to In-House Staff
• The Decontamination unit calls contact person, provided on log sheet, to notify that
department/unit decontaminated respirators are ready for pick up.
6
�•
•
•
•
•
Staff courier dons gloves and retrieves decontaminated respirators from the
Decontamination Unit’s designated clean pick up area.
Decontaminated respirators are in new, clean white bags displaying HCP’s and return
location. A new brown bag is included in the clean white bag to serve as new “dirty”
discard brown bag.
Staff courier logs name and time of pick up on the log sheet
White bags are returned to department/unit designated clean pick up location.
HCP will notice a tally mark has been added, by the UVGI associate, after
decontamination process, to track the number of times a particular mask has gone
through the decontamination.
Specific to Ambulatory Clinic and Immediate Care Clinic Staff
• Clean white bags (containing decontaminated respirators) are returned, by courier, to
each site’s designated “clean” delivery location. White bags are labeled (by
decontamination personnel) with each HCP’s name and site location. A new brown bag
is included in the clean white bag to serve as new “dirty” discard brown bag.
• HCP will notice a tally mark has been added, by the UVGI associate, after
decontamination process, to track the number of times a particular mask has gone
through the decontamination.
• Deliveries to clinic or ICC site are conducted at a time specific to site location.
* A note specific to in-house float staff: For HCP floating between multiple units, HCP may
designate their unit/department as the most recently worked resulting in their white bag, with
decontaminated bags, being returned to that location or, HCP may write “Float” as their
unit/department location. For HCP that designate their location as “Float”, their white bag, with
decontaminated respirators, need be picked up personally in the Decontamination Unit’s clean
storage location designated for float staff.
UVGI Associate
•
•
•
•
•
•
•
•
Acknowledge receipt of used respirators from courier in soiled utility closet. Ensure tote
drop-off log was completed. Note cycle start time on log sheet.
Don PPE (gown, gloves, procedural mask) for contact precautions.
Push brown cart to soiled utility closet and collect tote containing used respirators in
brown bags.
Transfer cart with used respirators, batched by location, to UVGI room.
Open one brown bag at a time and collect respirators from bag one at a time. Verify
name, location, and date is on respirator.
Delicately “bloom” respirator exposing as much outer surface as possible while
preserving structural integrity. Do not turn inside out.
Gently position elastic bands between nose and chin panels, if applicable.
Hang respirator with clothespin on one end of respirator, minimizing the clipping area as
much as possible.
7
�•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Continue hanging respirators one at a time until brown bag is empty. Ensure respirators
do not touch each other during any part of reprocessing.
Carefully fold empty brown bag in half, then discard in trash can and continue with next
brown bag until cart is empty.
Thoroughly wipe empty tote and cart with Oxivir® 1 wipes.
Verify two ClorDiSys Torches and UVGI sensor are plugged in and positioned in yellow
position boxes. Verify no objects block line of sight between Torches and hanging
respirators.
Doff gown and gloves at threshold of door.
Turn off all lights inside, exit room, and shut door.
Perform hand hygiene (wash hands thoroughly) immediately outside of room. Remove
procedural mask.
Push START on remote, and push “Start Logging” on UVGI meter box. Both UVGI
Torches will begin beeping inside room, progressively faster for ~ 60 seconds.
While UVGI machine is running ~5 minutes cycle time, folded new brown bags will be
placed inside new white bags. A metallic smell is normal during UV Torch operation.
Monitor Dosage on Control Panel. Press STOP on remote and “Stop Logging” when UV
Dosage reaches at least 60 mJ/cm2 (~5-6 min start to stop). Note elapsed time and total
dosage on process log sheet. Note: Prolonged UVGI exposure may degrade elastic
straps.
Don gloves only and enter UVGI room.
Collect respirators from line, one owner at a time and place tally mark on bottom of
respirator to record the decontamination cycle.
Deposit respirators into a new white bag, indicating owner and return location on
exterior of white bag. Staple white bag shut.
Continue collecting used respirators in white bags labeled by owner and location until all
respirators are collected.
Transfer reprocessed respirators in stapled white bags to courier clean pickup location
in UVGI hallway.
Return clean cart to desk and notify pickup location courier/contact/lead that
respirators are ready for pickup for their location.
Indicate process finish time, number of respirators processed, and other notes as
indicated on process log sheet.
Check for delivery of respirators ready for reprocessing.
8
�Appendix
Process Photos
Figure 3 - Required respirator markings.
Courier
Figure 4 – Deposit brown bags containing respirators on rack in soiled utility room.
9
�Figure 5 – Perform hand hygiene.
Figure 6 – Log respirator drop-off (must note contact for pickup of respirators when decontaminated).
10
�UVGI Associate
Figure 7 – Place bags with respirators on cart and transport to UVGI Room.
Figure 8 – Indicate name of respirator owner on new white bag, and number of respirators to return.
11
�Figure 9 – Wipe cart thoroughly with Oxivir® 1 wipes. Doff at threshold and exit room. Perform hand hygiene.
Figure 10 – Do not block UVGI arc from light to respirators.
12
�Figure 11 – Shut off lights and close door.
Figure 12 – Start cycle on remote. Start logging on touchscreen.
13
�Figure 13 – While cycle runs, write name on new brown bag and place in corresponding labeled white bag.
Figure 14 – Run cycle until dose is not less than 60 mJ/cm2.
14
�Figure 15 – Stop cycle on remote as soon as possible after minimum required dose.
Figure 16 – Enter room with gloves and procedure mask.
15
�Figure 17 – Add tally to respirator to indicate number of UVGI cycles.
Figure 18 – Carefully place respirator one at a time in corresponding bag for each owner.
16
�Figure 19 – Staple shut clean white bag with decontaminated respirators.
Figure 20 – Place stapled bags with decontaminated respirators in totes.
17
�Figure 21 – Contact staff indicated on drop-off log to communicate respirators are ready for pickup.
References:
1. Chun-Chieh Tseng & Chih-Shan Li (2007) Inactivation of Viruses on Surfaces by
Ultraviolet Germicidal Irradiation,Journal of Occupational and Environmental
Hygiene, 4:6, 400-405, DOI: 10.1080/15459620701329012
2. Michael B. Lore, Brian K. Heimbuch, Teanne L. Brown, Joseph D. Wander, Steven H.
Hinrichs, Effectiveness of Three Decontamination Treatments against Influenza Virus
Applied to Filtering Facepiece Respirators, The Annals of Occupational Hygiene, Volume
56, Issue 1, January 2012, Pages 92–101, https://doi.org/10.1093/annhyg/mer054
3. Dennis J. Viscusi, Michael S. Bergman, Benjamin C. Eimer, Ronald E. Shaffer, Evaluation
of Five Decontamination Methods for Filtering Facepiece Respirators, The Annals of
Occupational Hygiene, Volume 53, Issue 8, November 2009, Pages 815–
827, https://doi.org/10.1093/annhyg/mep070
4. William G. Lindsley, Stephen B. Martin Jr., Robert E. Thewlis, Khachatur Sarkisian, Julian
O. Nwoko, Kenneth R. Mead & John D. Noti (2015) Effects of Ultraviolet Germicidal
Irradiation (UVGI) on N95 Respirator Filtration Performance and Structural
Integrity, Journal of Occupational and Environmental Hygiene, 12:8, 509517, DOI: 10.1080/15459624.2015.1018518
5. Katelyn C. Jelden, Shawn G. Gibbs, Philip W. Smith, Angela L. Hewlett, Peter C. Iwen,
Kendra K. Schmid & John J. Lowe (2017) Ultraviolet (UV)-reflective paint with ultraviolet
germicidal irradiation (UVGI) improves decontamination of nosocomial bacteria on
18
�hospital room surfaces, Journal of Occupational and Environmental Hygiene, 14:6, 456460, DOI: 10.1080/15459624.2017.1296231
19
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
Citation
Citation information for the publication itself.
John J Lowe, Katie D Paladino, Jerald D Farke, Kathleen Boulter, Kelly Cawcutt, Mark Emodi, Shawn Gibbs, Richard Hankins, Lauren Hinkle, Terry Micheels, Shelly Schwedhelm, Angela Vasa, Michael Wadman, Suzanne Watson, and Mark E Rupp. 2020. "N95 Filtering Facemask Respirator Ultraviolet Germicidal Irradiation (UVGI) Process for Decontamination and Reuse." https://www.nebraskamed.com/for-providers/covid19
URL
https://www.nebraskamed.com/sites/default/files/documents/covid-19/n-95-decon-process.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
N95 Filtering Facemask Respirator Ultraviolet Germicidal Irradiation (UVGI) Process for Decontamination and Reuse
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The ongoing pandemic of SARS-CoV-2 resulting in COVID-19 has severely stressed the worldwide healthcare system and has created dangerous shortages of personal protective equipment (PPE) including N95 filtering facepiece respirators (N95 FFRs). In an effort to extend the stockpile of N95 FFRs at our institution, we developed a decontamination procedure involving the delivery of ultraviolet germicidal irradiation (UVGI) to used N95 FFRs. The evidence base supporting this program includes: 1) UVGI has been shown to effectively inactivate a wide range of human pathogens including coronaviruses and other human respiratory viruses; 2) UVGI has been demonstrated to inactivate human respiratory viruses, including coronaviruses, on various models of N95 FFRs; 3) levels of UVGI needed to inactive human respiratory viruses are well below the level of irradiation that adversely affects the fit and filtration characteristics of N95 FFRs; and 4) UVGI can be safely administered when appropriate safeguards are in place. Herein, we briefly describe our procedure to decontaminate and reuse N95 FFRs. <br /><br />Used N95 FFRs are subjected to UVGI at an exposure of 60 mJ/cm2. Single-stranded RNA viruses, such as SARS-CoV-2, are generally inactivated by UVGI exposure of 2-5 mJ/cm2 (1). Thus, the UVGI exposure we have chosen exceeds, by at least several fold, the amount of exposure needed to inactivate SARS-CoV-2 and provides a wide margin of safety. Respirators are secured on wires that are strung across a room with two UVGI towers (ClorDiSys UVGI Light System, https://www.clordisys.com/products.php) on either side. These UVGI towers are equipped with eight 254 nm bulbs, thesebulbs are routinely used in biosafety cabinets and produce 200 μw/cm2 at 10 feet distance for a dosage of 12 mJ/minute. We monitor the delivered UVGI exposure dose with a UVGI meter that can be initiated and monitored from outside the room to verify that the desired exposure has been achieved. As UVGI can cause damage to eyes and skin, this protects oru UVGI associate’s safety. We plan to decontaminate and reuse the N95 FFRs multiple times until respirator fit is impacted (2-4). Prior to initiating the decontamination program, the walls and ceiling were covered with a UV-reflective coating (https://lumacept.com) with which our group had experience (5). Our program initially involved the units with high N95 FFR use such as the emergency department and our COVID-19 ward, but we plan to rapidly expand to ambulatory settings. We believe a variety of UV light sources could be used in a similar fashion including UV equipped biosafety or sterilization cabinets or other UV disinfection systems and that this method can be applied to a variety of other critical items such as procedure masks. The method described below is a result of multiple tests, a review of the scientific literature, and incorporation of current institutional practice. (<a href="https://www.nebraskamed.com/for-providers/covid19" target="_blank" rel="noreferrer noopener">Nebraska Medicine</a>).
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Source
A related resource from which the described resource is derived
John J Lowe, Katie D Paladino, Jerald D Farke, Kathleen Boulter, Kelly Cawcutt, Mark Emodi, Shawn Gibbs, Richard Hankins, Lauren Hinkle, Terry Micheels, Shelly Schwedhelm, Angela Vasa, Michael Wadman, Suzanne Watson, and Mark E Rupp.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-21
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-10 (2 years)
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Decontamination
N95
Personal Protective Equipment (PPE)
R-PPE
SARS-CoV-2
-
https://repository.netecweb.org/files/original/a9145ba15f3d2234ca59c7c1576f0174.pdf
7eaccd5f9a557aeecf6abd27bc570528
PDF Text
Text
CONSERVE
PPE
View the PPE videos at
med.emory.edu/PPE
Contact gown
N95
respirator
Goggles
Gloves
Gloves, Setup
1
After glove and
gown removal
in the patient
room,
exit and...
2
Put on fresh
gloves.
Sanitize
gloves.
3
Place wipe
on table.
N95
4
Remove goggles and
place on wipe.
5
Sanitize
gloves.
6
7
Remove N95, lower
strap and then upper.
Store mask.
Sanitize
gloves.
8
Put on
mask.
Goggles
9
Wipe front
and back of
lens.
10
11
Wipe both
ear pieces.
12
Wipe
table.
13
Place goggles
on clean table
to dry.
15
Sanitize
gloves.
14
Remove
gloves.
Wash hands with
soap and water or
sanitize hands.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�CONSERVE
PPE
View the PPE videos at
med.emory.edu/PPE
Contact gown
N95
respirator
Face shield
Gloves
Gloves, Setup
1
After glove and
gown removal
in the patient
room,
exit and...
2
Put on fresh
gloves.
3
Sanitize
gloves.
Place wipe
on table.
N95
4
Remove face shield
and place on wipe.
5
Sanitize
gloves.
6
7
Remove N95, lower
strap and then upper.
Store mask.
Sanitize
gloves.
8
Put on
mask.
Face Shield
9
10
11
Wipe
table.
Wipe shield. Sanitize in the following
order:
12
Place
shield
upside
down to
dry.
14
Back of
shield.
Elastic
band.
Foam
band.
Sanitize
gloves.
13
Remove
gloves.
Wash hands with
soap and water or
sanitize hands.
Front of
shield.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated August 28, 2020
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/resources.html
Citation
Citation information for the publication itself.
Emory VME
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Conserving PPE flyer: Gown, N95, Goggles, Gloves
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 Resources: Reusing face shield, eyewear, and N95 - printable instructions
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-28
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01 ** Specific review date January 1st
2019-nCoV
Cleaning
Contingency and crisis capacities
Coronavirus
COVID-19
Disinfection
Example
Face shield
Gloves
Goggles
Gown
N95
Personal Protective Equipment (PPE)
R-PPE
Reuse
-
https://repository.netecweb.org/files/original/62dcc1adee58064b5e85260f66f8ec62.png
1560feba0ba6055982cdcc69f784df4a
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/RX3_TR02_AA" title="YouTube video player" frameborder="0"></iframe>
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/conserving-ppe.html#title_3
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Doffing (Taking OFF) DICE PPE (Mask)
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Taking off DICE droplet PPE - doffing video with conservation of resources<br /><br />Watch this video on <a href="https://youtu.be/bdf_jNeSt0w" target="_blank" rel="noreferrer noopener">Youtube</a>.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-23
Source
A related resource from which the described resource is derived
Emory VME
Contributor
An entity responsible for making contributions to the resource
2022-02-04 by Jill Morgan - PPE group - general asset review - Emory - Archive
2022-11-16 - by Jill/Britton - on SPORSA mark active
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-11-16
Relation
A related resource
Y - PPE pos 104 qualtrics 324
Y - D0.1PPE/D0.2PPE Qualtrics # 324
2019-nCoV
Coronavirus
COVID-19
Donning and Doffing
Droplet Transmission
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/6a03ac408a49d275146775c98facac44.png
1e1e6df21ca508acf299218714dcd558
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/4UtmIfYCLks" title="YouTube video player" frameborder="0"></iframe>
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/conserving-ppe.html#section3
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Doffing (Taking OFF) ACE PPE (N95)
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Taking off ACE airborne PPE - doffing video with conservation of resources<br /><br />Watch this video on <a href="https://youtu.be/7O_KOaXRiDE" target="_blank" rel="noreferrer noopener">Youtube</a>.
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-23
Source
A related resource from which the described resource is derived
Emory VME
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
ACE
Airborne Transmission
Coronavirus
COVID-19
Donning and Doffing
Example
N95
Personal Protective Equipment (PPE)
R-PPE
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/4345038c91f6818a8b4cfa00638e61d3.png
61829bdf49d586b6877d54203dc3daa5
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" src="https://www.youtube.com/embed/vZjYSdnyklE" title="YouTube video player" frameborder="0"></iframe>
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/covid-19-resources/conserving-ppe.html#section3
Dublin Core
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Title
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Donning (Putting ON) ACE PPE (N95)
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Putting on ACE airborne PPE - Donning video with conservation of resources<br /><br />Watch this video on <a href="https://youtu.be/WUyx6VoPdL8" target="_blank" rel="noreferrer noopener">Youtube</a>.
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Emory
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2020-03-23
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Emory VME
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2022-03-29 by Josia Mamora
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The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
2019-nCoV
Airborne Transmission
Contingency and crisis capacities
Coronavirus
COVID-19
Donning and Doffing
Example
N95
Personal Protective Equipment (PPE)
R-PPE
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/8060ad115d83937f8038b963faf6e7a9.png
8ff0b136d9d4ca86991e4a3eba7d1b13
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2020/03/06/preserving-ppe-supply-how-some-facilities-are-conserving-their-stockpiles/
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Preserving PPE Supply – How Some Facilities are Conserving Their Stockpiles
Subject
The topic of the resource
Infection Control
Description
An account of the resource
In response to developing national and international shortages of Personal Protective Equipment (PPE), many facilities are implementing enhanced clinical practice guidelines to preserve their supply of items such as gowns and masks. Including the potential safe use of expired supplies as indicated recently by NIOSH, some potential ways to do this are shown on this page.
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NETEC
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2020-03-06
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2023-12-04 by Jill Morgan/PPE Group - archive - blog post, so tagged archive
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The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
Do not review - archived
2019-nCoV
Archived
Blog
Coronavirus
COVID-19
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/a1800426dee4b835b316fbb78a21d064.png
aab0d7bd6f34f78df1ddf268c6973fa6
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Discover
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Guide
Document providing operation or response information, general guidance documents.
URL
https://netec.org/2020/03/05/niosh-tests-the-effectiveness-of-ppe-in-national-stockpile/
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NIOSH Tests the Effectiveness of PPE in National Stockpile
Subject
The topic of the resource
Infection Control
Description
An account of the resource
During a national emergency, demand for personal protective equipment (PPE), such as gloves, gowns and respirators, to protect healthcare workers can outpace the available stock... Researchers measured the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece APRs from ten stockpile facilities with varying storage conditions. This page links to and summarizes the tests.
Creator
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NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-05
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
2019-nCoV
Blog
Coronavirus
COVID-19
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/06a7f24e65f4fdec891e2a06c8bb3ba9.pdf
a3dff2d2effe0c580c2a1d6295a7b52c
PDF Text
Text
putting
PPE
ON
View the PPE video at
med.emory.edu/PPE
1/1
Contact gown
N95
respirator
Face shield
Gloves
Gown
1
2
Remove any personal
items and jewelry and
put in secure location,
not in pockets.
3
Sanitize
hands.
Put on contact
gown outside room.
Open-end faces
your back.
Tie the back of
the gown.
N95, Face Shield
4
5
Put on N95,
ensuring proper seal.
Ensure straps are
not crossing.
6
Place hands over the front
of the N95. Breathe an easy
deep breath in and out.
Put on face
shield.
If you feel air
escape the edges,
refit and repeat.
Gloves, Entry
7
Put on gloves
over the cuffs
of the gown.
8
Sanitize
gloves.
10
9
ENTER
room
Do not touch face or readjust N95 or face shield
inside room.
DO NOT enter the room if
you do not achieve a proper
respirator seal.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated September 4, 2020
�taking
PPE
OFF
View the PPE video at
med.emory.edu/PPE
1/1
N95, face shield, contact gown, gloves
Gown, Gloves
1
2
3
Sanitize
gloves.
4
Roll the gown towards
your hands.
Remove the gloves
with the gown.
Cross arms and
grip gown on
shoulders.
Pull and break
gown in controlled
fashion.
Sanitize
hands.
Dispose of
gloves and
gown.
Eye Protection
5
6
7
Remove
face shield
by the strap
over your
head without
touching your
skin.
Do not
touch face.
EXIT patient room
Sanitize
hands.
EXIT patient room
N95
8
9
Pinch bottom strap and
pull far over head.
Sanitize
hands
again.
Do not let straps
touch your face.
10
11
Pinch top strap and
pull far over head.
Do not let straps
touch your face as
you remove the
N95.
Head immediately to
handwashing station.
Wash hands with soap
and water.
The materials are intended solely for general educational and information purposes, are made available in the context of the public health emergency related to the coronavirus (COVID-19)
and have not been subject to review that typically would occur in a non-emergent situation. The materials do not constitute the provision of medical, legal or other professional advice.”
Creative Commons Attribution-NonCommercial-NoDerivs
Emory University, created by Visual Medical Education. Updated September 4, 2020
�
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Title
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Develop
Description
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
The following documents for use in your facility are related to COVID-19. These reflect the current supply shortage in which masks and goggles and face shields may be conserved.
URL
https://med.emory.edu/departments/medicine/divisions/infectious-diseases/serious-communicable-diseases-program/resources.html
Citation
Citation information for the publication itself.
Emory VME
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Title
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Putting ON AND Taking OFF PPE (ACE)
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19 Resources: Putting ON AND Taking OFF Airborne – Contact precautions with eyewear (ACE) Printable instructions
Creator
An entity primarily responsible for making the resource
Emory
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-04
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01 ** Specific Review Date
2019-nCoV
Airborne Transmission
Coronavirus
COVID-19
Donning and Doffing
Example
Face shield
Gloves
Gown
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/b8122a2c95f0dc0621b354261ee3965d.pdf
b9cfd9955fa76055b4a05aacf0416d07
PDF Text
Text
BioScience Trends Advance Publication
Policy Forum
Advance Publication
P1
DOI: 10.5582/bst.2020.01043
Challenges to the system of reserve medical supplies for public
health emergencies: reflections on the outbreak of the severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in
China
Xu Wang, Xiaoxi Zhang, Jiangjiang He*
Department of Health Policy Research, Shanghai Health Development Research Center (Shanghai Medical Information Center), Shanghai, China.
SUMMARY
On December 31, 2019, the Wuhan Municipal Health Commission announced an outbreak of severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2), China is now at a critical period in the
control of the epidemic. The Chinese Government has been taking a series of rapid, comprehensive,
and effective prevention and control measures. As the pandemic has developed, a fact has become
apparent: there is a serious dearth of emergency medical supplies, and especially an extreme shortage
of personal protective equipment such as masks and medical protective clothing. This is one of the
major factors affecting the progress of epidemic prevention and control. Although China has made
great efforts to strengthen the ability to quickly respond to public health emergencies since the
SARS outbreak in 2003 and it has clarified requirements for emergency supplies through legislation,
the emergency reserve supplies program has not been effectively implemented, and there are also
deficiencies in the types, quantity, and availability of emergency medical supplies. A sound system
of emergency reserve supplies is crucial to the management of public health emergencies. Based on
international experiences with pandemic control, the world should emphasize improving the system
of emergency reserve medical supplies in the process of establishing and improving public health
emergency response systems, and it should promote the establishment of international cooperative
programs to jointly deal with public health emergencies of international concern in the future.
Keywords
public health emergency, SARS-CoV-2, COVID-19, medical supplies
1. Introduction
After several cases were identified in Wuhan in Dec.
2019, severe acute respiratory syndrome coronavirus
2 (SARS-CoV-2) has gradually affected China as a
country and even spread worldwide. Prior to Feb. 12,
2020, China had reported 59,804 confirmed cases of
coronavirus disease 2019 (COVID-19), 1,367 deaths, and
5,911 recoveries (1). Compared to the SARS epidemic in
2003, this time China has apparently made great progress
in combating a pandemic through its development of
the capacity for biological detection and its greater
transparency with regard to information (2,3). However,
the situation also revealed that China still faces major
problems in terms of public health emergencies.
2. Shortage of medical supplies during the SARSCoV-2 epidemic in China
The key to a response to a public health emergency
lies in abundant reserves and proper allocation of
emergency medical supplies, for timely supplies are
crucial to reducing deaths and increasing the rate of
successful treatment (4). An epidemic caused by a new
pathogen can often deal a blow to the health system,
resulting in a shortage of supplies and medicines. For
example, the United States was faced with an outbreak
of H1N1 influenza in 2009; many hospitals suffered
from a shortage of personal protective equipment (5).
The SARS-CoV-2 outbreak coincided with Chinese
New Year, so most of the manufacturers and distributors
were on holiday; this further intensified the shortage of
medical protective supplies in combating the epidemic.
Hospitals across the country, and especially those in
Wuhan where the situation is the most severe, have
cited a vast shortage of medical supplies, and especially
personal protective supplies such as medical protective
clothing and N95 masks; the hospitals are urgently
calling for societal support (6). This shows that China
is still facing significant challenges and still needs to
www.biosciencetrends.com
�P2
BioScience Trends Advance Publication
enhance the reserve medical supplies program and
to remedy the faults in the allocation, distribution,
and utilization of supplies to deal with public health
emergencies.
3. Policy requirements and status of the reserve
medical supplies program in China
China's current reserve medical supplies program dates
back to the 1970s (7). In order to ensure the effective
supply of medical supplies required after disasters,
epidemics, or emergencies, the State Council issued the
"Notice on Reforming and Enhancing the Management
of Medical Reserves" in 1997. After the SARS outbreak
in 2003, the Chinese Government heavily emphasized
emergency preparation and related legislation. The
government issued the "Regulations on Public Health
Emergencies," the "National Emergency Plan for
Public Health Emergencies," the "(Draft) Catalogue of
health emergency personnel and equipment," and other
documents (Table 1). Moreover, the emergency reserve
supplies program clearly stipulates that "municipal
governments and county governments in areas where
emergencies are likely to occur should establish a
program for emergency reserve supplies, necessities,
and equipment"(8).
Although policies on the emergency reserve medical
supplies program have been continuously improved,
they are often not fully implemented. The SARS-CoV-2
epidemic shows that the Government failed to heed
its responsibility for effectively "reserving medical
supplies for the prevention and control of the pandemic"
(9). In 2010, all of the Centers for Disease Control and
Prevention on the provincial level were evaluated for
their capacity to respond to public health emergencies,
and the results indicated that the readiness of emergency
reserve supplies was only 37.5%, only 4.8% of all
centers met standards, and the types and quantities of
supplies were far from adequate (10). The first reason
for this is because the mechanism for funding reserve
medical supplies still has flaws; it lacks long-term
and sustainable input (11). Second, a mechanism for
managing emergency reserve supplies has yet to be
created; there is a lack of integrated planning, timely
storage, or rapid distribution. Third, the risks of an
emergency and response capabilities vary with the level
of economic and social development, necessitating the
continuous updating of lists of emergency supplies.
Since the issuance of the "(Draft) Catalogue of health
emergency personnel and equipment" in 2008, however,
no adjustments or updates have been made, resulting in
substantial inability to meet current standards (12).
4. Main systems of reserve medical supplies around
the world
With the frequent occurrence of public health
emergencies across the world, some countries have
established relatively mature medical stockpile systems
to protect their populations from potential public health
emergencies (13). In 2003, the United States created
the Strategic National Stockpile (SNS) Program to
maintain a stockpile of life-saving pharmaceuticals and
medical supplies for use in a public health emergency.
The SNS represents a real material asset in federal
warehouses that can be quickly activated to meet the
country's needs, enhancing the country's ability to
respond effectively to public health emergencies. There
are mainly three categories of SNS including 12-hour
push packages, vendor managed inventory (VMI),
and stockpile managed inventory (SMI). 12-hour push
packages can be delivered to the collection reserve
within 12 h of an emergency, and each emergency
package contains sufficient medicines and medical
supplies for hundreds of thousands of individuals to
sustain treatment and prevention for several days.
Vendor managed inventory (VMI) is managed inventory
maintained by specific vendors or manufacturers
that is stored at the supplier in the form of signed
contracts and that can be delivered within 24 to 36
hours upon approval. Stockpile managed inventory
(SMI) is directly managed and reserved by the SNS
and includes physical reserves and ordered reserves.
The US also has other forms of emergency supplies,
such as chemical kits and family medical kits. In the
event of an emergency, the SNS Program will deploy a
team of advisors to coordinate and assist state and local
authorities in receiving, managing, distributing, and
recovering emergency medical supplies. The stockpile
service advance group (SSAG) and technical advisory
response unit (TARU) consist of experts in public
health, emergency response, and logistics. In response
to public health emergencies, Canada and Australia
have also established the National Strategic Stockpile
(NESS) (14) and National Medical Stockpile (NMS)
(15) systems; these systems provide key reserves of
essential medicines and equipment, such as personal
protective equipment, antibiotics, and antivirals. The
NESS and NMS are maintained in various strategic
locations by federally leasing warehouses and by other
means (Table 2).
5. How to enhance the reserve medical supplies
system to deal with public health emergencies
Emerging pandemic have been increasing around
the world over the past few years, and more than 40
emerging infectious diseases have been detected, such
as SARS, H7N9 avian influenza, Ebola virus, and
MERS. Epidemics of novel infectious diseases have
emerged and rapidly spread globally in the context
of economic globalization and increasingly frequent
international exchanges, and these epidemics have
a significant impact on economic development and
www.biosciencetrends.com
�BioScience Trends Advance Publication
P3
Table 1. China's policy documents related to the reserve medical supplies programs
Year
Title of policy documents (ref.)
1997
Notice of the State Council on Reforming
and Enhancing the Management of Medical
Supplies (21).
State Council., [1997] Reference No. 23.
Reforms the current national system of medical supplies and pharmaceutical reserves,
establishes a reserves program both at the central and local levels, and implements a
dynamic reserve and paid redeployment program.
Measures for National Management of Medical
Supplies and Pharmaceutical Reserves (22).
Pharmacy department, National Economic
Trade Committee., [1999] Reference No. 544.
When major disasters, epidemics, or emergencies occur, or several provinces, autonomous
regions, or municipalities directly under the central government are involved, the region's
own medical reserves are used first. If those reserves are inadequate, the government can
request medical reserves from neighboring regions or designated departments based on
the paid redeployment program. If there are still unmet needs, the government can apply
to access the central medical reserves.
2003
Regulations on Preparedness for and Responses
to Emergent Public Health Hazards (23).
Order of the State Council of the People's
Republic of China (No.376).
Relevant departments of the State Council, governments at or above the county level, and
their relevant departments should ensure reserves of supplies such as emergency facilities,
equipment, medications, and medical equipment in accordance with the requirements of
emergency plans.
2004
The 2004 Revised Law of the People's Republic
of China on the Prevention and Treatment of
Infectious Diseases (24).
Order of the President of the People's
Republic of China (No.17).
Governments at or above the county level are responsible for reserving medicines,
medical equipment, and other supplies for the prevention and control of future outbreaks
of infectious diseases.
2005
Master State Plan for a Rapid Response to
Public Emergencies (25).
Establishes and improves the emergency supplies monitoring network, the early warning
system, and the emergency supplies production, storage, allocation, and distribution
system; improves emergency protocols and ensures the timely supply of emergency
supplies and daily necessities; enhances the supervision and management of supply
reserves, and provides timely supplements and updates.
2006
National Contingency Plan for Public Health
Emergencies (26).
Governments at all levels must establish reserves of supplies and ensure the production
capacity to handle public health emergencies. When a public health emergency occurs,
reserve supplies should be allocated as needed to manage the emergency. Emergency
reserves should be replenished in a timely manner after use.
2007
Law of the People's Republic of China on
Emergency Response (8).
Order of the President of the People's
Republic of China (No.69).
The state should establish a sound emergency reserve supplies program and improve
the program for the supervision, production, storage, allocation, and distribution of
important emergency supplies. Municipal governments and county governments in areas
where emergencies are likely to occur should establish a reserve program for emergency
supplies, necessities, and equipment.
2008
(Draft) Catalogue of health emergency
personnel and equipment (27).
Office of Health Emergency Response,
Ministry of Health., [2008] Reference No. 207.
Enhances the creation of health emergency response teams, implements standardized
management of health emergency response teams, and continuously improves health
emergency response capabilities.
2010
Guidance on Accelerating the Creation and
Development of Public Health Emergency
Systems (28).
Office of Health Emergency Response,
Ministry of Health., [2010] Reference No. 57.
Further improves the health emergency reserve supplies and allocation system. Improves
the list of health emergency supplies, reasonably determines the type, quantity, and
nature of the reserves; establishes procedures for effective use of emergency supplies in
conjunction with relevant departments, and improves the mechanism of inter-regional,
inter-departmental, and cross-military allocation of emergency supplies. Establishes and
improves the emergency reserve supplies program for health institutions at all levels to
facilitate the timely availability of emergency supplies.
2016
Notice of the National Health and Family
Planning Commission on Issuance of Guiding
Opinions on Enhancing the Standardization
and Devising of Responses to Health-related
Emergencies (29).
Office of Health Emergency, Ministry of
Health., [2016] Reference No. 68.
Improves supplies and technological reserves. Cooperates with industry and information
technology departments to improve the emergency reserve supplies program, reasonably
determines the material reserve catalogue, scale, and the extent of physical reserves, social
reserves, and production capacity reserves; establishes and improves the supply rotation
and allocation system and promotes the digitization of supply reserves records to improve
the comprehensive coordination and ensured provision of emergency supplies.
1999
Regulations
human health. Improving the national public health
emergency response system is crucial to the prevention
and control of novel infectious diseases, and the
emergency medical supplies is an indispensable element
of public health emergency response (16).
In the future, China and many other countries
should pay close attention to the reserve medical
supplies program in the process of enhancing the public
health emergency response system based on the lessons
of the SARS-CoV-2 pandemic and the prevention
and control of other epidemics. First, China should
establish a public health emergency reserve medical
supplies system and improve the nature of reserve
medical supplies based on the types, needs, and validity
of reserves (17), such as contracted reserves, physical
reserves, financial reserves, and production capacity
www.biosciencetrends.com
�P4
BioScience Trends Advance Publication
Table 2. Major forms of emergency reserve medical supplies around the world
Country
Reserve form (ref.)
United
States
Strategic National
Stockpile, SNS
(13,30).
Office of the Assistant Secretary for Preparedness and Response (ASPR), HHS manages the SNS program
The Stockpile includes 12-hour push packs (less than 5% of the SNS inventory) and managed inventories
maintained by specific vendors or manufacturers, or the SNS. Supplies are managed through vendor managed
inventory (VMI) and stockpile managed inventory (SMI).
The plan is to deliver critical medical resources to the site of a national emergency when local public health
resources would likely be or have already been overwhelmed by the magnitude of the medical emergency.
The stockpile includes vaccines, antitoxins (e.g., botulinum), airway equipment, and other medicines for
emergency conditions.
Canada
Emergency Strategic
Stockpile, NESS (14).
The Public Health Agency maintains the NESS to provide emergency supplies to provinces and territories
when requested.
A total of 11 federal warehouses are leased by the Public Health Agency: two main depots in the National
Capital Region (Ottawa) and nine warehouses located across Canada. There are no federal warehouses located
in the territories. The Public Health Agency has contracts in place for both custodians and security for all 11
federal warehouses.
In the event of a local emergency that overwhelms available municipal resources, the municipality contacts
the provincial/territorial emergency management authorities for additional resources.
The NESS contains a variety of assets, including medical equipment and supplies (such as ventilators,
personal protective equipment such as masks and gloves, etc.); pharmaceuticals (individual items such as
antiviral agents, antibiotics, etc.); social service supplies (such as generators, cots, blankets, flashlights, etc.)
Australia
National Medical
Stockpile, NMS (15).
The Health Emergency Management Branch (HEMB), Office of Health Protection, within the Department of
Health and Ageing (DHA), is responsible for managing the NMS, including inventory management, planning
and developing Memoranda of Understanding with states and territories for deployment of the stockpile.
The NMS is kept in various strategic locations around Australia. All jurisdictions possess a pharmaceutical
stockpile separate from the NMS and all jurisdictions maintain stockpiles of personal protective equipment
(PPE) for responding to chemical, biological and radio-nuclear (CBRN) health disaster or pandemic influenza.
Decisions to use the NMS are based on both internal and external expert clinical advice and on threat and
risk assessment from the Australian National Security Agency.
The NMS is a national strategic reserve of essential vaccines, antibiotics, antiviral drugs, chemical and
radiological antidotes, and personal protective equipment. It also includes specialized medical supplies, such
as the nation's stock of smallpox vaccine.
Details
reserves. Second, standards for emergency medical
supplies should be rationally devised and dynamically
adjusted in accordance with changes in international
and domestic circumstances. Third, programs for
the planning, management, storage, deployment,
distribution, emergency production, and urgent
requisition of emergency supplies should be improved
through legislation, and the roles and responsibilities
of various departments and individuals in institutional
arrangements should be clarified to ensure the
effective implementation of those systems. Interagency
agreements among the Ministry of Health, the Ministry
of Defense, and logistics companies should be drafted to
actively facilitate the transportation of medical supplies
in response to a public health emergency without
disruption or delay. The World Health Organization has
pointed out that the world faces a chronic shortage of
personal protective equipment such as respirators and
masks because of the COVID-19 pandemic (18). To
respond to public health emergencies during special
periods, countries around the world should establish a
system of international cooperation to jointly cope with
major emerging emergencies and they should improve
the global system for procurement and deployment
of emergency supplies, with priority given to medical
personnel.
China has set up a team to ensure medical supplies
under the State Council that is responsible for the joint
prevention and control of the SARS-CoV-2 epidemic.
The production of key medical supplies such as medical
protective clothing, medical goggles, medical masks,
and disinfection supplies is organized by the Ministry
of Industry and Information Technology, which is also
responsible for coordinating and deploying urgently
needed materials (19). On January 23, the Ministry
of Industry and Information Technology of China
expedited the delivery of 10,000 sets of protective
clothing and 50,000 sets of gloves to Wuhan from
the National Medicines Reserve, and it instituted six
measures including the establishment of a national
temporary production scheduling system for key
enterprises and national temporary reserve supplies for
epidemic prevention and control (20). Since the SARSCoV-2 outbreak, China has also received medical
masks, protective clothing, goggles, and other materials
donated by South Korea, Japan, Britain, France, and
other countries. With joint efforts of the international
community, China should be able to deal with the
epidemic at an early date and help to safeguard regional
and global public health security.
References
1. National Health Commission of the People's Republic
of China. Latest information of the prevalence of
pneumonia caused by the severe acute respiratory
syndrome coronavirus 2 as of 12 AM Feb 12. http://
www.nhc.gov.cn/xcs/yqtb/202002/26fb16805f024382bf
www.biosciencetrends.com
�BioScience Trends Advance Publication
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
f1de80c918368f.shtml (accessed February 13, 2020) (in
Chinese)
State Council of the People's Republic of China.
Secretary-General of the Shanghai Cooperation
Organization praises China's efforts to combat
novel coronavirus pneumonia. http://www.gov.cn/
xinwen/2020-01/31/content_5473474.htm (accessed
February 9, 2020) (in Chinese)
World Health Organization. WHO Director-General's
statement on IHR Emergency Committee on Novel
Coronavirus (2019-nCoV). https://www.who.int/dg/
speeches/detail/who-director-general-s-statement-onihr-emergency-committee-on-novel-coronavirus-(2019ncov) (accessed February 9, 2020).
Wang LZ. A system for allocation of emergency medical
supplies and reserves primarily in large hospitals. Soft
Science of Health. 2010; 24:402-403. (in Chinese)
Rebmann T, Wagner W. Infection preventionists'
experience during the first months of the 2009 novel
H1N1 influenza A pandemic. Am J Infect Control. 2009;
37:e5-e16.
National Health Commission of the People's Republic of
China. Transcript of a press conference on February 4,
2020. http://www.nhc.gov.cn/wjw/xwdt/202002/35990d5
6cfcb43f4a70d7f9703b113c0.shtml (accessed February 4,
2020) (in Chinese)
Wang ZJ. Discussion on establishing a medical stockpile
system for public health emergencies. Chinese Journal
of Public Health Management. 2004; 6:502-503. (in
Chinese)
The Central People's Government of the People's
Republic of China. Law of the People's Republic of
China on Emergency Response. http://www.gov.cn/
ziliao/flfg/2007-08/30/content_732593.htm (accessed
February 4, 2020) (in Chinese)
Legalweekly. Medical stockpile system needs to be
urgently implemented. http://www.legalweekly.cn/
rwjs/17400.html (accessed February 4, 2020) (in
Chinese)
Wu D, Hu DD, Sun M, Li CY, Chang FS, Zhang JH, Li
PP, Ning N, Hao M. CDC emergency response capacity
and current state of public health emergency in China.
Chinese Journal of Health Policy. 2014; 7:30-37. (in
Chinese)
Guangming Daily. The transformation of and hidden
concerns with China's disease prevention and control
system. http://epaper.gmw.cn/gmrb/html/2015-04/24/
nw.D110000gmrb_20150424_1-05.htm (accessed
February 4, 2020) (in Chinese)
Sun M, Wu D, Shi JH, Li CY, Lv J, Su ZX, Ning N,
Zhang JH, Xu P, Hao M. Policy changes related to the
handling of public health emergencies in China: From
2003 to 2013. Chinese Journal of Health Policy. 2014;
7:24-29. (in Chinese)
U.S. Department of Health & Human Services. Strategic
National Stockpile. https://www.phe.gov/about/sns/
Pages/default.aspx (accessed February 4, 2020).
Government of Canada. National Emergency Strategic
Stockpile. https://www.canada.ca/en/public-health/
services/emergency-preparedness-response/nationalemergency-strategic-stockpile.html (accessed February 4,
2020)
The Department of Health of Australian Government.
National Medical Stockpile. https://www1.health.gov.
au/internet/main/publishing.nsf/Content/health-pubhlth-
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
P5
strateg-bio-factsht_stckpile.htm (accessed February 4,
2020)
Jiang XC, Gao XQ, Li WY. Discussion on the model
of an integrated emergency stockpile for public health
emergencies. Jiangsu Health Care. 2013; 15:36-37. (in
Chinese)
Wang LZ. Discussion on the mechanism of an
emergency medical stockpile for public health
emergencies in Guangzhou. Chinese Health Service
Management. 2010; 27(3:177-177. (in Chinese)
World Health Organization. WHO Director-General's
briefing to the Executive Board on outbreak of 2019
novel coronavirus. https://www.who.int/dg/speeches/
detail/who-director-general-s-briefing-to-the-executiveboard-on-outbreak-of-2019-novel-coronavirus (accessed
February 9, 2020).
Ministry of Industry and Information Technology of
People's Republic of China. Six departments report on
the state of key medical supplies and living supplies for
epidemic prevention and control. http://www.miit.gov.cn/
n1146290/n1146402/n7039597/c7662828/content.html
(accessed February 9, 2020) (in Chinese)
Ministry of Industry and Information Technology
of People's Republic of China. Six measures of the
Ministry of Industry and Information Technology to
meet demands for the epidemic prevention and control
stockpile. http://www.miit.gov.cn/n1146290/n1146402/
n7039597/c7644932/content.html (accessed February 9,
2020) (in Chinese)
Law Yearbook of China. Notice of the State Council
on Reforming and Enhancing the Management of the
Pharmaceutical Stockpile. http://www.pkulaw.cn/fulltext_
form.aspx?Db=qikan&gid=1510046077 (accessed
February4, 2020) (in Chinese)
The State Economic and Trade Commission. Provisions
for a National Pharmaceutical Stockpile. http://www.
ccdi.gov.cn/fgk/law_display/3502 (accessed February 4,
2020) (in Chinese)
National Health Commission of the People's Republic of
China. Regulations on Preparedness for and Responses
to Emergent Public Health Hazards. http://www.nhc.gov.
cn/wjw/flfg/200804/c0aef6fa264048b3b0af617e445144b
c.shtml (accessed February 4, 2020) (in Chinese)
The Central People's Government of the People's
Republic of China. The 2004 Revised Law of the
People's Republic of China on the Prevention and
Treatment of Infectious Diseases. http://www.gov.cn/
gongbao/content/2004/content_62975.htm (accessed
February 4, 2020) (in Chinese)
The Central People's Government of the People's
Republic of China. Master State Plan for a Rapid
Response to Public Emergencies. http://www.gov.cn/
yjgl/2006-01/08/content_21048.htm (accessed February
4, 2020) (in Chinese)
The Central People's Government of the People's
Republic of China. National Contingency Plan for Public
Health Emergencies. http://www.gov.cn/yjgl/2006-02/26/
content_211654.htm (accessed February 4, 2020) (in
Chinese)
National Health Commission of the People's Republic
of China. (Draft) Catalogue of health emergency
personnel and equipment. https://wenku.baidu.com/view/
b8261d33f111f18583d05aa6.html (accessed February 4,
2020) (in Chinese)
National Health Commission of the People's Republic
www.biosciencetrends.com
�P6
BioScience Trends Advance Publication
of China. Guidance on accelerating the creation and
development of a public health emergency system.
http://www.cqvip.com/QK/70161X/20108/664581203.
html (accessed February 4, 2020) (in Chinese)
29. National Health Commission of the People's Republic of
China. Issuance of Guiding Opinions on Enhancing the
Standardization and Devising of Responses to Healthrelated Emergencies. http://www.nhc.gov.cn/yjb/s785
9/201612/3a3b5ce97fa940c58a64ff1892f4b3e1.shtml
(accessed February 4, 2020) (in Chinese)
30. Esbitt D. The Strategic National Stockpile: Roles
and responsibilities of health care professionals
for receiving the stockpile assets. Disaster Manag
Response. 2003; 1:68-70.
Received February 1, 2020; Revised February 14, 2020;
Accepted February 16, 2020.
*Address correspondence to:
Jiangjiang He, Shanghai Health Development Research
Center (Shanghai Medical Information Center), No.1477
Beijing (W) Road, Jing'an District, Shanghai 200040, China.
E-mail: hejiangjiang@shdrc.org
Released online in J-STAGE as advance publication February
17, 2020.
www.biosciencetrends.com
�
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Wang, Xu, Xiaoxi Zhang, and Jiangjiang He. 2020. "Challenges to the system of reserve medical supplies for public health emergencies: reflections on the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in China." BioScience Trends advpub.
Abstract
On December 31, 2019, the Wuhan Municipal Health Commission announced an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), China is now at a critical period in the control of the epidemic. The Chinese Government has been taking a series of rapid, comprehensive, and effective prevention and control measures. As the pandemic has developed, a fact has become apparent: there is a serious dearth of emergency medical supplies, and especially an extreme shortage of personal protective equipment such as masks and medical protective clothing. This is one of the major factors affecting the progress of epidemic prevention and control. Although China has made great efforts to strengthen the ability to quickly respond to public health emergencies since the SARS outbreak in 2003 and it has clarified requirements for emergency supplies through legislation, the emergency reserve supplies program has not been effectively implemented, and there are also deficiencies in the types, quantity, and availability of emergency medical supplies. A sound system of emergency reserve supplies is crucial to the management of public health emergencies. Based on international experiences with pandemic control, the world should emphasize improving the system of emergency reserve medical supplies in the process of establishing and improving public health emergency response systems, and it should promote the establishment of international cooperative programs to jointly deal with public health emergencies of international concern in the future.
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URL
https://www.jstage.jst.go.jp/article/bst/advpub/0/advpub_2020.01043/_article
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https://doi.org/10.5582/bst.2020.01043
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Challenges to the system of reserve medical supplies for public health emergencies: reflections on the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in China
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Physical Infrastructure
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On December 31, 2019, the Wuhan Municipal Health Commission announced an outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), China is now at a critical period in the control of the epidemic.
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Wang, Xu, Xiaoxi Zhang, and Jiangjiang He.
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2020-03-15
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2022-01-10 by Shawn Gibbs
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2025-01-10 (3 years)
2019-nCoV
Coronavirus
COVID-19
Emergency Management
Gloves
Gown
Mask
Masks
N95
Occupational Health
Personal Protective Equipment (PPE)
R-PPE
SARS-CoV-2
-
https://repository.netecweb.org/files/original/19e8310b5ad109c07dae3616fe424160.pdf
7df2dbc16695c5b9716114ebff5efe93
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility One of
Ten: Inhalation and Exhalation Resistance and Filtration Efficiency
Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio, Kerri Wizner
March 1, 2020
NIOSH found that 344 of 344 N95
filtering facepiece respirators
stockpiled at Facility One that
were 8-11 years old maintained
their inhalation and exhalation
resistance and filtration
performance in accordance with
NIOSH performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages were reported and, during the 2016 Ebola
outbreak and the first U.S. fatality, there was a 10-200 fold increase in PPE orders [DHHS 2012; NIOSH 2018]. To
prepare for these shortages, large quantities of PPE are strategically stockpiled at hospital, local, state, and
federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report describes the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
APRs collected from Facility One of Ten. This facility is a state stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility One
•
NIOSH researchers visited Facility One in August 2017 (Figure 1). This facility was located within the U.S.
Department of Health and Human Services Region 2, representing New York, New Jersey, Puerto Rico,
and the Virgin Islands.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH documented storage practices at Facility One such as location and type of lighting,
pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH reviewed facility temperature and percent relative humidity (%RH) data provided by Facility One
stockpile personnel. This data was collected in 30-minute intervals from March 2014 to February 2017.
Collection of Respirator Samples
•
•
Facility One’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs).
Samples were collected from three different manufacturing models 1: 1) 3M 1860 (two different
manufacturing years); 2) Gerson 1730; and 3) Medline/Alpha ProTech (APT) NON27501 2 (Table 1).
Upon reviewing the detailed APR inventories and storage location by lot within Facility One, two
different manufacturing lots for each model were identified and sampled within Facility One. Two lots
Based on the other nine collaborating stockpiles’ inventories, these three models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
2
The FFR model NON27501 has been manufactured by Alpha ProTech as a private label to Medline under TC-84A-0457.
1
2
�•
were sampled to evaluate and attempt to account for inter-lot variation. Products were collected and
shipped to the NIOSH facility overnight to reduce exposure to non-climate-controlled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 3.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
•
Table 1 provides a summary of the respirator models sampled from Facility One.
Table 1. FFRs Sampled from Stockpile Facility One
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
3M 1860
3M 1860
3M 1860
3M 1860
Gerson 1730
Gerson 1730
Medline/APT
NON 27501
Medline/APT
NON27501
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
2009
2009
2008
2008
2006
2006
No
No
No
No
No
No
Lot A
2008
No
Lot B
2008
No
Respirator Age at
Time of Testing 4
8 years
9 years
11 years
9 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 5
Past 5-year shelf
life3
No shelf life
designated
No shelf life
designated
Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The Gerson 1730 and Medline/APT NON27501 controls were manufactured in 2017
and the 3M 1860 controls were manufactured in 2018. NIOSH testing requirements state that a
minimum of three respirator units must be tested for inhalation and exhalation resistance. The same
three respirators can be used for both inhalation and exhalation resistance testing [NIOSH 2018].
• Inhalation and exhalation resistance and filtration performance of the stockpiled and control
respirators were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for
approving respirators under 42 Code of Federal Regulations Part 84, “Approval of Respiratory
Protective Devices” [NIOSH 2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
•
•
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
4
Testing was completed in 2017.
5
In 2013, 3M designated a five-year shelf life for the 3M 1860 model [3M 2018]. As of February 2020, this model still has a
five-year shelf life.
3
3
�Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration
Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
36
35
35
35
40 7
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility One;
examples of the most amount of dust and damage to product packaging are shown in Figures 2 and 3.
Of the 344 respirators visually inspected, only one concern was noted, which was a slight deformation to
one Gerson 1730 respirator (Figure 4).
Figure 2: Most amount of dust observed on product cases from Facility One.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
7
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
6
4
�Figure 3: Most amount of product case damage observed from Facility One.
Figure 4: Most amount of product damage observed from Facility One.
•
•
Temperature was controlled; temperature and %RH were monitored. Facility lights were off when not in
use and no windows allowed sunlight to enter the facility. No evidence of excess moisture or chemical
spills that persisted beyond immediate mitigation were observed. Pallets were shrink wrapped around
the four pallet sides but not across the top or bottom. With the exception of the top-most row, pallets
were separated by racks. On the top-most row, pallets were stacked two-high causing some weight/load
to be applied to the bottom pallet.
Percent RH (Figure 5) and Temperature (Figure 6)
o At the time of publication, the recommended storage requirements for %RH and temperature
are
3M 1860: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
Gerson 1730: remain under 80 %RH; remain within -4°F to 95°F [Gerson 2019]
Medline/APT NON27501: avoid excessive moisture (water droplets or direct submersion
in water); avoid prolonged extreme temperatures (< 60°F and >80°F) [Alpha ProTech
2019]
o The average temperature between the 2014-2017 time period was 71.3°F. The average %RH
between 2014-2019 was 38.3%; these averages are within the 3M, Gerson, and APT
recommended temperature and %RH storage conditions.
o No %RH or temperature data points deviated from the recommended storage conditions for the
3M 1860, Medline/APT, or the Gerson 1730 respirator models.
5
�o
Some respirators from Facility One were previously stored and deployed from a federal SNS
facility. Although the current tracking process does not allow for retrieval of the historical
location(s) and environmental conditions for these sampled products, subsequent discussions
with SNS leadership suggest that SNS storage conditions met the recommended conditions.
6
�Figure 5: Percent Relative Humidity (% RH) from March 2014 – February 2017 for two data loggers stored at
Facility One. Data is plotted as a 50-point moving average for visualization purposes. Maximum and minimum
temperatures reported are noted for each data logger.
7
�Figure 6: Temperatures from March 2014 – February 2017 for two data loggers stored at Facility One. Data is
plotted as a 50-point moving average for visualization purposes. Maximum and minimum temperatures
reported are noted for each data logger.
8
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 24 stockpiled and 9 control
respirators. All stockpiled and control respirators from each model passed these tests (Figure 7).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for inhalation and exhalation
resistance when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) Gerson 1730 stockpiled Lot A had a statistically higher inhalation resistance; 2) Gerson 1730
stockpiled Lot A had a statistically higher exhalation resistance; and 3) Medline/APT NON27501
stockpiled Lot B had a statistically lower exhalation resistance. The mean inhalation and exhalation
resistances values are shown in Figure 7.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (11.93 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (11.43 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
9
�Figure 7: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data. N95 FFRs must have
an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than 25 mmH 2 O. The pass/fail
threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error bars represent the 99%
confidence interval and estimate the population parameters. This confidence interval suggests that 99% of any
repeated samples tested and evaluated from this lot will have a mean between the upper and lower bounds.
10
�Filtration Performance
•
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 320 stockpiled respirators and 60 controls. All
stockpiled and control respirators from each model passed this test (Figure 8).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for filtration when averaging across
models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) 3M 1860 stockpiled 2008 Lot A had a higher penetration; 2) 3M 1860 stockpiled 2009 Lot B
had a higher penetration; 3) Gerson 1730 stockpiled Lot B had a higher penetration; and 4) Medline/APT
NON27501 stockpiled Lot A and B had a statistically significantly lower penetration. The mean percent
particle penetration for each lot of respirators tested is shown in Figure 8.
The individual stockpiled respirator with the highest penetration (4.43%) was nearly identical to the
control respirator with the highest penetration (4.44%), with both being below the NIOSH maximum
limit for product approval (5.0% penetration allowable).
Additionally, the respirator shown in Figure 4 that had a visual inspection concern had a value of 1.00%
maximum penetration when tested and, therefore, was not the stockpiled respirator associated with the
highest penetration.
Figure 8: Control and stockpiled respirator particle filtration performance data. N95 FFRs must have a particle
penetration of less than 5.0%. Error bars represent the 99% confidence interval and estimate the population
parameters. This confidence interval suggests that 99% of any repeated samples tested and evaluated from this
lot will have a mean between the upper and lower bounds.
11
�CASE Findings
Findings for the Gerson 1730 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. No shelf
life was designated for this model by the approval holder. These findings pertain to Gerson 1730 units from
Facility One and may not be applicable to other stockpile facilities and/or under different environmental storage
conditions.
Findings for the 3M 1860 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a five-year shelf life; Appendix 1 shows a 3M letter to end users with shelf life and recommended
storage condition information [3M 2020]. Thus, these respirators tested are past their designated shelf life.
These findings pertain to 3M units from Facility One and may not be applicable to other stockpile facilities
and/or under different environmental storage conditions.
Findings for the Medline/Alpha ProTech NON27501 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. No shelf
life was designated for this model (Appendix 2, [Alpha ProTech, 2020]). These findings pertain to Medline/Alpha
ProTech units from Facility One and may not be applicable to other stockpile facilities and/or under different
environmental storage conditions.
Stockpile Storage Conditions:
The data made available by Facility One to the NIOSH research team suggests that all three respirator models
evaluated in this study were stored in an environment that was within the previously described
recommendations for %RH and temperature. Stored under these conditions, NIOSH found that the 344 N95
FFRs evaluated in this study, which were 8-11 years old, maintained their inhalation and exhalation resistance
and filtration performance (i.e., all respirators were below the NIOSH maximum limit as defined by 42 CFR Part
84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 8 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
8
An approval may be granted to a non-manufacturing entity.
12
�resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
13
�What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
14
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility One of Ten. By Greenawald, L., Moore, S., Yorio, P., and Wizner, K. Pittsburgh, PA U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
Alpha ProTech [2019] Alpha ProTech Customer Service Representative, email correspondence, October 1, 2019.
Alpha ProTech [2020] Shelf Life/Expiration Dating. (Appendix 2)
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
Gerson [2019]. Gerson Customer Service, email correspondence, October 1, 2019.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
15
�Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
16
�Appendix 1 [3M 2020]
17
�18
�19
�Appendix 2 [Alpha ProTech 2020]
20
�
https://repository.netecweb.org/files/original/536e8a45d9e9c455c4e3e8dca88d872e.pdf
4c6fc0583e6b7f7b9bbaf86e711c8f55
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Two of
Ten: Inhalation and Exhalation Resistance and Filtration Efficiency
Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 301 of 301
N95 filtering facepiece
respirators stockpiled at Facility
Two that were 8-11 years old
maintained their inhalation and
exhalation resistance and
filtration performance in
accordance with NIOSH
performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages
were reported and, during the 2016 Ebola outbreak and the first U.S. fatality, there was a 10-200 fold increase in
PPE orders [DHHS 2012; NIOSH 2018]. To prepare for these shortages, large quantities of PPE are strategically
stockpiled at hospital, local, state, and federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
APRs collected from Facility Two of Ten. This facility is a state stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Two
•
NIOSH researchers visited Facility Two in November 2017 (Figure 1). This facility was located within the
U.S. Department of Health and Human Services Region 2, representing New York, New Jersey, Puerto
Rico, and the Virgin Islands.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Two such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH reviewed facility temperature and percent relative humidity (%RH) data provided by Facility Two
stockpile personnel. This data was collected in 30-minute intervals from September 2013 to August
2016.
Collection of Respirator Samples
•
•
NIOSH collected samples for three APR models stockpiled at Facility Two. Facility Two’s inventory
included APRs that are classified as N95 filtering facepiece respirators (FFRs). Samples were collected
from two different manufacturing models 1: 1) 3M 1860 (three different manufacturing years) and 2)
Gerson 1730 (one manufacturing year) (Table 1).
Upon reviewing the detailed APR inventories and storage location by lot within Facility Two, two
different manufacturing lots for each model were identified and sampled within Facility Two. Two lots
Based on the other nine collaborating stockpiles’ inventories, these two models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
1
2
�•
were sampled to evaluate and attempt to account for inter-lot variation. Products were sampled and
shipped to the NIOSH facility overnight to reduce exposure to non-climate-controlled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
Table 1 provides a summary of the respirator models sampled from Facility Two.
Table 1. FFRs Sampled from Stockpile Facility Two
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
3M 1860
3M 1860
3M 1860
3M 1860
3M 1860
3M 1860
Gerson 1730
Gerson 1730
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
2006
2006
2008
2008
2009
2009
2006
2006
No
No
No
No
No
No
No
No
Respirator Age at
Time of Testing 3
11 years
9 years
8 years
11 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
Past 5-year shelf
life4
No shelf life
designated
Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
•
•
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The Gerson 1730 controls were manufactured in 2017 and the 3M 1860 controls were
manufactured in 2018. NIOSH testing requirements state that a minimum of three respirator units must
be tested for inhalation and exhalation resistance. The same three respirators can be used for both
inhalation and exhalation resistance testing [NIOSH 2018].
Inhalation and exhalation resistance and filtration performance of the stockpiled and control respirators
were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for approving respirators
under 42 Code of Federal Regulations Part 84, “Approval of Respiratory Protective Devices” [NIOSH
2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
3
Testing was completed in 2017.
4
In 2013, 3M designated a five-year shelf life for the 3M 1860 model [3M 2018]. As of February 2020, this model still has a
five-year shelf life.
2
3
�Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration
Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
35
35
35
35
40 6
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility Two;
examples of the most amount of dust and damage to product packaging are shown in Figures 2 and 3.
Of the 301 respirators visually inspected, twelve concerns were noted which involved respirator nose
foam sticking to adjacent units for the 3M 1860 model (Figure 4).
Figure 2: Most amount of dust observed on product cases from Facility Two.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
6
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
5
4
�Figure 3: Most amount of product case damage observed from Facility Two.
Figure 4: Most amount of product damage observed from Facility Two.
•
•
Facility Two shared the warehouse space with another entity. On Facility Two’s side, facility lights were
off when not in use and no windows allowed sunlight to enter the facility. Stockpile personnel noted
that although temperature and %RH are monitored, there is no air-conditioning, but fans exist and
circulate air throughout the facility. No evidence of excess moisture or chemical spills that persisted
beyond immediate mitigation were observed. Generally, the pallets were shrink wrapped around the
four pallet sides but not across the top or bottom. Pallets were separated by metal racks, preventing
weight/load applied to individual pallets.
Percent RH (Figure 5) and Temperature (Figure 6)
o At the time of publication, the recommended storage requirements for %RH and temperature
are
3M 1860: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
Gerson 1730: remain under 80 %RH; remain within -4°F to 95°F [Gerson 2019]
o The average temperature between the 2013-2016 time period was 73.3°F. The average %RH
between 2013-2016 was 40.4%; these averages are within the 3M and Gerson recommended
temperature and %RH storage conditions.
o No %RH or temperature data points deviated from the recommended storage conditions for the
3M 1860 or the Gerson 1730 respirator models.
5
�o
Some respirators from Facility Two were previously stored and deployed from a federal SNS
facility. Although the current tracking process does not allow for retrieval of the historical
location(s) and environmental conditions for these sampled products, subsequent discussions
with SNS leadership suggest that SNS storage conditions met recommended conditions.
6
�Figure 5: Percent Relative Humidity (% RH) from September 2013 – June 2016 for two data loggers stored at
Facility Two. Data is plotted as a 50-point moving average for visualization purposes. Maximum and minimum
temperatures reported are noted for each data logger.
7
�Figure 6: Temperatures from September 2013 – June 2016 for two data loggers stored at Facility Two. Data is
plotted as a 50-point moving average for visualization purposes. Maximum and minimum temperatures
reported are noted for each data logger.
8
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 21 stockpiled and 6 control
respirators. All stockpiled and control respirators from each model passed these tests (Figure 7).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for inhalation and exhalation
resistance when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the Gerson 1730 stockpiled 2008 Lot A was statistically
significantly higher for both inhalation and exhalation resistance. The mean inhalation and exhalation
resistance values are shown in Figure 7.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (10.40 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (9.63 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
9
�Figure 7: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data. N95 FFRs must have
an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than 25 mmH 2 O. The pass/fail
threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error bars represent the 99%
confidence interval and estimate the population parameters. This confidence interval suggests that 99% of any
repeated samples tested and evaluated from this lot will have a mean between the upper and lower bounds.
10
�Filtration Performance
•
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 280 stockpiled respirators and 40 controls. All
stockpiled and control respirators from each model passed this test (Figure 8).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for filtration when averaging across
models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) 3M 1860 stockpiled 2006 Lot A had a higher penetration; 2) 3M 1860 stockpiled 2008 Lot A
had a higher penetration; 3) 3M 1860 stockpiled 2008 Lot B had a lower penetration; 4) 3M 1860
stockpiled 2009 Lot B had a lower penetration; and 5) Gerson 1730 stockpiled 2008 Lot A had a higher
penetration. The mean percent particle penetration for each lot of respirators tested is shown in Figure
8.
None of the individual respirators tested exceeded the 5.0% maximum. The highest penetration for an
individual stockpiled respirator was 2.82% and the highest penetration for an individual control
respirator was 1.59%, both being below the NIOSH maximum limit for product approval.
Additionally, the respirator shown in Figure 4 is an example of one of 12 respirators where the nose
foam stuck together. The highest maximum penetration when these units were tested was 1.61%, and,
therefore, was not the stockpiled respirator associated with the highest penetration.
Figure 8: Control and stockpiled respirator particle filtration performance data. N95 FFRs must have a particle
penetration of less than 5.0%. Error bars represent the 99% confidence interval and estimate the population
parameters. This confidence interval suggests that 99% of any repeated samples tested and evaluated from this
lot will have a mean between the upper and lower bounds.
11
�CASE Findings
Findings for the Gerson 1730 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. No shelf
life was designated for this model by the approval holder. These findings pertain to Gerson 1730 units from
Facility Two and may not be applicable to other stockpile facilities and/or under different environmental storage
conditions.
Findings for the 3M 1860 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a five-year designated shelf life; the Appendix shows a 3M letter to end users with shelf life and
recommended storage condition information [3M 2020]. Thus, these respirators tested are past their designated
shelf life. These findings pertain to 3M units from Facility Two and may not be applicable to other stockpile
facilities and/or under different environmental storage conditions.
Stockpile Storage Conditions:
The data made available by Facility Two to the NIOSH research team suggests that both respirator models
evaluated in this study were stored in an environment that was within the previously described
recommendations for %RH and temperature. Stored under these conditions, NIOSH found that the 301 N95
FFRs evaluated in this study, which were 8-11 years old, maintained their inhalation and exhalation resistance
and filtration performance (i.e., all respirators were below the NIOSH maximum limit as defined by 42 CFR Part
84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 7 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
7
An approval may be granted to a non-manufacturing entity.
12
�recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the manufacturer- designated shelf life.
What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
13
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Two of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
Gerson [2019] Gerson Customer Service, email correspondence, October 1, 2019.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
14
�Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
15
�Appendix [3M 2020]
16
�17
�18
�
https://repository.netecweb.org/files/original/33b1087f89f805f43f26e2736e0c2fb1.pdf
4fb20b7e3f83bb778d8170c51a39f4c8
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Three
of Ten: Inhalation and Exhalation Resistance and Filtration
Efficiency Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 256 of 258 N95
filtering facepiece respirators
stockpiled at Facility Three that
were 8-11 years old maintained
their inhalation and exhalation
resistance and filtration
performance in accordance with
NIOSH performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages were reported and, during the 2016 Ebola
outbreak and the first U.S. fatality, there was a 10-200 fold increase in PPE orders [DHHS 2012; NIOSH 2018]. To
prepare for these shortages, large quantities of PPE are strategically stockpiled at hospital, local, state, and
federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
APRs collected from Facility Three of Ten. This facility is a county stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Three
•
NIOSH researchers visited Facility Three in December 2017 (Figure 1). This facility was located within the
U.S. Department of Health and Human Services Region 4, representing Alabama, Florida, Georgia,
Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Three such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH collected facility temperature and percent relative humidity (%RH) data by placing two data
loggers in the facility: Data Logger 1 was placed in a non-climate controlled room adjacent to where the
respirators used to be stored. Data Logger 2 was placed in the storage room where the respirators are
currently stored; this room is only recently temperature-controlled, thus the majority of the respirator’s
storage life within Facility Three has been under non-climate controlled conditions, represented by Data
Logger 1. This data was collected in 60-minute intervals from October 2017 to November 2018 (Data
Logger 1) and January 2018 to January 2019 (Data Logger 2). Data Logger 2 was placed after Data Logger
1 as a result of a decision to collect environmental conditions in the storage room.
2
�Collection of Respirator Samples
•
•
•
Facility Three’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs).
NIOSH collected samples for two APR models stockpiled at this location 1: 1) 3M 1860 (two different
manufacturing years) and 2) Kimberly Clark (KC) 46827 (one manufacturing year) (Table 1).
A detailed APR inventory was not available for Facility Three. two different manufacturing lots for each
model were identified and sampled within Facility Three. Two lots were sampled to evaluate and
attempt to account for inter-lot variation. Products were sampled and shipped to the NIOSH facility
overnight to reduce exposure to non-climate-controlled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
•
Table 1 provides a summary of the respirator models sampled from Facility Three.
Table 1. FFRs Sampled from Stockpile Facility Three
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
3M 1860
3M 1860
3M 1860
3M 1860
KC 46727
KC 46727
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
2006
2006
2009
2009
2006
2006
No
No
No
No
No
No
Respirator Age at
Time of Testing 3
11 years
8 years
11 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
Past 5-year shelf
life 5
Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The KC 46827 controls were manufactured in 2017 and the 3M 1860 controls were
manufactured in 2018. NIOSH testing requirements state that a minimum of three respirator units must
be tested for inhalation and exhalation resistance. The same three respirators can be used for both
inhalation and exhalation resistance testing [NIOSH 2018].
Based on the other nine collaborating stockpiles’ inventories, these three models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
2
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
3
Testing was completed in 2017.
4
In 2013, 3M designated a five-year shelf life for the 3M 1860 model [3M 2018]. As of February 2020, this model still has a
five-year shelf life.
5
In 2014, KC designated a five-year shelf life for the KC 46727 model [KC 2018]. As of February 2020, this model still has a
five-year shelf life.
1
3
�•
•
Inhalation and exhalation resistance and filtration performance of the stockpiled and control respirators
were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for approving respirators
under 42 Code of Federal Regulations Part 84, “Approval of Respiratory Protective Devices” [NIOSH
2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration
Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
36
36
36
36
40 7
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility
Three. Product boxes were outside of the original packaging (i.e. case; Figure 2A), and product cases
were open (Figure 2B). Five boxes had damage (Figure 3). Of the 258 respirators visually inspected, only
one concern was noted, which was damage to the metal nose bridge (Figure 4).
Figure 2: Product boxes outside of product cases (A) and product cases open (B) in Facility Three
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
7
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
6
4
�Figure 3: Slight damage to product boxes from Facility Three
Figure 4: Most amount of product damage observed from Facility Three (the respirator is affixed to a test plate
via beeswax).
•
•
Facility lights were off when not in use and no windows allowed sunlight to enter the facility. Some
moisture damage was observed on the ceiling, but not directly above the respirator products. Products
were stored in—or on top of—Rubbermaid containers.
Percent RH (Figure 5) and Temperature (Figure 6)
o At the time of publication, the recommended storage requirements for %RH and temperature
are
3M 1860: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
KC 46727: remain under 60 %RH; remain within 68°F to 77°F [KC 2020]
5
�o
o
o
o
The average temperature for Data Loggers 1 and 2 were 67.8°F and 75.0°F, respectively. The
average %RH for Data Loggers 1 and 2 were 54.7% and 40.2%, respectively. These averages are
within the 3M and KC recommended temperature and %RH storage conditions.
Data Logger 1 (representing historical climate conditions for the products sampled): For the 3M
1860 model, no temperature data points deviated from the recommended storage conditions.
For the KC 46727 respirator model, 53% of data points were below 68°F and 38% were above
77°F. For %RH, 1.5% of data points deviated from 3M’s recommended storage conditions, and
46% of data points deviated from KC’s recommended conditions.
Data Logger 2 (representing current climate conditions for the products sampled): For the 3M
model, no temperature data points deviated from the recommended storage conditions. For the
KC 46727 respirator model, 8% of data points were below 68°F and 23% of data points were
above 77°F. For %RH, 11.5% of data points deviated from 3M’s recommended storage
conditions, and 12% of data points deviated from KC’s recommended conditions.
Some respirators from Facility Three may have been previously stored and deployed from a
federal SNS facility. Although the current tracking process does not allow for retrieval of the
historical location(s) and environmental conditions for these sampled products, subsequent
discussions with SNS leadership suggest that SNS storage conditions met the recommended
conditions.
6
�Figure 5: Percent relative humidity (%RH) from October 2017 – January 2019 (Data Logger 1) and January 2018 –
January 2019 (Data Logger 2) stored at Facility Three. Data is plotted as a 50-point moving average for
visualization purposes. Maximum and minimum temperatures reported are noted for each data logger.
7
�Figure 6: Temperatures from October 2017 – January 2019 (Data Logger 1) and January 2018 – January 2019
(Data Logger 2) stored at Facility Three. Data is plotted as a 50-point moving average for visualization purposes.
Maximum and minimum temperatures reported are noted for each data logger.
8
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 18 stockpiled and 6 control
respirators. All stockpiled and control respirators from each model passed these tests (Figure 7).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for inhalation and exhalation
resistance when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, there were no statistically significant differences detected. The
mean inhalation and exhalation resistance values are shown in Figure 7.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (12.19 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (10.40 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
9
�Figure 7: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data. N95 FFRs must have
an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than 25 mmH 2 O. The pass/fail
threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error bars represent the 99%
confidence interval and estimate the population parameters. This confidence interval suggests that 99% of any
repeated samples tested and evaluated from this lot will have a mean between the upper and lower bounds.
10
�Filtration Performance
•
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 240 stockpiled respirators and 40 controls.
Two individual 3M 1860 stockpiled respirators tested exceeded the 5.0% maximum. These respirators
were from two different production lots: one respirator was manufactured in 2006, and the second
respirator was manufactured in 2009. The highest penetration for an individual stockpiled respirator
was 11.00% (3M 1860) and the highest penetration for an individual control respirator was 4.93% (KC
46727).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for filtration when averaging across
models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) 3M 1860 stockpiled 2006 Lot B had a higher penetration; and 2) 3M 1860 stockpiled 2009
Lot A had a higher penetration. The mean percent particle penetration for each lot of respirators tested
is shown in Figure 8.
Additionally, the respirator shown in Figure 4 that had a visual inspection concern had a value of 3.10%
maximum penetration when tested and, therefore, was not the stockpiled respirator associated with the
highest penetration.
Figure 8: Control and stockpiled respirator particle filtration performance data. N95 FFRs must have a particle
penetration of less than 5.0%. Error bars represent the 99% confidence interval and estimate the population
parameters. This confidence interval suggests that 99% of any repeated samples tested and evaluated from this
lot will have a mean between the upper and lower bounds.
11
�CASE Findings
Findings for the KC 46727 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a five-year recommended shelf life; Appendix 1 shows a KC letter to end users with shelf life
information [KC 2018]. Thus, these respirators tested are past their recommended shelf life. These findings
pertain to KC units from Facility Three and may not be applicable to other stockpile facilities and/or under
different environmental storage conditions.
Findings for the 3M 1860 Model:
No failures for inhalation resistance or exhalation resistance were observed; two failures for filtration
performance were observed, where these two respirators came from two different lots. This model currently
has a five-year recommended shelf life; the Appendix 2 shows a 3M letter to end users with shelf life and
recommended storage condition information [3M 2018, 3M 2020]. Thus, these respirators tested are past their
recommended shelf life. These findings pertain to 3M units from Facility Three and may not be applicable to
other stockpile facilities and/or under different environmental storage conditions.
Stockpile Storage Conditions:
No temperature data points deviated from recommended storage conditions for the 3M model, but did for the
KC model. %RH data points deviated from both 3M and KC’s recommended storage conditions as recorded by
both data loggers (representing historical and current climate conditions for the respirators). Stored under these
conditions, NIOSH found that 256 of the 258 N95 FFRs evaluated in this study, which were 8-11 years old,
maintained their inhalation and exhalation resistance and filtration performance (i.e. 99% of tested respirators
from Facility Three were below the NIOSH maximum limit as defined by 42 CFR Part 84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 8 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
8
An approval may be granted to a non-manufacturing entity.
12
�not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
13
�What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
14
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Three of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
KC [2018]. Kimberly Clark Letter to Customers (Appendix 1).
KC [2020]. Kimberly Clark representatives, email correspondence, February 25, 2020.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
15
�Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
16
�Appendix 1 [KC 2018]
17
�Appendix 2 [3M 2020]
18
�19
�20
�
https://repository.netecweb.org/files/original/5c39b84c6ae04b143d6c742e0cbece87.pdf
0368ee80811e8e794699bfd2b804bc06
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Four
of Ten: Inhalation and Exhalation Resistance and Filtration
Efficiency Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 540 of 574
N95 filtering facepiece
respirators and P95 filters
stockpiled at Facility Four that
were 8-12 years old maintained
their inhalation and exhalation
resistance and filtration
performance in accordance with
NIOSH performance standards.
In the event of a national emergency, eighteen million U.S.
healthcare workers may face high-consequence infectious disease
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For example, during the 2009 H1N1 pandemic,
local respirator shortages were reported and, during the 2016 Ebola outbreak and the first U.S. fatality, there
was a 10-200 fold increase in PPE orders [DHHS 2012; NIOSH 2018]. To prepare for these shortages, large
quantities of PPE are strategically stockpiled at hospital, local, state, and federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled air-purifying respirators. NIOSH
obtained samples of PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
respirators and P95 filters collected from Facility Four of Ten. This facility is a state stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Four
•
NIOSH researchers visited Facility Four in March 2018 (Figure 1). This facility was located within the U.S.
Department of Health and Human Services Region 9, representing Arizona, California, Hawaii and
Nevada.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Four such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH collected facility temperature and percent relative humidity (%RH) data by placing two data
loggers in the facility. This data was collected in 60-minute intervals from October 2017 to November
2018.
2
�Collection of Respirator Samples
•
•
•
Facility Four’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs), as
well as one P95 filter cartridge model. Samples were collected from six different manufacturing models 1:
1) 3M 1860 (two different manufacturing years); 2) 3M 1870; 3) 3M 8210; 4) 3M 9010; 5) 3M 2071; and
6) Kimberly Clark (KC) 46827 (Table 1).
Upon reviewing the detailed APR inventories and storage location by lot within Facility Four, two
different manufacturing lots for each model were identified and sampled within Facility Four. Two lots
were sampled to evaluate and attempt to account for inter-lot variation. More than two lots were
sampled from a model if conditions presented “worst-case scenario” conditions within the facility.
Products were sampled and shipped to the NIOSH facility overnight to reduce exposure to non-climatecontrolled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
•
Table 1 provides a summary of the respirator models sampled from Facility Four.
Based on the other nine collaborating stockpiles’ inventories, these six models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
2
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
1
3
�Table 1. APRs Sampled from Stockpile Facility Four
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
Respirator Age at
Time of Testing 3
3M 1860
Lot A
2006
No
12 years
3M 1860
3M 1860
3M 1870
3M 1870
3M 8210
3M 8210
3M 9010
3M 9010
3M 2071
3M 2071
KC 46827
KC 46827
KC 46827
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot C
2010
2010
2010
2010
2006
2006
2006
2006
2006
2006
2007
2007
2007
No
No
No
No
No
No
No
No
No
No
No
No
No
8 years
8 years
12 years
12 years
12 years
11 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life 5
Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
•
•
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The 3M 1860 and 3M 2071 controls were manufactured in 2018, the 3M 8210
controls were manufactured in 2015, the 3M 1870 controls were manufactured in 2014, the 3M
9010 controls were purchased in 2018 but have an unknown manufacturing date, and the KC 46827
controls were manufactured in 2017. NIOSH testing requirements state that a minimum of three
respirator units must be tested for inhalation and exhalation resistance. The same three respirators
can be used for both inhalation and exhalation resistance testing [NIOSH 2018].
Inhalation and exhalation resistance and filtration performance of the stockpiled and control
respirators were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for
approving respirators under 42 Code of Federal Regulations Part 84, “Approval of Respiratory
Protective Devices” [NIOSH 2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
Testing was completed in 2018.
3M designated a five-year shelf life for these models [3M 2018]. As of February 2020, these models still have a five-year
shelf life.
5
KC designated a five-year shelf life for this model [KC 2018]. As of February 2020, this model still has a five-year shelf life.
3
4
4
�Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration
Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 53: Liquid Particulate Filter
Efficiency for P95
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
36
36
36
36
40 7
20
407
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility Four;
examples of the most amount of dust and damage to product packaging are shown in Figures 2, 3, and
4. Nine boxes shown minor damage. Of the 574 respirators visually inspected, no concerns were noted.
Figure 2: Most amount of dust observed on product cases from Facility Four.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
7
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
6
5
�Figure 3: Most amount of product case damage observed from Facility Four.
Figure 4: Most amount of product box damage observed from Facility Four.
•
•
Facility lights were off when not in use. Small ceiling vents allowed sunlight to enter the facility in
specific locations on the top pallet. No evidence of excess moisture or chemical spills that persisted
beyond immediate mitigation were observed. Pallets were generally shrink wrapped around the four
pallet sides but not across the top or bottom. With the exception of the top-most row, pallets were
stacked two-high causing some weight/load to be applied to the bottom pallet.
Percent RH (Figure 5) and Temperature (Figure 6)
o At the time of publication, the recommended storage requirements for %RH and temperature
are
3M 1860, 3M 1870, 3M 8210, 3M 9010, and 3M 2071: remain under 80 %RH; remain
within -4°F to 86°F [3M 2017]
KC 46827: remain under 60 %RH; remain within 68°F to 77°F [KC 2020]
o Data was aggregated across the two data loggers. The average temperature between the 20172018 time period was 67.0°F. The average %RH between 2017-2018 was 49.6%; the average
temperature is within the 3M recommended temperature but deviates for the KC
recommended temperature. The average %RH meets both 3M and KC’s recommended %RH
storage conditions.
o For the 3M models, 0.02% of the total temperature data points deviated from the
recommended storage conditions. For the KC 46827 model, 62.0% of data points were below
6
�68°F and 4.4% were above 77°F. For %RH, no data points deviated from 3M’s recommended
storage conditions, and 25.8% of data points deviated from KC’s recommended conditions.
7
�Figure 5: Percent Relative Humidity (% RH) from October 2017 – November 2018 for two data loggers stored at
Facility Four. Data is plotted as a 50-point moving average for visualization purposes. Maximum and minimum
temperatures reported are noted for each data logger.
8
�Figure 6: Temperatures from October 2017 – November 2018 for two data loggers stored at Facility Four. Data is
plotted as a 50-point moving average for visualization purposes. Maximum and minimum temperatures
reported are noted for each data logger.
9
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 39 stockpiled and 18 control
respirators. All stockpiled and control respirators from each model passed these tests. The 3M 1860,
3M 1870, 3M 9210, and 3M 9010 data are shown in Figure 7. The 3M 2071 (P95 filter cartridge) data is
shown in Figure 8. The KC 46827 data is shown in Figure 9.
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the controls and stockpiled respirators for inhalation and exhalation resistance when
averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the 3M 1870 stockpiled 2006 Lot B displayed significantly
lower inhalation and exhalation resistance when compared to the control.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (17.02 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (14.22 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
10
�Figure 7: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data for the 3M 1860, 3M
1870, 3M 8210, and 3M 9010 models. N95 FFRs must have an inhalation resistance less than 35 mmH 2 O and an
exhalation resistance less than 25 mmH 2 O. The pass/fail threshold for inhalation (A) and exhalation (B)
resistance is shown by the red line. Error bars represent the 99% confidence interval and estimate the
population parameters. This confidence interval suggests that 99% of any repeated samples tested and
evaluated from this lot will have a mean between the upper and lower bounds.
11
�Figure 8: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data for the 3M 2071
model. P95 filters must have an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than
25 mmH 2 O. The pass/fail threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error
bars represent the 99% confidence interval and estimate the population parameters. This confidence interval
suggests that 99% of any repeated samples tested and evaluated from this lot will have a mean between the
upper and lower bounds.
12
�Figure 9: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data for the KC 46827
model. N95 FFRs must have an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than
25 mmH 2 O. The pass/fail threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error
bars represent the 99% confidence interval and estimate the population parameters. This confidence interval
suggests that 99% of any repeated samples tested and evaluated from this lot will have a mean between the
upper and lower bounds.
13
�Filtration Performance
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 535 stockpiled respirators and 120 controls.
The 3M 1860, 3M 1870, 3M 9210, and 3M 9010 data are shown in Figure 10. The 3M 2071 (P95 filter)
data is shown in Figure 11. The KC 46827 data is shown in Figure 12.
34 individual stockpiled respirators—all KC 46827—exceeded the 5.0% maximum. Twenty-five failing
units came from one production lot while the remaining 9 came from a second lot, both manufactured
in 2007. The third lot tested did not show any failures. The highest penetration for an individual KC
46827 stockpiled respirator was 8.90% and the highest penetration for an individual KC 46827 control
respirator was 2.84%.
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the 3M controls and 3M stockpiled respirators for filtration when averaging across
models. There was a statistically significant difference between the KC controls (mean percent
penetration=1.77%, SD=0.45) and KC stockpiled respirators (mean percent penetration=4.36%,
SD=1.44), p<0.001.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) 3M 1860 stockpiled 2006 Lot A had a higher penetration; 2) 3M 1860 stockpiled 2010 Lot B
had a higher penetration; 3) both 3M 1870 stockpiled 2010 Lots A and B had a higher penetration; 4) 3M
8210 stockpiled 2006 Lot A had a lower penetration; 5) all three KC 46827 stockpiled 2007 lots had a
higher penetration; and 6) 3M 2071 stockpiled 2006 Lot B had a higher penetration.
14
�Figure 10: Control and stockpiled respirator particle filtration performance data for the 3M 1860, 3M 1870, 3M
8210, and 3M 9010 models. N95 FFRs must have a particle penetration of less than 5.0%. Error bars represent
the 99% confidence interval and estimate the population parameters. This confidence interval suggests that 99%
of any repeated samples tested and evaluated from this lot will have a mean between the upper and lower
bounds.
15
�Figure 11: Control and stockpiled respirator particle filtration performance data for the 3M 2071 model. P95
filters must have a liquid particle penetration of less than 5.0%. Error bars represent the 99% confidence interval
and estimate the population parameters. This confidence interval suggests that 99% of any repeated samples
tested and evaluated from this lot will have a mean between the upper and lower bounds.
Figure 12: Control and stockpiled respirator particle filtration performance data for the KC 46827 model. N95
FFRs must have a particle penetration of less than 5.0%. Error bars represent the 99% confidence interval and
estimate the population parameters. This confidence interval suggests that 99% of any repeated samples tested
and evaluated from this lot will have a mean between the upper and lower bounds.
16
�CASE Findings
Findings for the KC 46827 Model:
No failures for inhalation resistance or exhalation resistance were observed; 34 failures for filtration
performance were observed. Twenty-five failing units came from one production lot while the remaining 9
came from a second lot, both manufactured in 2007. This model currently has a five-year shelf life; Appendix 1
shows a KC letter to end users with shelf life information, which states respirators past their shelf life should be
discarded [KC 2018]. Thus, these respirators tested are past their recommended shelf life. These findings pertain
to KC units from Facility Four and may not be applicable to other stockpile facilities and/or under different
environmental storage conditions.
Findings for the 3M 1860, 3M 1870, 3M 8210, 3M 9010, and 3M 2071 Models:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. These five
models currently have a five-year recommended shelf life; Appendix 2 shows two 3M letters to end users with
shelf life and recommended storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are
past their recommended shelf life. These findings pertain to 3M units from Facility Four and may not be
applicable to other stockpile facilities and/or under different environmental storage conditions.
Stockpile Storage Conditions:
For the 3M models, 0.02% of the total temperature data points deviated from the recommended storage
conditions. For the KC 46827 model, 62% of the temperature data points deviated from the recommended
storage conditions. For %RH, no data points deviated from 3M’s recommended storage conditions, and 26% of
data points deviated from KC’s recommended conditions. Stored under these conditions, NIOSH found that 540
of the 574 APRs evaluated in this study, which were 8-12 years old, maintained their inhalation and exhalation
resistance and filtration performance (i.e. 94% of the sampled respirators were below the NIOSH maximum limit
as defined by 42 CFR Part 84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 8 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
8
An approval may be granted to a non-manufacturing entity.
17
�conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
18
�What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
19
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Four of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
KC [2018]. Kimberly Clark Letter to Customers (Appendix 1).
KC [2020]. Kimberly Clark representatives, email correspondence, February 25, 2020.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
20
�Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
21
�Appendix 1 [KC 2018]
22
�Appendix 2 [3M 2018], [3M 2020]
23
�24
�25
�26
�27
�
https://repository.netecweb.org/files/original/652b30d7817d8cddcba8b46944920892.pdf
ae85d84f230a14b0edbc456bf4cef83c
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Five of
Ten: Inhalation and Exhalation Resistance and Filtration Efficiency
Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 602 of 602 N95
filtering facepiece respirators and
P95 filters stockpiled at Facility
Five that were 8-12 years old
maintained their inhalation and
exhalation resistance and
filtration performance in
accordance with NIOSH
performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages
were reported and, during the 2016 Ebola outbreak and the first U.S. fatality, there was a 10-200 fold increase in
PPE orders [DHHS 2012; NIOSH 2018]. To prepare for these shortages, large quantities of PPE are strategically
stockpiled at hospital, local, state, and federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
respirators and P95 filters collected from Facility Five of Ten. This facility is a state stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Five
•
NIOSH researchers visited Facility Five in March 2018 (Figure 1). This facility was located within the U.S.
Department of Health and Human Services Region 9, representing Arizona, California, Hawaii and
Nevada.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Five such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH collected facility temperature and percent relative humidity (%RH) data by placing two data
loggers in the facility. This data was collected in 60-minute intervals from October 2017 to October
2018.
2
�Collection of Respirator Samples
•
•
•
Facility Five’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs), as
well as one P95 filter cartridge model. Samples were collected from six different manufacturing models 1:
1) 3M 1860 (two different manufacturing years); 2) 3M 1870; 3) 3M 8210; 4) 3M 9010; 5) 3M 2071; and
6) Kimberly Clark (KC) 46827 (Table 1).
Upon reviewing the detailed APR inventories and storage location by lot within Facility Five, two
different manufacturing lots for each model were identified and sampled within Facility Five. Two lots
were sampled to evaluate and attempt to account for inter-lot variation. More than two lots were
sampled from a model if conditions presented “worst-case scenario” conditions within the facility.
Products were sampled and shipped to the NIOSH facility overnight to reduce exposure to non-climatecontrolled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
•
Table 1 provides a summary of the respirator models sampled from Facility Five.
Based on the other nine collaborating stockpiles’ inventories, these six models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
2
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
1
3
�Table 1. APRs Sampled from Stockpile Facility Five
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
3M 1860
3M 1860
3M 1860
3M 1860
3M 1870
3M 1870
3M 8210
3M 8210
3M 9010
3M 9010
3M 2071
3M 2071
KC 46827
KC 46827
Lot A
Lot A
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
2007
2007
2010
2010
2011
2011
2006
2006
2006
2006
2006
2006
2006
2006
No
No
No
No
No
No
No
No
No
No
No
No
No
No
Respirator Age at
Time of Testing 3
11 years
8 years
7 years
12 years
12 years
12 years
12 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life 5
Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
•
•
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The 3M 1860 and 3M 2071 controls were manufactured in 2018, the 3M 8210
controls were manufactured in 2015, the 3M 1870 controls were manufactured in 2014, the 3M
9010 controls were purchased in 2018 but have an unknown manufacturing date, and the KC 46827
controls were manufactured in 2017. NIOSH testing requirements state that a minimum of three
respirator units must be tested for inhalation and exhalation resistance. The same three respirators
can be used for both inhalation and exhalation resistance testing [NIOSH 2018].
Inhalation and exhalation resistance and filtration performance of the stockpiled and control
respirators were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for
approving respirators under 42 Code of Federal Regulations Part 84, “Approval of Respiratory
Protective Devices” [NIOSH 2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
Testing was completed in 2018.
3M designated a five-year shelf life for these models [3M 2018]. As of February 2020, these models still have a five-year
shelf life.
5
KC designated a five-year shelf life for this model [KC 2018]. As of February 2020, this model still has a five-year shelf life.
3
4
4
�Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration
Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 53: Liquid Particulate Filter
Efficiency for P95
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
36
36
36
36
40 7
20
407
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility Five;
examples of the most amount of dust and damage to product packaging are shown in Figures 2 and 3.
No product boxes showed damage. Of the 602 respirators visually inspected, no concerns were noted.
Figure 2: Most amount of dust observed on product cases from Facility Five.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
7
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
6
5
�Figure 3: Most amount of product case damage observed from Facility Five.
•
•
Temperature nor %RH were controlled. Facility lights were off when not in use. A skylight allowed
sunlight to enter the facility in specific places, including indirectly onto pallets storing respirators. No
evidence of excess moisture or chemical spills that persisted beyond immediate mitigation were
observed. Pallets were generally shrink wrapped around the four pallet sides but not across the top or
bottom. Generally, all pallets were stacked three (or more) high causing some weight/load to be applied
to the bottom pallet.
Percent RH (Figure 4) and Temperature (Figure 5)
o At the time of publication, the recommended storage requirements for %RH and temperature
are
3M 1860, 3M 1870, 3M 8210, 3M 9010, and 3M 2071: remain under 80 %RH; remain
within -4°F to 86°F [3M 2017]
KC 46827: remain under 60 %RH; remain within 68°F to 77°F [KC 2020]
o Data was aggregated across the two data loggers. The average temperature between the 20172018 time period was 70.2°F. The average %RH between 2017-2018 was 42.3%; these averages
are within the 3M and KC recommended temperature and %RH storage conditions.
o For the 3M models, 7.4% of the total temperature data points deviated from the recommended
storage conditions. For the KC 46827 model, 44.5% of data points were below 68°F and 30.9%
were above 77°F. For %RH, no data points deviated from 3M’s recommended storage
conditions, and 2.2% of data points deviated from KC’s recommended conditions.
6
�Figure 4: Percent Relative Humidity (% RH) from October 2017 – October 2018 for two data loggers stored at
Facility Five. Data is plotted as a 50-point moving average for visualization purposes. Maximum and minimum
temperatures reported are noted for each data logger.
7
�Figure 5: Temperatures from October 2017 – October 2018 for two data loggers stored at Facility Five. Data is
plotted as a 50-point moving average for visualization purposes. Maximum and minimum temperatures
reported are noted for each data logger.
8
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 42 stockpiled and 18 control
respirators. All stockpiled and control respirators from each model passed these tests. The 3M 1860,
3M 1870, 3M 9210, and 3M 9010 data are shown in Figure 6. The 3M 2071 (P95 filter cartridge) data is
shown in Figure 7. The KC 46827 data is shown in Figure 8.
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the controls and stockpiled respirators for inhalation and exhalation resistance when
averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following differences were observed for exhalation
resistance: 1) 3M 1870 stockpiled 2006 Lots A and B were lower; 2) the 3M 8210 stockpiled 2006 Lot B
was higher; 3) and the KC 46827 stockpiled 2006 Lot B was lower. For inhalation resistance the following
differences were observed for inhalation resistance: 1) 3M 1870 stockpiled 2006 Lots A and B were
lower; and 2) the 3M 8210 stockpiled 2006 Lot B was higher.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (16.00 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (13.46 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
9
�Figure 6: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data for the 3M 1860, 3M
1870, 3M 8210, and 3M 9010 models. N95 FFRs must have an inhalation resistance less than 35 mmH 2 O and an
exhalation resistance less than 25 mmH 2 O. The pass/fail threshold for inhalation (A) and exhalation (B)
resistance is shown by the red line. Error bars represent the 99% confidence interval and estimate the
population parameters. This confidence interval suggests that 99% of any repeated samples tested and
evaluated from this lot will have a mean between the upper and lower bounds.
10
�Figure 7: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data for the 3M 2071
model. P95 filters must have an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than
25 mmH 2 O. The pass/fail threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error
bars represent the 99% confidence interval and estimate the population parameters. This confidence interval
suggests that 99% of any repeated samples tested and evaluated from this lot will have a mean between the
upper and lower bounds.
11
�Figure 8: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data for the KC 46827
model. P95 filters must have an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than
25 mmH 2 O. The pass/fail threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error
bars represent the 99% confidence interval and estimate the population parameters. This confidence interval
me suggests that 99% of any repeated samples tested and evaluated from this lot will have a mean between the
upper and lower bounds.
12
�Filtration Performance
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 560 stockpiled respirators and 120 controls.
The 3M 1860, 3M 1870, 3M 9210, and 3M 9010 data are shown in Figure 9. The 3M 2071 (P95 filter
cartridge) data is shown in Figure 10. The KC 46827 data is shown in Figure 11.
None of the individual respirators tested exceeded the 5.0% maximum. The highest penetration for an
individual stockpiled respirator was 4.53% (KC 46827) and the highest penetration for an individual
control respirator was 2.84% (KC 46827).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the 3M controls and 3M stockpiled respirators for filtration when averaging across
models. There was a statistically significant difference between the KC controls (mean percent
penetration=1.77%, SD=0.45) and KC stockpiled respirators (mean percent penetration=2.73%,
SD=0.68), p<0.001.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) 3M 1860 stockpiled 2007 Lot A had a higher penetration; 2) 3M 1860 stockpiled 2010 Lot A
had a higher penetration; 3) 3M 1870 stockpiled 2011 Lot A had a higher penetration; 4) Both 3M 8210
stockpiled 2006 Lot A and Lot B had a lower penetration; and 5) Both KC 46827 stockpiled 2006 Lots A
and B had a higher penetration.
Figure 9: Control and stockpiled respirator particle filtration performance data for the 3M 1860, 3M 1870, 3M
8210, and 3M 9010 models. N95 FFRs must have a particle penetration of less than 5.0%. Error bars represent
the 99% confidence interval and estimate the population parameters. This confidence interval suggests that 99%
of any repeated samples tested and evaluated from this lot will have a mean between the upper and lower
bounds.
13
�Figure 10: Control and stockpiled respirator particle filtration performance data for the 3M 2071 model. P95
FFRs must have a liquid particle penetration of less than 5.0%. Error bars represent the 99% confidence interval
and estimate the population parameters. This confidence interval means that 99% of any repeated samples
tested and evaluated from this lot will have a mean between the upper and lower bounds.
Figure 11: Control and stockpiled respirator particle filtration performance data for the KC 46827 model. N95
FFRs must have a particle penetration of less than 5.0%. Error bars represent the 99% confidence interval and
estimate the population parameters. This confidence interval suggests that 99% of any repeated samples tested
and evaluated from this lot will have a mean between the upper and lower bounds.
14
�CASE Findings
Findings for the KC 46827 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a five-year recommended shelf life; Appendix 1 shows a KC letter to end users with shelf life
information, which states respirators past their shelf life should be discarded [KC 2018]. Thus, these respirators
tested are past their recommended shelf life. These findings pertain to KC units from Facility Five and may not
be applicable to other stockpile facilities and/or under different environmental storage conditions.
Findings for the 3M 1860, 3M 1870, 3M 8210, 3M 9010, and 3M 2071 Models:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. These five
models currently have a five-year recommended shelf life; Appendix 2 shows two 3M letters to end users with
shelf life and recommended storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are
past their recommended shelf life. These findings pertain to 3M units from Facility Five and may not be
applicable to other stockpile facilities and/or under different environmental storage conditions.
Stockpile Storage Conditions:
For the 3M models, 7.4% of the total temperature data points deviated from the previously described
recommended storage conditions. For the KC 46827 model, 75.4% of the total temperature data points deviated
from the previously described recommended storage conditions. For %RH, no data points deviated from 3M’s
recommended storage conditions, and 2.2% of data points deviated from KC’s recommended conditions. Stored
under these conditions, NIOSH found that 602 APRs evaluated in this study, which were 8-12 years old,
maintained their inhalation and exhalation resistance and filtration performance (i.e. all sampled respirators
were below the NIOSH maximum limit as defined by 42 CFR Part 84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 8 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
8
An approval may be granted to a non-manufacturing entity.
15
�exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
16
�What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
17
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Five of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
KC [2018]. Kimberly Clark Letter to Customers (Appendix 1)
KC [2020]. Kimberly Clark representatives, email correspondence, February 25, 2020.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
18
�Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
19
�Appendix 1 [KC 2018]
20
�Appendix 2 [3M 2018], [3M 2020]
21
�22
�23
�24
�25
�
https://repository.netecweb.org/files/original/899c273e79e99051f9059147b067c88a.pdf
457f3c5612c139a7b2211bb2055330f0
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Six of
Ten: Inhalation and Exhalation Resistance and Filtration Efficiency
Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 387 of 387 N95
filtering facepiece respirators
stockpiled at Facility Six that were
11-12 years old maintained their
inhalation and exhalation
resistance and filtration
performance in accordance with
NIOSH performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages were reported and, during the 2016 Ebola
outbreak and the first U.S. fatality, there was a 10-200 fold increase in PPE orders [DHHS 2012; NIOSH 2018]. To
prepare for these shortages, large quantities of PPE are strategically stockpiled at hospital, local, state, and
federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
APRs collected from Facility Six of Ten. This facility is a state stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Six
•
NIOSH researchers visited Facility Six in April 2018 (Figure 1). This facility was located within the U.S.
Department of Health and Human Services Region 10, representing Alaska, Idaho, Oregon, and
Washington.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Six such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH reviewed facility temperature and percent relative humidity (%RH) data provided by Facility Six
stockpile personnel. This data was collected intermittently from January 2013 to November 2017. The
data included temperatures taken at five different locations, which were averaged.
Collection of Respirator Samples
•
•
Facility Six’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs).
Samples were collected from four different manufacturing models 1: 1) Kimberly Clark (KC) 46727; 2) KC
46827; 3) Moldex 2201; and 4) 3M 8000 (Table 1).
Upon reviewing the detailed APR inventories and storage location by lot within Facility Six, two different
manufacturing lots for each model were identified and sampled within Facility Six. Two lots were
sampled to evaluate and attempt to account for inter-lot variation. More than two lots were sampled
Based on the other nine collaborating stockpiles’ inventories, these six models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
1
2
�•
from a model if conditions presented “worst-case scenario” conditions within the facility. Products were
sampled and shipped to the NIOSH facility overnight to reduce exposure to non-climate-controlled
conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
•
Table 1 provides a summary of the respirator models sampled from Facility Six.
Table 1. FFRs Sampled from Stockpile Facility Six
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
KC 46727
KC 46727
KC 46827
KC 46827
Moldex 2201
Moldex 2201
3M 8000
3M 8000
3M 8000
Lot A
Lot A
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot C
2006
2006
2007
2007
2006
2006
2006
2006
2006
No
No
No
No
Yes - 2010
Yes - 2010
No
No
No
Respirator Age at
Time of Testing 3
12 years
11 years
12 years
12 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
Past 9-year shelf
life 5
Past 5-year shelf
life 6
Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
•
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The KC 46827 and 46727 controls were manufactured in 2017, the Moldex 2201 controls
were manufactured in 2018, and the 3M 8000 controls were manufactured in 2006 7. NIOSH testing
requirements state that a minimum of three respirator units must be tested for inhalation and
exhalation resistance. The same three respirators can be used for both inhalation and exhalation
resistance testing [NIOSH 2018].
Inhalation and exhalation resistance and filtration performance of the stockpiled and control respirators
were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for approving respirators
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
3
Testing was completed in 2018.
4
KC designated a five-year shelf life for this model [KC 2018]. As of February 2020, this model still has a five-year shelf life
5
Moldex designated a nine-year shelf life for these models [Moldex 2015]. In 2006, the shelf life was designated as four
years, but was changed in 2009 to nine years. As of February 2020, these models still have a nine-year shelf life.
6
3M designated a five-year shelf life for these models [3M 2018]. As of February 2020, these models still have a five-year
shelf life; the 3M 8000 model is no longer produced or sold by 3M.
7
3M 8000 is no longer manufactured thus NIOSH was not able to purchase new units to be used as controls.
2
3
�•
under 42 Code of Federal Regulations Part 84, “Approval of Respiratory Protective Devices” [NIOSH
2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration
Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
38
38
38
38
40 9
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility Six;
examples of the most amount of dust is shown in Figure 2. No product boxes showed damage. Of the
387 respirators visually inspected, no concerns were noted.
Figure 2: Most amount of dust observed on product cases from Facility Six.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
9
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
8
4
�•
•
Temperature and %RH were controlled and intermittently monitored. Back-up generator existed in case
of power outage. Facility lights were off when not in use. Ceiling fans continuously ran to circulate air.
No evidence of excess moisture or chemical spills that persisted beyond immediate mitigation were
observed. Pallets were generally shrink wrapped around the four pallet sides and across the top.
Generally, all pallets were separated by rack, reducing weight/load applied to a single pallet.
Percent RH (Figure 3) and Temperature (Figure 4)
o At the time of publication, the recommended storage requirements for %RH and temperature
are
KC 46727 and 46827: remain under 60 %RH; remain within 68°F to 77°F [KC 2020]
Moldex 2201: no specific %RH recommendations; remain within 14°F and 122°F [Moldex
2019]
3M 80007: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
o Temperature data was averaged across the five temperature collection locations. The average
temperature between the 2013-2017 time period was 71.4°F. The average %RH between 20132017 was 34.0%; these averages are within KC, Moldex, and 3M’s recommended temperature
and %RH storage conditions.
o For the KC models, 2.6% of data points were below 68°F and 0.3% were above 77°F. No
temperature data points deviated from Moldex or 3M’s recommended conditions. For %RH, no
data points deviated from KC, 3M, or Moldex’s recommended storage conditions.
o Some respirators from Facility Six were previously stored and deployed from a federal SNS
facility. Although the current tracking process does not allow for retrieval of the historical
location(s) and environmental conditions for these sampled products, subsequent discussions
with SNS leadership suggest that SNS storage conditions met recommended conditions.
5
�Figure 3: Percent Relative Humidity (% RH) from January 2013 – November 2017 taken at one location within
Facility Six. Data is plotted as a 5-point moving average for visualization purposes. Maximum and minimum
temperatures reported are noted for each data logger.
6
�Figure 4: Temperatures from January 2013 – November 2017 taken at five locations within Facility Six. Data is
plotted as a 5-point moving average for visualization purposes. Maximum and minimum temperatures reported
are noted for each data logger.
7
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 27 stockpiled and 12 control
respirators. All stockpiled and control respirators from each model passed these tests (Figure 5).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for inhalation and exhalation
resistance when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were found
with respect to exhalation resistance: 1) 3M 8000 stockpiled 2006 Lots A and B were statistically
significantly higher; 2) KC 46827 stockpiled 2007 Lot A was significantly lower; and 3) Moldex 2201
stockpiled 2006 Lot A was significantly higher. The following statistically significant differences were
found with respect to inhalation resistance: 1) 3M 8000 stockpiled 2006 Lots A and B were statistically
significantly higher; 2) KC 46827 stockpiled 2007 Lots A and B were significantly lower; and 3) Moldex
2201 stockpiled 2006 Lot A was statistically significantly higher.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (15.75 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (14.22 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
8
�Figure 5: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data. N95 FFRs must have
an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than 25 mmH 2 O. The pass/fail
threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error bars represent the 99%
confidence interval and estimate the population parameters. This confidence interval suggests that 99% of any
repeated samples tested and evaluated from this lot will have a mean between the upper and lower bounds.
9
�Filtration Performance
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 360 stockpiled respirators and 80 controls.
None of the individual stockpiled respirators tested exceeded the 5.0% maximum (Figure 6). The highest
penetration for an individual stockpiled respirator was 4.82% (KC 46727) and the highest penetration for
an individual control respirator was 4.93% (KC 46727).
Using an analysis of variance (ANOVA), there was not a statistically significant difference (defined as
α<0.05) between KC control and KC stockpiled respirators. 3M controls (mean percent
penetration=2.45%, SD=0.36) displayed a significantly higher penetration when compared to 3M
stockpiled respirators (mean percent penetration=1.75%, SD=0.67) when averaging across models; and
Moldex controls (mean percent penetration=1.66%, SD=0.31) displayed a statistically significantly higher
penetration when compared to Moldex stockpiled respirators (mean percent penetration=0.74%,
SD=0.31) when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) each of the 3M 8000 stockpiled 2006 Lots had a lower penetration; 2) KC 46727 stockpiled
2006 Lot A had a lower penetration; 3) KC 46827 stockpiled 2007 Lot A had a higher penetration; and 4)
both Moldex 2201 stockpiled 2006 Lots A and B had a lower penetration.
Figure 6: Control and stockpiled respirator particle filtration performance data. N95 FFRs must have a particle
penetration of less than 5.0%. Error bars represent the 99% confidence interval and estimate the population
parameters. This confidence interval suggests that 99% of any repeated samples tested and evaluated from this
lot will have a mean between the upper and lower bounds.
10
�CASE Findings
Findings for the KC 46727 and 46827 Models:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a five-year recommended shelf life; Appendix 1 shows a KC letter to end users with shelf life
information, which states respirators past their shelf life should be discarded [KC 2018]. Thus, these respirators
tested are past their recommended shelf life. These findings pertain to KC units from Facility Six and may not be
applicable to other stockpile facilities and/or under different environmental storage conditions.
Findings for the 3M 8000 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
is no longer produced and sold by 3M. Additionally, Appendix 2 shows two 3M letters to end users with shelf
life and recommended storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are past
their recommended shelf life. These findings pertain to 3M units from Facility Six and may not be applicable to
other stockpile facilities and/or under different environmental storage conditions.
Findings for the Moldex 2201 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a nine-year recommended shelf life; Appendix 3 shows a Moldex memo to customers and
distributors with shelf life and recommended storage condition information [Moldex 2015]. Thus, all respirators
tested are past their recommended shelf life. These findings pertain to Moldex units from Facility Six and may
not be applicable to other stockpile facilities and/or under different environmental storage conditions.
Stockpile Storage Conditions:
For the KC models, 2.9% of data points deviated from the previously described recommended conditions. No
temperature data points deviated from Moldex or 3M’s recommended conditions. For %RH, no data points
deviated from KC, 3M, or Moldex’s recommended storage conditions. Stored under these conditions, NIOSH
found that 387 N95 FFRs evaluated in this study, which were 11-12 years old, maintained their inhalation and
exhalation resistance and filtration performance (i.e. all sampled respirators were below the NIOSH maximum
limit as defined by 42 CFR Part 84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 10 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
10
An approval may be granted to a non-manufacturing entity.
11
�Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
NIOSH recommends users contact 3M regarding use of 3M model 8000 respirators.
12
�What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content
of these websites. All web addresses referenced in this document were
accessible as of the publication date.
13
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Six of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
KC [2018]. Kimberly Clark Letter to Customers (Appendix 1).
KC [2020]. Kimberly Clark representatives, email correspondence, February 25, 2020.
Moldex [2015] Moldex Memo to Customers and Distributors (Appendix 3).
Moldex [2019]. Moldex Customer Service Representative, personal communication through email, October 31, 2019)
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
14
�Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
15
�Appendix 1 [KC 2018]
16
�Appendix 2 [3M 2018], [3M 2020]
17
�18
�19
�20
�21
�Appendix 3 [Moldex 2015]
22
�
https://repository.netecweb.org/files/original/6caf3a2ce513443597134e89d13d0cc7.pdf
46a9770e67b795bee0d853076124e6cc
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Seven
of Ten: Inhalation and Exhalation Resistance and Filtration
Efficiency Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 519 of 559
N95 filtering facepiece
respirators stockpiled at Facility
Seven that were 5-12 years old
maintained their inhalation and
exhalation resistance and
filtration performance in
accordance with NIOSH
performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages
were reported and, during the 2016 Ebola outbreak and the first U.S. fatality, there was a 10-200 fold increase in
PPE orders [DHHS 2012; NIOSH 2018]. To prepare for these shortages, large quantities of PPE are strategically
stockpiled at hospital, local, state, and federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
APRs collected from Facility Seven of Ten. This facility is a state stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Seven
•
NIOSH researchers visited Facility Seven in August 2018 (Figure 1). This facility was located within the
U.S. Department of Health and Human Services Region 1, representing Connecticut, Maine,
Massachusetts, New Hampshire, Rhode Island, and Vermont.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Seven such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH placed one data logger in the facility to collect temperature and percent relative humidity (%RH)
data for one year. This data was collected in 30-minute intervals from November 2017 to November
2018.
2
�Collection of Respirator Samples
•
•
•
Facility Seven’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs).
Samples were collected from six different manufacturing models 1: 1) 3M 1860 (two different
manufacturing years); 2) 3M 1870; 3) 3M 8000; 4) 3M 9010; 5) Kimberly Clark (KC) 46727; and 6) KC
46827 (Table 1).
Upon reviewing the detailed APR inventories and storage location by lot within Facility Seven, two
different manufacturing lots for each model were identified and sampled within Facility Seven. Two lots
were sampled to evaluate and attempt to account for inter-lot variation. More than two lots were
sampled from a model if conditions presented “worst-case scenario” conditions within the facility.
Products were sampled and shipped to the NIOSH facility overnight to reduce exposure to non-climatecontrolled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
•
Table 1 provides a summary of the respirator models sampled from Facility Seven.
Based on the other nine collaborating stockpiles’ inventories, these six models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
2
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
1
3
�Table 1. FFRs Sampled from Stockpile Facility Seven
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
3M 1860
3M 1860
3M 1860
3M 1860
A
B
A
B
2007
2007
2010
2010
No
No
No
No
3M 1870
A
2013
No
3M 8000
3M 8000
3M 9010
3M 9010
KC 46727
KC 46727
KC 46827
KC 46827
A
B
A
B
A
B
A
B
2007
2007
2007
2007
2006
2007
2006
2006
No
No
No
No
No
No
No
No
Respirator Age at
Time of Testing 3
11 years
8 years
5 years
11 years
11 years
12 years
11 years
12 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life4
Past 5-year shelf
life5
Past 5-year shelf
life 5
Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
•
•
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The 3M 1860 controls were manufactured in 2018, the 3M 1870 controls were
manufactured in 2014, the 3M 9010 controls were purchased in 2018 but have an unknown
manufacturing date, the 3M 8000 controls 6 were manufactured in 2006, and the KC 46727 and KC
46827 controls were manufactured in 2017. NIOSH testing requirements state that a minimum of three
respirator units must be tested for inhalation and exhalation resistance. The same three respirators can
be used for both inhalation and exhalation resistance testing [NIOSH 2018].
Inhalation and exhalation resistance and filtration performance of the stockpiled and control respirators
were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for approving respirators
under 42 Code of Federal Regulations Part 84, “Approval of Respiratory Protective Devices” [NIOSH
2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
Testing was completed in 2018.
3M designated a five-year shelf life for these models [3M 2018]. As of February 2020, these models still have a five-year
shelf life; the 3M 8000 is no longer produced or sold by 3M.
5
KC designated a five-year shelf life for this model [KC 2018]. As of February 2020, this model still has a five-year shelf life.
6
3M 8000 is no longer supported by the approval holder thus NIOSH was not able to purchase new units to be used as
controls.
3
4
4
�Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration
Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
37
37
37
37
40 8
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility
Seven; examples of the most amount of dust and damage to product packaging are shown in Figures 2
and 3. Of the 559 respirators visually inspected, no concerns were noted.
Figure 2: Most amount of dust and water damage observed on product cases from Facility Seven.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
8
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
7
5
�Figure 3: Most amount of product case damage observed from Facility Seven.
•
•
•
•
Facility lights were off when not in use. Temperature and %RH were not monitored; no air-conditioning
unit existed but a radiator provided heat. Windows allowed indirect sunlight. Evidence of excess
moisture persisted beyond immediate mitigation were observed on walls near where PPE was stored.
Pallets were generally shrink wrapped around the four pallet sides, and a plastic covering was placed on
top. Pallets were generally separated by metal racks to prevent weight/load to the bottom pallet.
Percent RH (Figure 5) and Temperature (Figure 6)
• At the time of publication, the recommended storage requirements for %RH and temperature
are
3M 1860, 3M 1870, and 3M 9010: remain under 80 %RH; remain within -4°F to 86°F [3M
2017]
3M 80006: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
KC 46727 and KC 46827: remain under 60 %RH; remain within 68°F to 77°F [KC 2020]
The average temperature between the 2017-2018 time period was 76.4°F. The average %RH between
2017-2018 was 38.4%; these averages are within the 3M and KC recommended temperature and %RH
storage conditions.
For the 3M models, 10.5% of the temperature data points deviated above the recommended storage
conditions. For the KC models, 11.6% of the temperature data points were below 68°F and 50.4% were
above 77°F. For %RH, 0.2% of data points deviated from 3M’s recommended storage conditions, and
26.7% of data points deviated from KC’s recommended conditions.
6
�Figure 5: Percent Relative Humidity (% RH) from November 2017 – November 2018 for two data loggers stored
at Facility Seven. Data is plotted as a 50-point moving average for visualization purposes. Maximum and
minimum temperatures reported are noted for each data logger.
7
�Figure 6: Temperatures from November 2017 – November 2018 for two data loggers stored at Facility Seven.
Data is plotted as a 50-point moving average for visualization purposes. Maximum and minimum temperatures
reported are noted for each data logger.
8
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 39 stockpiled and 18 control
respirators. All stockpiled and control respirators from each model passed these tests. The 3M 1860,
3M 1870, 3M 8000, and 3M 9010 data are shown in Figure 7. The KC 46727 and KC 46827 models are
shown in Figure 8.
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for inhalation and exhalation
resistance when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following differences were found in terms of both
inhalation and exhalation resistance: 1) 3M 1870 stockpiled 2013 Lot A displayed significantly lower
resistance; 2) both KC 46727 stockpiled 2006 Lots A and B were lower; and 3) both KC 46827 stockpiled
2006 Lots A and B were lower.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (13.97 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (12.45 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
9
�Figure 7: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data for the 3M 1860, 3M
1870, 3M 8000, and 3M 9010 models. N95 FFRs must have an inhalation resistance less than 35 mmH 2 O and an
exhalation resistance less than 25 mmH 2 O. The pass/fail threshold for inhalation (A) and exhalation (B)
resistance is shown by the red line. Error bars represent the 99% confidence interval and estimate the
population parameters. This confidence interval suggests that 99% of any repeated samples tested and
evaluated from this lot will have a mean between the upper and lower bounds.
10
�Figure 8: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data for the KC 46727 and
KC 46827 models. N95 FFRs must have an inhalation resistance less than 35 mmH 2 O and an exhalation
resistance less than 25 mmH 2 O. The pass/fail threshold for inhalation (A) and exhalation (B) resistance is shown
by the red line. Error bars represent the 99% confidence interval and estimate the population parameters. This
confidence interval suggests that 99% of any repeated samples tested and evaluated from this lot will have a
mean between the upper and lower bounds.
11
�Filtration Performance
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 520 stockpiled respirators and 120 controls.
The 3M 1860, 3M 1870, 3M 8000, and 3M 9010 data are shown in Figure 9. The KC 46727 and KC 46827
models are shown in Figure 10.
Forty individual stockpiled respirators—all KC 46727 2007, Lot A—exceeded the 5.0% maximum. The
highest penetration for an individual stockpiled respirator was 10.40% and the highest penetration for
an individual control respirator was 4.93%.
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the 3M controls and 3M stockpiled respirators for filtration when averaging across
models. There was a statistically significant difference between the KC controls (mean percent
penetration=2.16%, SD=1.04) and KC stockpiled respirators (mean percent penetration=4.35%,
SD=2.38), p<0.001.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) 3M 1860 stockpiled 2010 Lot A had a higher penetration; 2) 3M 1860 stockpiled 2007 Lot B
had a higher penetration; 3) both 3M 8000 stockpiled 2008 Lots A and B had a lower penetration; 4) KC
46727 stockpiled 2007 Lot A had a higher penetration; and 5) both KC 46827 stockpiled 2006 Lots A and
B had a higher penetration.
Figure 9: Control and stockpiled respirator particle filtration performance data for the 3M 1860, 3M 1870, 3M
8000, and 3M 9010 models. N95 FFRs must have a particle penetration of less than 5.0%. Error bars represent
the 99% confidence interval and estimate the population parameters. This confidence interval suggests that 99%
of any repeated samples tested and evaluated from this lot will have a mean between the upper and lower
bounds.
12
�Figure 12: Control and stockpiled respirator particle filtration performance data for the KC 46727 and KC 46827
models. N95 FFRs must have a particle penetration of less than 5.0%. Error bars represent the 99% confidence
interval and estimate the population parameters. This confidence interval suggests that 99% of any repeated
samples tested and evaluated from this lot will have a mean between the upper and lower bounds.
13
�CASE Findings
Findings for the KC 46727 Model:
No failures for inhalation resistance or exhalation resistance were observed; 40 failures for filtration
performance were observed. All 40 units came from one production lot manufactured in 2007. This model
currently has a five-year recommended shelf life; Appendix 1 shows a KC letter to end users with shelf life
information, which states respirators past their shelf life should be discarded [KC 2018]. Thus, these respirators
tested are past their recommended shelf life. These findings pertain to KC units from Facility Seven and may not
be applicable to other stockpile facilities and/or under different environmental storage conditions.
Findings for the KC 46827 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. TThis
model currently has a five-year recommended shelf life; Appendix 1 shows a KC letter to end users with shelf life
information, which states respirators past their shelf life should be discarded [KC 2018]. Thus, these respirators
tested are past their recommended shelf life. These findings pertain to KC units from Facility Seven and may not
be applicable to other stockpile facilities and/or under different environmental storage conditions.
Findings for the 3M 1860, 3M 1870, and 3M 9010 Models:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e.,
based on the storage conditions in this facility, the performance data suggests that these units would be
protective so long as a proper fit is achieved. These three models currently have a five-year manufacturerrecommended shelf life; Appendix 2 shows two 3M letters to end users with shelf life and recommended
storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are past their recommended
shelf life. These findings pertain to 3M units from Facility Seven and may not be applicable to other stockpile
facilities and/or under different environmental storage conditions.
Findings for the 3M 8000 model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
is no longer produced and sold by 3M. Additionally, Appendix 2 shows two 3M letters to end users with shelf
life and recommended storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are past
their recommended shelf life. These findings pertain to 3M units from Facility Seven and may not be applicable
to other stockpile facilities and/or under different environmental storage conditions.
Stockpile Storage Conditions:
For the 3M models, 10.5% of the temperature data points deviated from the previously described
recommended storage conditions. For the KC models, 62.0% of the temperature data points deviated from the
previously described recommended storage conditions. For %RH, 0.2% of data points deviated from 3M’s
recommended storage conditions, and 26.7% of data points deviated from KC’s recommended conditions.
Stored under these conditions, NIOSH found that 519 of the 559 N95 APRs evaluated in this study, which were 512 years old, maintained their inhalation and exhalation resistance and filtration performance (i.e.
14
�approximately 93% of the sampled respirators were below the NIOSH maximum limit as defined by 42 CFR Part
84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 9 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
NIOSH recommends users contact 3M regarding use of 3M model 8000 respirators.
9
An approval may be granted to a non-manufacturing entity.
15
�What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
16
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Seven of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
KC [2018]. Kimberly Clark Letter to Customers (Appendix 1).
KC [2020]. Kimberly Clark representatives, email correspondence, February 25, 2020.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
17
�Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
18
�Appendix 1 [KC 2018]
19
�Appendix 2 [3M 2018], [3M 2020]
20
�21
�22
�23
�24
�
https://repository.netecweb.org/files/original/35cdef7cd26d09a7a8bf500c651f3dbf.pdf
1b1e8e2f937e65449f4456b4a8d90c4b
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Eight
of Ten: Inhalation and Exhalation Resistance and Filtration
Efficiency Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 344 of 344
N95 filtering facepiece
respirators stockpiled at Facility
Eight that were 9-12 years old
maintained their inhalation and
exhalation resistance and
filtration performance in
accordance with NIOSH
performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages
were reported and, during the 2016 Ebola outbreak and the first U.S. fatality, there was a 10-200 fold increase in
PPE orders [DHHS 2012; NIOSH 2018]. To prepare for these shortages, large quantities of PPE are strategically
stockpiled at hospital, local, state, and federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
APRs collected from Facility Eight of Ten. This facility is a regional stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Eight
•
NIOSH researchers visited Facility Eight in November 2018 (Figure 1). This facility was located within the
U.S. Department of Health and Human Services Region 8, representing Colorado, Montana, North
Dakota, South Dakota, Utah, and Wyoming.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Eight such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH collected facility temperature and percent relative humidity (%RH) data by placing one data
logger in the facility. This data was collected in 60-minute intervals from December 2018 to July 2019.
2
�Collection of Respirator Samples
•
•
•
Facility Eight’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs).
Samples were collected from five different manufacturing models 1: 1) 3M 1860; 3M 8000; Kimberly
Clark (KC) 46727; KC 46827; and Moldex 1512 (Table 1).
Upon reviewing the detailed APR inventories and storage location by lot within Facility Eight, two
different manufacturing lots for each model were identified and sampled within Facility Eight. Two lots
were sampled to evaluate and attempt to account for inter-lot variation. Only one lot for the KC 46727
and KC 46827 were available for sampling. Products were sampled and shipped to the NIOSH facility
overnight to reduce exposure to non-climate-controlled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
•
Table 1 provides a summary of the respirator models sampled from Facility Eight.
Table 1. FFRs Sampled from Stockpile Facility Eight
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
3M 1860
3M 1860
3M 8000
3M 8000
KC 46727
KC 46827
Moldex 1512
Moldex 1512
Lot A
Lot B
Lot A
Lot B
Lot A
Lot A
Lot A
Lot B
2007
2007
2008
2008
2006
2006
2009
2009
No
No
No
No
No
No
Yes-2018
Yes-2018
Respirator Age at
Time of Testing 3
11 years
10 years
12 years
9 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
Past 5-year shelf
life 5
Past 9-year shelf
life 6
Based on the other nine collaborating stockpiles’ inventories, these six models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
2
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
3
Testing was completed in 2018.
4
3M designated a five-year shelf life for these models [3M 2018]. As of February 2020, the 3M 1860 model still has a fiveyear shelf life; the 3M 8000 is no longer produced or sold by 3M.
5
KC designated a five-year shelf life for this model [KC 2018]. As of February 2020, this model still has a five-year shelf life.
6
Moldex designated a nine-year shelf life for these models [Moldex 2015]. As of February 2020, these models still have a
nine-year shelf life.
1
3
�Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
•
•
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The KC 46827 and 46727 controls were manufactured in 2017, the Moldex 2201 controls
were manufactured in 2018, and the 3M 8000 controls were manufactured in 2006 7. NIOSH testing
requirements state that a minimum of three respirator units must be tested for inhalation and
exhalation resistance. The same three respirators can be used for both inhalation and exhalation
resistance testing [NIOSH 2018].
Inhalation and exhalation resistance and filtration performance of the stockpiled and control respirators
were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for approving respirators
under 42 Code of Federal Regulations Part 84, “Approval of Respiratory Protective Devices” [NIOSH
2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
38
38
38
38
40 9
20
3M 8000 is no longer manufactured thus NIOSH was not able to purchase new units to be used as controls.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
9
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
7
8
4
�What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility Eight;
examples of the most amount of dust and product case damage are shown in Figures 2 and 3. Three
product boxes showed damage. Of the 387 respirators visually inspected, no concerns were noted.
Figure 2: Most amount of dust observed on product cases from Facility Eight.
Figure 3: Most amount of damage observed on product cases from Facility Eight.
•
Temperature was controlled by swamp coolers and heaters with minimum and maximum control on a
thermostat. No %RH controls or monitoring existed. No back-up generators existed in case of power
outage. Facility lights were off when not in use. No evidence of excess moisture or chemical spills that
persisted beyond immediate mitigation were observed. Pallets were generally shrink wrapped around
the four pallet sides and across the top; many products were not on pallets, but the product cases were
shrink wrapped. Other products were not on pallets nor shrink wrapped. Generally, some pallets were
separated by rack, and others were stacked two high causing some weight/load applied to a single
pallet.
5
�•
10
Percent RH (Figure 4) and Temperature (Figure 5)
o At the time of publication, the recommended storage requirements for %RH and temperature
are
KC 46727 and 46827: remain under 60 %RH; remain within 68°F to 77°F [KC 2020]
Moldex 1512: no specific %RH recommendations; remain within 14°F and 122°F [Moldex
2019]
3M 1860: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
3M 8000 10: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
o The average temperature between the 2018-2019 time period was 68.15°F. The average %RH
between 2018-2019 was 72.8%; these averages are within KC, Moldex, and 3M’s recommended
temperature and %RH storage conditions.
o For the KC models, 63.8% of data points were below 68°F and 7.9% were above 77°F. For the 3M
models, 0.02% of temperature data points deviated from recommended conditions. No
temperature data points deviated from Moldex’s recommended conditions. For %RH, 2.9% of
data points deviated for the KC models, where no data points deviated from 3M’s or Moldex’s
recommended storage conditions.
This model is no longer produced and sold by 3M.
6
�Figure 4: Percent Relative Humidity (% RH) from December 2018 – July 2019 for one data logger stored at
Facility Eight. Data is plotted as a 20-point moving average for visualization purposes. Maximum and minimum
temperatures reported are noted for each data logger.
7
�Figure 5: Temperatures from December 2018 – July 2019 for one data logger stored at Facility Eight. Data is
plotted as a 20-point moving average for visualization purposes. Maximum and minimum temperatures
reported are noted for each data logger.
8
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 24 stockpiled and 15 control
respirators. All stockpiled and control respirators from each model passed these tests (Figure 6).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for inhalation and exhalation
resistance when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were found
with respect to inhalation and exhalation resistance: 1) KC 46727 stockpiled 2006 Lot A was higher; and
2) KC 46827 stockpiled 2006 Lot A was lower.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (14.99 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (14.48 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
9
�Figure 6: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data. N95 FFRs must have
an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than 25 mmH 2 O. The pass/fail
threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error bars represent the 99%
confidence interval and estimate the population parameters. This confidence interval suggests that 99% of any
repeated samples tested and evaluated from this lot will have a mean between the upper and lower bounds.
10
�Filtration Performance
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 320 stockpiled respirators and 100 controls
(Figure 7).
Using an analysis of variance (ANOVA), there was no statistically significant difference (defined as
α<0.05) between the 3M and Moldex controls and the stockpiled respirators when averaging across
models. There was a statistically significant difference between the KC controls (mean penetration=2.16,
SD=1.04) and the KC stockpiled respirators (mean penetration=1.80, SD=0.54), p=0.01.
When comparing the particle penetration for stockpiled respirator models to their respective controls
through an ANOVA with adjusted, post-hoc multiple comparisons, the following statistically significant
differences were detected: 1) both 3M 1860 stockpiled 2007 lots A and B were higher; 2) both 3M 8000
stockpiled 2006 lots A and B were lower; and 3) KC 46727 stockpiled 2006 Lot A was lower.
None of the individual stockpiled respirators tested exceeded the 5.0% maximum. The highest
penetration for an individual stockpiled respirator was 3.96% and the highest penetration for an
individual control respirator was 4.93%.
Figure 7: Control and stockpiled respirator particle filtration performance data. N95 FFRs must have a particle
penetration of less than 5.0%. Error bars represent the 99% confidence interval and estimate the population
parameters. This confidence interval suggests that 99% of any repeated samples tested and evaluated from this
lot will have a mean between the upper and lower bounds.
11
�CASE Findings
Findings for the KC 46727 and 46827 Models:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. These
models currently have a five-year recommended shelf life; Appendix 1 shows a KC letter to end users with shelf
life information, which states respirators past their shelf life should be discarded [KC 2018]. Thus, these
respirators tested are past their recommended shelf life. These findings pertain to KC units from Facility Eight
and may not be applicable to other stockpile facilities and/or under different environmental storage conditions.
Findings for the 3M 1860 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a five-year recommended shelf life; Appendix 2 shows two 3M letters to end users with shelf life
and recommended storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are past their
recommended shelf life. These findings pertain to 3M units from Facility Eight and may not be applicable to
other stockpile facilities and/or under different environmental storage conditions.
Findings for the 3M 8000 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
Is no longer produced and sold by 3M. Appendix 2 shows two 3M letters to end users with shelf life and
recommended storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are past their
recommended shelf life. These findings pertain to 3M units from Facility Eight and may not be applicable to
other stockpile facilities and/or under different environmental storage conditions.
Findings for the Moldex 1512 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a nine-year recommended shelf life; Appendix 3 shows a Moldex memo to customers and
distributors with shelf life and recommended storage condition information [Moldex 2015]. Thus, all respirators
tested are past their recommended shelf life. These findings pertain to Moldex units from Facility Eight and may
not be applicable to other stockpile facilities and/or under different environmental storage conditions.
Stockpile Storage Conditions:
For the KC models, 71.7% of temperature data points deviated from the previously described recommended
storage conditions. For the 3M models, 0.02% of temperature data points deviated from the previously
described recommended conditions. No temperature data points deviated from Moldex‘s recommended
conditions. For %RH, 2.9% of data points deviated for the KC models, where no data points deviated from 3M’s
or Moldex’s recommended storage conditions. Stored under these conditions, NIOSH found that 384 N95 FFRs
evaluated in this study, which were 9-12 years old, maintained their inhalation and exhalation resistance and
12
�filtration performance (i.e. all sampled respirators were below the NIOSH maximum limit as defined by 42 CFR
Part 84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 11 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
NIOSH recommends users contact 3M regarding use of 3M model 8000 respirators.
11
An approval may be granted to a non-manufacturing entity.
13
�What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
14
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Eight of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
KC [2018]. Kimberly Clark Letter to Customers (Appendix 1).
KC [2020]. Kimberly Clark representatives, email correspondence, February 25, 2020.
Moldex [2015] Moldex Memo to Customers and Distributors (Appendix 3).
Moldex [2019]. Moldex Customer Service Representative, email correspondence, October 31, 2019.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
15
�Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
16
�Appendix 1 [KC 2018]
17
�Appendix 2 [3M 2018], [3M 2020]
18
�19
�20
�21
�22
�Appendix 3 [Moldex 2015]
23
�
https://repository.netecweb.org/files/original/d2b5412869f27224aefa99179c381434.pdf
000318276a932d81cc1c5c13badaad36
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Nine
of Ten: Inhalation and Exhalation Resistance and Filtration
Efficiency Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 172 of 172
N95 filtering facepiece
respirators stockpiled at Facility
Nine that were 15 years old
maintained their inhalation and
exhalation resistance and
filtration performance in
accordance with NIOSH
performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages
were reported and, during the 2016 Ebola outbreak and the first U.S. fatality, there was a 10-200 fold increase in
PPE orders [DHHS 2012; NIOSH 2018]. To prepare for these shortages, large quantities of PPE are strategically
stockpiled at hospital, local, state, and federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
APRs collected from Facility Nine of Ten. This facility is a regional stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Nine
•
NIOSH researchers visited Facility Nine in November 2018 (Figure 1). This facility was located within the
U.S. Department of Health and Human Services Region 8, representing Colorado, Montana, North
Dakota, South Dakota, Utah, and Wyoming.
Assessment of Storage Conditions
•
•
•
Respirators were stored in a trailer for at least seven years and were recently moved into a building
basement (approximately in October 2018, one month prior to product sampling).
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Nine such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH collected facility temperature and percent relative humidity (%RH) data by placing one data
logger in the trailer. This data was collected in 60-minute intervals from November 2018 to August 2019.
Collection of Respirator Samples
•
Facility Nine’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs).
Samples were collected from two different manufacturing models 1: 1) Kimberly Clark (KC) 46727 and 2)
KC 46827 (Table 1).
Based on the other nine collaborating stockpiles’ inventories, these six models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
1
2
�•
•
•
Upon reviewing the detailed APR inventories and storage location by lot within Facility Nine, two
different manufacturing lots for each model were identified and sampled within Facility Nine. Two lots
were sampled to evaluate and attempt to account for inter-lot variation. Products were sampled and
shipped to the NIOSH facility overnight to reduce exposure to non-climate-controlled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Control respirators were purchased from the open market to be used as a comparison between
stockpiled and new respirators.
Table 1. FFRs Sampled from Stockpile Facility Nine
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
KC 46727
KC 46727
KC 46827
KC 46827
Lot A
Lot B
Lot A
Lot B
2003
2003
2003
2003
No
No
No
No
Respirator Age at
Time of Testing 3
15 years
15 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
Evaluation of Inhalation and Exhalation Resistance and Filtration Performance
•
•
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The KC 46827 and 46727 controls were manufactured in 2017. NIOSH testing
requirements state that a minimum of three respirator units must be tested for inhalation and
exhalation resistance. The same three respirators can be used for both inhalation and exhalation
resistance testing [NIOSH 2018].
Inhalation and exhalation resistance and filtration performance of the stockpiled and control respirators
were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for approving respirators
under 42 Code of Federal Regulations Part 84, “Approval of Respiratory Protective Devices” [NIOSH
2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
3
Testing was completed in 2018.
4
KC designated a five-year shelf life for this model [KC 2018]. As of February 2020, this model still has a five-year shelf life.
2
3
�Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
35
35
35
35
40 6
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
A
Visual Inspections—Dust and damage to product packaging was observed at Facility Nine. Many product
cases and boxes were opened. Twelve product boxes showed damage due to crushing, mold, and/or
dust. Examples of damage observed on product boxes are shown in Figures 2A and B. Of the 172
respirators visually inspected, 43 concerns were noted. An example of damage observed to the
respirator is shown in Figure 3.
B
Figure 3: Most amount of damage observed on (A) and in (B) product boxes from Facility Nine.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
6
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
5
4
�Figure 3: Most amount of damage observed to respirators from Facility Nine.
•
•
Temperature and %RH were not controlled or monitored. Lights were off when not in use. No evidence
of excess moisture or chemical spills that persisted beyond immediate mitigation were observed. Dust
was limited. No air circulation existed. Trailer was always kept outside in direct sunlight. Products were
not shrink-wrapped.
Percent RH (Figure 4) and Temperature (Figure 5)
o At the time of publication, the KC recommended storage requirements for %RH and
temperature are to remain under 60 %RH and to remain within 68°F to 77°F [KC 2020].
o The average temperature between the 2018-2019 time period was 52.3°F. The average %RH
between 2018-2019 was 34.2%; this average temperature deviates from KC’s recommended
temperature storage condition but is within the recommended %RH storage condition.
o 72.9% of temperature data points were below 68°F and 16.6% were above 77°F. For %RH, no
data points deviated from KC’s recommended conditions.
5
�Figure 4: Percent Relative Humidity (% RH) from November 2018 – August 2019 for one data logger stored at
Facility Nine. Data is plotted as a 20-point moving average for visualization purposes. Maximum and minimum
temperatures reported are noted for each data logger.
Figure 5: Temperatures from November 2018 – August 2019 for one data logger stored at Facility Nine. Data is
plotted as a 20-point moving average for visualization purposes. Maximum and minimum temperatures
reported are noted for each data logger.
6
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 12 stockpiled and 6 control
respirators. All stockpiled and control respirators from each model passed these tests (Figure 6).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between the FFR controls and FFR stockpiled respirators for inhalation and exhalation
resistance when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were found
with respect to inhalation and exhalation resistance: 1) both of the KC 46727 stockpiled 2003 Lots A and
B were lower; 2) KC 46827 stockpiled 2003 Lot A was lower; and 3) KC 46827 stockpiled 2003 Lot B was
higher.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (17.27 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (16.00 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
7
�Figure 6: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data. N95 FFRs must have
an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than 25 mmH 2 O. The pass/fail
threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error bars represent the 99%
confidence interval and estimate the population parameters. This confidence interval suggests that 99% of any
repeated samples tested and evaluated from this lot will have a mean between the upper and lower bounds.
8
�Filtration Performance
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 160 stockpiled respirators and 40 controls
(Figure 7).
None of the individual stockpiled respirators tested exceeded the 5.0% maximum. The highest
penetration for an individual stockpiled respirator was 2.92% and the highest penetration for an
individual control respirator was 4.93%.
Using an analysis of variance (ANOVA), there was no statistically significant difference (defined as
α<0.05) between the FFR controls and the FFR stockpiled respirators when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were
detected: 1) both of the KC 46727 stockpiled 2003 Lots A and B had a lower penetration; and 2) KC
46827 stockpiled 2003 Lot B had a higher penetration.
Figure 7: Control and stockpiled respirator particle filtration performance data. N95 FFRs must have a particle
penetration of less than 5.0%. Error bars represent the 99% confidence interval and estimate the population
parameters. This confidence interval suggests that 99% of any repeated samples tested and evaluated from this
lot will have a mean between the upper and lower bounds.
9
�CASE Findings
Findings for the KC 46727 and 46827 Models:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. These
models currently have a five-year recommended shelf life; Appendix 1 shows a KC letter to end users with shelf
life information, which states respirators past their shelf life should be discarded [KC 2018]. Thus, these
respirators tested are past their recommended shelf life. These findings are based on units evaluated from
Facility Nine and may not be applicable at other stockpile facilities and/or under different environmental storage
conditions.
Stockpile Storage Conditions:
For the KC models, 89.5% of temperature data points deviated from the previously described recommended
storage conditions. For %RH, no data points deviated from the previously described recommended conditions.
Stored under these conditions, NIOSH found that 172 N95 FFRs evaluated in this study, which were 15 years old,
maintained their inhalation and exhalation resistance and filtration performance (i.e. all sampled respirators
were below the NIOSH maximum limit as defined by 42 CFR Part 84).
NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 7 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
7
An approval may be granted to a non-manufacturing entity.
10
�How Can You Learn More About the Respirators in Your Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
11
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Nine of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
KC [2018]. Kimberly Clark Letter to Customers (Appendix 1).
KC [2020]. Kimberly Clark representatives, email correspondence, February 25, 2020.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
12
�Appendix 1 [KC 2018]
13
�
https://repository.netecweb.org/files/original/6ef764709c5acc22256113aa57ea7a66.pdf
f614d28f957af025e796d6ccd621983c
PDF Text
Text
PPE CASE
Personal Protective Equipment Conformity Assessment Studies and Evaluations
Performance of Stockpiled Air-Purifying Respirators, Facility Ten of
Ten: Inhalation and Exhalation Resistance and Filtration Efficiency
Performance
National Institute for Occupational Safety and Health (NIOSH)
National Personal Protective Technology Laboratory (NPPTL)
Lee A. Greenawald, Susan M. Moore, Patrick L. Yorio
March 1, 2020
NIOSH found that 430 of 430
N95 filtering facepiece
respirators stockpiled at Facility
Ten that were 12-13 years old
maintained their inhalation and
exhalation resistance and
filtration performance in
accordance with NIOSH
performance standards.
In the event of a national emergency, eighteen million U.S. healthcare
workers may face high-consequence infectious disease exposures
[NIOSH 2017]. Personal protective equipment (PPE), such as gowns,
gloves, goggles, and respirators, is an important measure within the
infection prevention hierarchy of controls. During public health
emergencies, the sudden increase in PPE demand may exceed
supplies for upwards of three months while manufacturers increase
production [ASTHO 2013; Carias et al. 2015]; [Patel et al. 2017]. For
example, during the 2009 H1N1 pandemic, local respirator shortages
were reported and, during the 2016 Ebola outbreak and the first U.S. fatality, there was a 10-200 fold increase in
PPE orders [DHHS 2012; NIOSH 2018]. To prepare for these shortages, large quantities of PPE are strategically
stockpiled at hospital, local, state, and federal facilities [NIOSH 1997].
Due to the decision to stockpile PPE, stockpile personnel and decision makers have sought to understand if
stockpiled PPE is still viable following long-term storage. NIOSH does not require approval holders (i.e. those
granted the approval from NIOSH) to designate a shelf life for particulate-only air-purifying respirators (APR),
although some choose to do so and may provide this information on product packaging or online. There is
limited published data to understand the viability of respirators that have undergone long-term storage with or
without a designated shelf life. Over the past decade, the Strategic National Stockpile (SNS) and state and local
stockpile personnel asked NIOSH to evaluate the performance of stockpiled PPE as well as better understand
storage conditions in U.S. stockpile facilities that store PPE.
In 2017, NIOSH established a PPE Stockpile Partnership consisting of 1) federal entities and stockpiles; 2) state,
county, and city stockpiles; 3) hospital-related stockpile entities; and 4) a manufacturer trade association to
inform the design and execution of an empirical study to evaluate stockpiled APRs. NIOSH obtained samples of
PPE from geographically dispersed stockpiles with varying storage conditions.
This report details the inhalation/exhalation resistance and filtration performance of N95 filtering facepiece
APRs collected from Facility Ten of Ten. This facility is a federal stockpile facility.
�How NIOSH Evaluated Respirators and Storage Conditions
Description of Facility Ten
•
NIOSH researchers visited Facility Ten in January 2019 (Figure 1). This facility was located within the U.S.
Department of Health and Human Services Region 6, representing Arkansas, Louisiana, New Mexico,
Oklahoma, and Texas.
Assessment of Storage Conditions
•
•
NIOSH, in conjunction with the PPE Partnership members, developed checklists to document site and
packaging (i.e. pallet, case, and box) conditions that may impact respirator performance.
NIOSH documented the following storage conditions: 1) the PPE packaging presence of dust, shrinkwrapping, chemicals, and moisture, 2) exposure to sunlight and direct light; 3) proximity to fans,
windows, doors, and ventilation systems; 4) damage to pallet and product packaging; and 5) location of
pallet on storage rack (e.g., top, bottom) and location of PPE product on pallet (e.g., top/not loadbearing, bottom/load-bearing).
Figure 1: NIOSH researchers documented storage practices at Facility Ten such as location and type of
lighting, pallet stacking practices, and conditions of the flooring, roofing, and exterior walls.
•
NIOSH reviewed facility temperature and percent relative humidity (%RH) data provided by Facility Ten
stockpile personnel. This data was collected from January 2014 to February 2019.
2
�Collection of Respirator Samples
•
•
•
Facility Ten’s inventory included APRs that are classified as N95 filtering facepiece respirators (FFRs).
Samples were collected from five different manufacturing models 1: 1) 3M 1860; Kimberly Clark (KC)
46827; 3M 8000; 3M 8210; and Gerson 1730 (Table 1).
Upon reviewing the detailed APR inventories and storage location by lot within Facility Ten, two
different manufacturing lots for each model were identified and sampled within Facility Ten. Two lots
were sampled to evaluate and attempt to account for inter-lot variation. Products were sampled and
shipped to the NIOSH facility overnight to reduce exposure to non-climate-controlled conditions.
Forty-three respirators were tested from each manufacturing lot for inhalation and exhalation
resistance (n=3) and filtration performance testing (n=40) 2.
Selection of Control Respirators
•
Control respirators of the same model as those sampled from the facility were purchased from the open
market to be used as a comparison between stockpiled and new respirators.
Characteristics of Sampled Respirators
•
Table 1 provides a summary of the respirator models sampled from Facility Ten.
Table 1. FFRs Sampled from Stockpile Facility Ten
Model
Lot #
Year of
Manufacture
Shelf Life on
Packaging?
3M 1860
3M 1860
3M 8000
3M 8000
3M 8210
3M 8210
KC 46827
KC 46827
Gerson 1730
Gerson 1730
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
Lot A
Lot B
2006
2006
2006
2006
N/A 5
N/A5
2006
2007
2006
2006
No
No
No
No
No
No
No
No
No
No
Respirator Age at
Time of Testing 3
13 years
13 years
N/A
N/A
12-13 years
13 years
Shelf Life
Status at Time
of Testing
Past 5-year shelf
life 4
Past 5-year shelf
life4
N/A
N/A
Past 5-year shelf
life 6
No shelf life
designated
Based on the other nine collaborating stockpiles’ inventories, these six models were sampled in order to compare
performance within common respirator models when stored under disparate conditions.
2
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance and a minimum of 20 must be tested for filtration efficiency [NIOSH 2018].
3
Testing was completed in 2019.
4
3M designated a five-year shelf life for these models [3M 2018]. As of February 2020, the 3M 1860 still has a five-year
shelf life. The 3M 8000 is no longer produced or sold by 3M.
5
3M was consulted and could not determine the manufacturing date for this lot; it is estimated to be ~2006 based on the
other APR inventory.
6
KC designated a five-year shelf life for this model [KC 2018]. As of February 2020, this model still has a five-year shelf life.
1
3
�•
•
•
Twenty-three control respirators were tested for inhalation and exhalation resistance and filtration
performance. The 3M 1860 controls were manufactured in 2016, the 3M 8000 controls were
manufactured in 2006 7, the KC 46827 controls were manufactured in 2017, and the Gerson 1730
controls were manufactured in 2017. NIOSH testing requirements state that a minimum of three
respirator units must be tested for inhalation and exhalation resistance. The same three respirators can
be used for both inhalation and exhalation resistance testing [NIOSH 2018].
Inhalation and exhalation resistance and filtration performance of the stockpiled and control respirators
were evaluated using the same Standard Test Procedures (STPs) NIOSH uses for approving respirators
under 42 Code of Federal Regulations Part 84, “Approval of Respiratory Protective Devices” [NIOSH
2018] (Table 2).
Table 2 describes the method for evaluating the inhalation and exhalation resistance and filtration
performance of sampled respirators and control respirators.
Table 2. NIOSH Tests Conducted to Evaluate Inhalation and Exhalation Resistance and Filtration Performance.
NIOSH Standard Test
Procedures (STPs)
STP 3: Exhalation Resistance
STP 7: Inhalation Resistance
STP 59: Particulate Filter
Efficiency for N95
Pass/Fail Criteria for APRs
<25 mm H 2 O column @ 85 liters
per minute (LPM)
<35 mm H 2 O column @ 85 LPM
<5.0% particulate penetration
(>95.0% filter efficiency)
Stockpiled Respirators
Tested Per
Manufacturing Lot
Control Respirators
Tested
38
38
38
38
40 9
20
What NIOSH Found Through Inspection, Testing, and Evaluation
Storage Conditions
•
Visual Inspections—Dust and damage to product packaging was limited or not observed at Facility Ten;
an example of the most amount of product case damage is shown in Figure 2. Four product boxes
showed damage. Of the 430 respirators visually inspected, no concerns were noted.
3M 8000 is no longer produced or sold by 3M.
NIOSH testing requirements state that a minimum of three respirator units must be tested for inhalation and exhalation
resistance. The same three respirators can be used for both inhalation and exhalation resistance testing.
9
An increased sample size was used for the stockpiled respirators as opposed to the control respirators to increase the
precision of the performance estimates investigated.
7
8
4
�Figure 2: Most amount of damage observed on product cases from Facility Ten.
•
•
Temperature in the facility was controlled; temperature and %RH were monitored. Temperature was
monitored in 24 locations around the facility, with four temperature probes per location (for a total of
96 temperature probes). Percent relative humidity was monitored in one location. Fans were activated if
the temperature reached a set point. Stockpile personnel were automatically alerted if the temperature
or %RH were close to going out of range. Facility lights had motion sensor capabilities and were on for
10 minutes each time they were activated. Windows were covered with installation. No evidence of
excess moisture or chemical spills that persisted beyond immediate mitigation were observed. Pallets
were generally shrink wrapped around the four pallet sides and across the top. Generally, all pallets
were separated by a metal rack to reduce weight/load applied to a single pallet.
Percent RH (Figure 3) and Temperature (Figure 4)
o At the time of publication, the recommended storage requirements for %RH and temperature
are
3M 1860: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
3M 80007: remain under 80 %RH; remain within -4°F to 86°F [3M 2017]
KC 46827: remain under 60 %RH; remain within 68°F to 77°F [KC 2020]
Gerson 1730: remain under 80 %RH; remain within -4°F to 95°F [Gerson 2019]
o Facility Ten stockpile personnel provided annual average, minimum, and maximum temperature
and %RH data for 96 temperature probes and one %RH probe stored within the facility between
January 2014 – February 2019.
o The average temperature between the 2014 – 2019 time period was 71.9°F. The average %RH
between 2014 – 2019 was 44.6%; these averages were within the KC, 3M, and Gerson
recommended temperature and %RH storage conditions.
o 11 of the 15 maximum %RH probe readings provided from 2014 – 2019 exceeded KC’s
recommended minimum %RH of 60%. As shown in Figure 3, the largest deviation observed was
23.3 %RH, which was between January 2016 – January 2017.
5
�o
o
75 of the 478 maximum temperature probe readings provided from 2014 – 2019 exceeded KC’s
recommended maximum storage temperature of 77°F. As shown in Figure 4, the largest
deviation observed was 1.7°F, which was between January 2018 – February 2019 time period.
140 of the 478 minimum temperature probe readings provided from 2014 – 2019 went below
KC’s recommended minimum storage temperature of 68°F. As shown in Figure 4, the largest
deviation observed was 3.96°F, which was between January 2015 – January 2016.
6
�Figure 3: Percent Relative Humidity (% RH) from January 2014 – February 2019 for one %RH probe stored at
Facility Ten. Data is plotted as minimum, maximum, and average %RH.
Figure 4: Temperatures from January 2014 – February 2019 for 96 temperature probes stored at Facility Ten.
Data is plotted as minimum, maximum, and average temperatures.
7
�Inhalation and Exhalation Resistance
•
•
•
•
NIOSH evaluated the inhalation and exhalation resistance for a total of 30 stockpiled and 15 control
respirators. All stockpiled and control respirators from each model passed these tests (Figure 5).
Using an analysis of variance (ANOVA), there were no statistically significant differences (defined as
α<0.05) between each of the FFR controls and FFR stockpiled respirators for inhalation and exhalation
resistance when averaging across models.
When comparing the individual respirator models to their respective controls through an ANOVA with
adjusted, post-hoc multiple comparisons, the following statistically significant differences were found
with respect to inhalation and exhalation resistance: 1) both KC 46827 stockpiled 2006 Lots A and B
were lower; and 2) both Gerson 1730 stockpiled 2008 Lots A and B were higher.
For inhalation resistance, the individual stockpiled respirator with the highest resistance (12.45 mm
H 2 O) was below the NIOSH maximum limit for product approval (35 mm H 2 O allowable maximum). For
exhalation resistance, the individual stockpiled respirator with the highest resistance (12.19 mm H 2 O)
was below the NIOSH maximum limit for product approval (25 mm H 2 O allowable maximum).
8
�Figure 5: Control and stockpiled respirator inhalation (A) and exhalation (B) resistance data. N95 FFRs must have
an inhalation resistance less than 35 mmH 2 O and an exhalation resistance less than 25 mmH 2 O. The pass/fail
threshold for inhalation (A) and exhalation (B) resistance is shown by the red line. Error bars represent the 99%
confidence interval and estimate the population parameters. This confidence interval suggests that 99% of any
repeated samples tested and evaluated from this lot will have a mean between the upper and lower bounds.
9
�Filtration Performance
•
•
•
•
NIOSH evaluated the particulate penetration efficiency for 400 stockpiled respirators and 100 controls.
The mean percent particle penetration for each lot of respirators tested is shown in Figure 6.
None of the individual stockpiled respirators tested exceeded the 5.0% maximum. The highest
penetration for an individual stockpiled respirator was 4.03% and the highest penetration for an
individual control respirator was 3.37%.
Using an analysis of variance (ANOVA), there was an overall statistically significant difference (defined
as α<0.05) between the 3M controls (mean penetration=1.86, SD=0.57) and 3M stockpiled respirators
(mean penetration=1.06, SD=0.72), p<0.001; between Gerson controls (mean penetration=1.04,
SD=0.17) and Gerson stockpiled respirators (mean penetration=0.81, SD=0.19), p<0.001; and between
KC controls (mean penetration=1.77, SD=0.45) and KC stockpiled respirators (mean penetration=2.67,
SD=0.42), p<0.001.
When comparing the particle penetration for stockpiled respirator models to their respective controls
through an ANOVA with adjusted, post-hoc multiple comparisons, each of the comparisons were
significantly different.
Figure 6: Control and stockpiled respirator particle filtration performance data. N95 FFRs must have a particle
penetration of less than 5.0%. Error bars represent the 99% confidence interval and estimate the population
parameters. This confidence interval suggests that 99% of any repeated samples tested and evaluated from this
lot will have a mean between the upper and lower bounds.
10
�CASE Findings
Findings for the KC 46827 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
currently has a five-year recommended shelf life; Appendix 1 shows a KC letter to end users with shelf life
information, which states respirators past their shelf life should be discarded [KC 2018]. Thus, these respirators
tested are past their recommended shelf life. These findings pertain to KC units from Facility Ten and may not be
applicable to other stockpile facilities and/or under different environmental storage conditions.
Findings for the 3M 1860 and 3M 8210 Models:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. These two
models currently have a five-year recommended shelf life. Appendix 2 shows two 3M letters to end users with
shelf life and recommended storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are
past their recommended shelf life. These findings pertain to 3M units from Facility Ten and may not be
applicable to other stockpile facilities and/or under different environmental storage conditions.
Findings for the 3M 8000 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. This model
Is no longer produced and sold by 3M. Appendix 2 shows two 3M letters to end users with shelf life and
recommended storage condition information [3M 2018, 3M 2020]. Thus, all respirators tested are past their
recommended shelf life. These findings pertain to 3M units from Facility Ten and may not be applicable to other
stockpile facilities and/or under different environmental storage conditions.
Findings for the Gerson 1730 Model:
No failures for inhalation resistance, exhalation resistance, or filtration performance were observed—i.e., the
performance data suggests that these units would be protective so long as a proper fit is achieved. No shelf
life was designated for this model by the approval holder. These findings pertain to Gerson units from Facility
Ten and may not be applicable to other stockpile facilities and/or under different environmental storage
conditions.
Stockpile Storage Conditions:
The average temperature between the 2014-2019 time period was 71.9°F. The average %RH between 2014 2019 was 44.6%; these averages were within the KC, 3M, and Gerson previously described recommended
temperature and %RH storage conditions. Data points deviated from the KC recommended storage conditions
for the minimum and maximum temperature and maximum %RH. Stored under these conditions, NIOSH found
that 430 N95 FFRs evaluated in this study, which were 12-13 years old, maintained their inhalation and
exhalation resistance and filtration performance (i.e. all sampled respirators were below the NIOSH maximum
limit as defined by 42 CFR Part 84).
11
�NIOSH regulation sets the minimum quality and performance requirements for the approval of respirators
[NIOSH 1997]. NIOSH does not have requirements for shelf life or storage conditions for particulate-only APRs.
The approval holder 10 (i.e. the entity that is granted the approval from NIOSH) is responsible for understanding
how their products’ design or performance may be affected by various use or storage conditions and must
provide instruction for establishing the proper use, storage, and maintenance procedures for their approved
products, which may include designating a shelf life [NIOSH 2019]. FFR or particulate filter packaging (such as
the box) often includes NIOSH-approved user instructions, label information, and recommendations on shelf life.
Additionally, some approval holders also disseminate recommendations related to storage and shelf life through
resources such as user and web notices. The respirators tested in this study were generally not designed for
long-term storage.
At this time, we do not have enough information to definitively know the level of protection that may be
provided by respirators that 1) are stored for prolonged periods of times; 2) are stored under various storage
conditions; or 3) have exceeded the approval holder’s designated shelf life. Users of respirators that have
exceeded the designated shelf life should be forewarned to avoid a false sense of confidence; these devices may
not provide the same level of protection as those that have not exceeded the designated shelf life. We
recommend contacting the approval holder(s) of the respirators in the stockpile with specific questions
regarding the use of product beyond the designated shelf life.
NIOSH recommends users contact 3M regarding use of 3M model 8000 respirators.
10
An approval may be granted to a non-manufacturing entity.
12
�What Can Stockpile Personnel Do to Learn More about the
Respirators in their Stockpile?
•
•
•
Stockpile personnel should check the product information from the approval holder as well as the
NIOSH Certified Equipment List to remain up-to-date on product storage conditions, shelf-life
information, and NIOSH approval status. Check NIOSH’s Certified Equipment List to verify the respirator
model currently maintains its NIOSH approval at
https://www.cdc.gov/niosh/npptl/topics/respirators/cel/default.html
Stockpile personnel should work with the approval holder(s) of the stockpiled products with specific
questions regarding the use of expired product.
Sign up for NPPTL’s Listserv at https://www.cdc.gov/niosh/npptl/sub-NPPTL.html to receive email
notifications relevant to PPE.
For more information related to personal protective equipment, visit the NIOSH NPPTL website
https://www.cdc.gov/niosh/npptl/
Get More Information
Find NIOSH products and get answers to workplace safety and health questions:
1-800-CDC-INFO (1-800-232-4636) | TTY: 1-888-232-6348
CDC/NIOSH INFO: cdc.gov/info | cdc.gov/niosh
Monthly NIOSH eNews: cdc.gov/niosh/eNews
All photos courtesy of NIOSH NPPTL.
Disclaimer
The recommendations in this report are made based on the findings at the stockpile evaluated and may not be
applicable to other stockpile facilities.
Mention of any company or product does not constitute endorsement by the National Institute for Occupational Safety and Health
(NIOSH). In addition, citations to websites external to NIOSH do not constitute NIOSH endorsement of the sponsoring organizations or
their programs or products. Furthermore, NIOSH is not responsible for the content of these websites. All web addresses referenced in
this document were accessible as of the publication date.
13
�Suggested Citation
NIOSH PPE CASE: Inhalation and Exhalation Resistance and Filtration Performance of Stockpiled Air-Purifying Respirators:
Facility Ten of Ten. By Greenawald, L., Moore, S., and Yorio, P. Pittsburgh, PA U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health.
References
3M [2017]. Frequently Asked Questions: 3M Filtering Facepiece/Disposable Respirator Storage Conditions and Shelf Life. St.
Paul, MN. https://multimedia.3m.com/mws/media/1015853O/faq-3m-filtering-facepiece-disposable-respirator-storageconditions-and-shelf-life.pdf [accessed February 27, 2020].
3M [2018]. 3M Personal Safety Division Letter. St. Paul, MN: The 3M Company.
https://multimedia.3m.com/mws/media/1430383O/3m-filtering-facepiece-shelf-life-letter.pdf.
3M [2020]. Frequently Asked Questions: 3M Health Care Particulate Respirator and Surgical Masks Storage Conditions and
Shelf Life. St. Paul, MN. http://multimedia.3m.com/mws/media/869238O/3m-health-care-particulate-respirator-andsurgical-masks-storage-conditions-and-shelf-life-faq.pdf
ASTHO [2013]. Federal Emergency Preparedness Directives and Systems- Emergency Authority and Immunity Toolkit.
Arlington, VA: Association of State and Territorial Health Officials. http://www.astho.org/Programs/Preparedness/PublicHealth-Emergency-Law/Emergency-Authority-and-Immunity-Toolkit/Federal-Emergency-Preparedness-Directives-andSystems-Fact-Sheet/.
Carias C, Rainisch G, Shankar M, Adhikari BB, Swerdlow DL, Bower WA, Piliai SK, Meltzer MI, Koonin LM [2015]. Potential
demand for respirators and surgical masks during a hypothetical influenza pandemic in the United States. Clinical Infectious
Diseases 60 (1): S42-S51 https://doi.org/10.1093/cid/civ141.
DHHS [2012]. An HHS retrospective on the 2009 H1N1 influenza pandemic to advance all hazards preparedness.
Washington D.C: U.S. Department of Health and Human Services, https://www.phe.gov/Preparedness/mcm/h1n1retrospective/Documents/h1n1-retrospective.pdf.
Gerson [2019]. Gerson Customer Service, email correspondence, October 1, 2019.
KC [2018]. Kimberly Clark Letter to Customers (Appendix 1).
KC [2020]. Kimberly Clark representatives, email correspondence, February 25, 2020.
NIOSH [1997]. 42 CFR Part 84 respiratory protective devices. Cincinnati, OH: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/topics/respirators/pt84abs2.html.
NIOSH [2017]. Workplace safety and health topics: healthcare workers. Cincinnati, OH: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/topics/healthcare/default.html.
NIOSH [2018]. Standard respirator testing procedures. Cincinnati, OH: U.S. Department of Health and Human Services,
Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/stps/apresp.html.
NIOSH [2019]. NIOSH conformity assessment notice: NIOSH CA 2019-1012, NIOSH respirator approval contents and
meaning. Pittsburgh, PA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention,
National Institute for Occupational Safety and Health,
https://www.cdc.gov/niosh/npptl/resources/pressrel/letters/conformitynotice/CA-2019-1012.html.
14
�Patel A, D'Alessandro M, Ireland KJ, Burel WG, Wencil EB, Rasmussen SA [2017]. Personal protective equipment supply
chain: lessons learned from recent public health emergency responses. Health Security. 15 (3): 244-252
https://doi.org/10.1089/hs.2016.0129.
Rottach DR, Lei Z [2017] Stockpiled N95 filtering facepiece respirator polyisoprene strap performance. J Int Soc Respir Prot.
34 (2): 69-80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6198819/.
15
�Appendix 1 [KC 2018]
16
�Appendix 2 [3M 2018], [3M 2020]
17
�18
�19
�20
�21
�
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PPE CASE Reports: Performance of Stockpiled Air-Purifying Respirators
Subject
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Infection Control
Description
An account of the resource
Personal Protective Equipment Conformity Assessment Studies and Evaluations (PPE CASE) provide the public with findings from post-market personal protective equipment tests, evaluations, and investigations. <br /><br />On this page NIOSH provides ten PPE CASE reports related to the performance of over 3,900 stockpiled air-purifying respirators that were sampled from 10 U.S. stockpile facilities. The reports and findings are available on the NIOSH website: <a href="https://www.cdc.gov/niosh/npptl/ppecase/default.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/npptl/ppecase/default.html<br /></a>
<div class="row">
<div class="col-md-12">
<h3>Performance of Stockpiled Air-Purifying Respirators</h3>
<ul class="list-false">
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-1-v3-03012020-508.pdf">Facility One of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 2 MB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-2-v2-03012020-508.pdf">Facility Two of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 2 MB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-3-v2-03012020-508.pdf">Facility Three of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 2 MB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-4-v2-03012020-508.pdf">Facility Four of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 3 MB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-5-v2-03012020-508.pdf">Facility Five of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 3 MB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-6-v2-03012020-508.pdf">Facility Six of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 3 MB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-7-v2-03012020-508.pdf">Facility Seven of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 3 MB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-8-v2-03012020-508.pdf">Facility Eight of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 3 MB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-9-v2-03012020-508.pdf">Facility Nine of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 861 KB]</span></a></li>
<li><a href="https://www.cdc.gov/niosh/npptl/ppecase/pdfs/PPE-CASE-Stockpile-10-v2-03012020-508.pdf">Facility Ten of Ten: Inhalation and Exhalation Resistance and Filtration Efficiency Performance <span class="sr-only">pdf icon</span><span class="fi cdc-icon-pdf x16 fill-pdf"></span><span class="file-details">[PDF – 3 MB]</span></a></li>
</ul>
</div>
</div>
Creator
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CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-25
Contributor
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2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Airborne Transmission
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/fa965d28d489a2e532959fc35e1580ad.pdf
4199b93b796b395274ccc32dc3bd7dd5
PDF Text
Text
Radonovich et al. BMC Infectious Diseases (2016) 16:243
DOI 10.1186/s12879-016-1494-2
STUDY PROTOCOL
Open Access
The Respiratory Protection Effectiveness
Clinical Trial (ResPECT): a clusterrandomized comparison of respirator and
medical mask effectiveness against
respiratory infections in healthcare
personnel
Lewis J. Radonovich Jr.1*, Mary T. Bessesen2,12, Derek A. Cummings13,14, Aaron Eagan1, Charlotte Gaydos3,
Cynthia Gibert4, Geoffrey J. Gorse5, Ann-Christine Nyquist6,12, Nicholas G. Reich7, Maria Rodrigues-Barradas8,
Connie Savor-Price9,12, Ronald E. Shaffer10, Michael S. Simberkoff11 and Trish M. Perl3
Abstract
Background: Although N95 filtering facepiece respirators and medical masks are commonly used for protection
against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal
settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane
research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from
public health organizations, professional societies, and experts.
Methods: The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory
protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient
settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections
during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections,
acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with
symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily
diaries. Adherence to study protocols will be monitored by the study team.
Discussion: ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness
among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders
make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory
infections and prevention of spread within healthcare systems.
Trial registration: The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010).
Keywords: Respirators, Masks, Healthcare personnel, Influenza, Respiratory infections
* Correspondence: lewis.radonovich@va.gov
1
U.S. Department of Veterans Affairs, National Center for Occupational Health
and Infection Control, 1601 SW Archer Road, Mailstop 151E, Gainesville,
FL 32608, USA
Full list of author information is available at the end of the article
© 2016 Radonovich et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
Background
Healthcare personnel (HCP) are exposed to respiratory
pathogens in many clinical settings [1]. Infected HCP
may spread infection to their patients [2–5] or coworkers [3–6], to family members [4, 7], or to other
community members [4, 8]. Respiratory viral infections
among healthcare workers can negatively impact delivery
of healthcare services [9–11].
United States national guidelines call for modes of
transmission to dictate infection control measures [3].
For most human respiratory viruses, the precise mode(s)
of person-to-person transmission is incompletely understood [12, 13]. The predominant mode of transmission
for some human respiratory pathogens, such as influenza virus, respiratory syncytial virus, and coronavirus is
believed to be droplet transmission. Airborne transmission plays a role with some human respiratory pathogens
via small aerosol particles, often called droplet nuclei
[3]. Airborne transmission is the predominant mode of
transmission for Mycobacterium tuberculosis [3, 14] and
recent evidence has suggested a larger role than previously thought for Influenza A and B viruses [15, 16].
Disposable respiratory protective devices (RPD) that fit
tightly to the wearer’s face, sometimes called airpurifying respirators or filtering facepiece respirators,
are primarily designed to protect the wearer against infection spread by ill patients. N95 filtering facepiece respirators (commonly known as “N95 respirators”) are one
type of RPD capable, with proper facial fit and usage, of
reducing inhalation of airborne particulates by a factor
of 10 or greater [17]. Medical masks (MM), typically
called surgical masks in operative settings, are primarily
devised to protect patients against infection spread by
the wearer [18]. Both types of devices also serve as a
physical barrier keeping sprays and splashes of infectious
materials and contaminated hands and objects away
from oronasal region of wearer. Although RPD and MM
are capable of filtering particulates [19], RPD are
designed to filter smaller particulates that may remain
airborne for long periods. A tight seal between the respirator and the wearer’s face is designed to prevent leakage
of particulates, a feature not provided by loose-fitting
MM. The U.S. Department of Labor’s Occupational Safety
and Health Administration (OSHA) requires employers to
ensure each HCP, who may be exposed to airbornetransmissible infections in the workplace, receives an RPD
with an adequate respirator-to-face seal that is determined
during a mandated annual “fit-test”.
However, evidence is inconclusive that RPD are better
than MM at protecting HCPs from respiratory infections
in clinical settings [20–25], despite tight-fitting RPD
produced by manufacturers, with higher levels of exposure reduction validated by numerous laboratory studies
[19, 26–28], and the use of a complete respiratory
Page 2 of 10
protection program (e.g., training, initial and annual fit
test) as defined by OSHA to protect HCP. Intuitively,
RPD should better protect HCP against airborne infections than MM, but objective evidence has not validated
this supposition. One possibility that may explain this
discrepancy between expectations and observations is
pragmatic: HCP, in general, do not tolerate N95 respirators as well as medical masks [29, 30], perhaps prompting them to remove respirators more frequently and/or
for longer periods, increasing the likelihood of exposure
to infections. Models have shown that 25 % or more
non-wear time during exposure negates any significant
differences in protective ability between types of RPDs
[17, 31]. Given the difficulty with HCP adherence to
guidelines [4] and general dissatisfaction [4, 32–34] with
RPD, medical masks worn more consistently may provide similar levels of reduction in respiratory viral disease transmission as N95 respirators.
This key gap in knowledge has contributed to discrepant clinical and public health recommendations about
respiratory protection for HCP [35, 36]. Needed are additional well-designed clinical trials conducted in patientcare settings during outbreaks of respiratory infections.
The following is an abridged version of the full research
protocol for the Respiratory Protection Effectiveness
Clinical Trial (ResPECT).
Objective
To compare the effectiveness of N95 respirators and
medical masks at protecting HCP from acquiring viral
respiratory illnesses in the workplace.
Hypotheses
Null Hypothesis: The incidence of laboratory confirmed
influenza (primary), influenza-like illness (ILI), acute respiratory illness (ARI) and other respiratory infections will
not be different between HCPs who practice 2007 guidelines (medical masks) or 2009 guidelines (N95 respirators).
Alternative Hypothesis: The incidence of laboratory
confirmed influenza (primary), influenza-like illness
(ILI), acute respiratory illness (ARI) and other respiratory infections will be different between HCPs who practice the CDC’s 2007 guidelines for influenza protection
(medical masks) versus 2009 guidelines for influenza
protection (N95 respirators).
Methods
General overview
ResPECT is a prospective comparison of respiratory protective equipment to be conducted at multiple, geographically
distributed U.S. study sites. HCP who work in outpatient settings will be cluster-randomized to wear N95 respirators
[37] or MM [38] for protection against infections during respiratory virus season, the “intervention” period.
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
The null hypothesis assumes N95 and MM intervention
groups will have no differences in outcomes, including (1)
laboratory confirmed influenza or (2) influenza-like illness
(ILI), (3) acute respiratory illness (ARI), and (4) laboratory
confirmed respiratory illness (LCRI). The alternative hypothesis asserts the incidence of at least one outcome
would be different between intervention groups.
Because respiratory virus season varies year-to-year in
onset, severity, and duration, multiple season-years of
the study will be necessary to account for expected variance and optimally generalize the resulting knowledge.
The beginning of each season’s data collection will be
independently determined for each study site using an
epidemiologic predictive tool designed for ResPECT to
capture the largest possible number of respiratory
infections. These data will be collected for twelve weeks
each season.
Participant exposures to patients, coworkers, and
others with symptoms and signs of respiratory infection,
both within and beyond the workplace, will be recorded
in daily diaries. Adherence to study protocols will be
measured by the study team at each site. Since periodic
changes in infection control guidance and practice may
occur over the study years, participants will be expected
to adhere to the most up-to-date guidance issued by the
Centers for Disease Control and Prevention (CDC) and
local policies at each study institution, at a minimum.
For example, a participant randomized to the MM arm
will be expected to don an N95 when participating in
an aerosol-generating procedure, assuming no further
changes in pertinent national guidance [39].
Participants and setting
The study participants will be recruited from outpatient
settings where patients are relatively likely to present
with symptoms and signs of acute respiratory infection.
Participants will be eligible to enroll for multiple study
seasons, yet each will be provided with informed consent
and complete enrollment procedures prior to each study
season.
Clinical Study sites will be distributed geographically:
1. Veterans Affairs New York Harbor Healthcare
System; New York, NY
2. Johns Hopkins Health System and University;
Baltimore, MD;
3. Washington DC Veterans Affairs Healthcare
System; Washington, DC;
4. Veterans Affairs Eastern Colorado Healthcare
System; Denver, CO;
5. Denver Health; Denver, CO
6. Childrens’ Hospital Colorado; Aurora, CO
7. Michael E. DeBakey Veterans Affairs Medical
Center; Houston, TX
Page 3 of 10
Inclusion criteria
(1) Clinical study site leadership agree to have one or
more staff participate
(2) Participant meets the definition of “healthcare
personnel”
(a) Provides healthcare to patients and/or
(b) Routinely positions herself/himself within 6 feet of
patients (“close contact”) and
(c) Is a full-time employee (average of ≥ 24 hours/
week) working 75 % of the time at a study site and
not employed at another location where the study
is being conducted
(3) Participant is able to read and sign informed consent
(4) Participant agrees to all requirements of the
protocol, including fit-testing and diary-keeping
(5) Participant is age 18 years or greater
(6) Participant passes fit-testing for at least one of
the study respirator models and, if assigned to the
respirator arm, agrees to use that model for the
seasonal study period.
Exclusion criteria
(1) Participant self-identifies as having severe heart,
lung, neurological or other systemic disease that
one or more Investigator believes may preclude safe
participation.
(2) Participant is known to not tolerate wearing
respiratory protective equipment for any period.
(3) Participant has facial hair adornments or other
anatomic features that preclude respirator
Occupational Safety and Health Administration
(OSHA)-compliant fit-testing or proper fit during
the seasonal data collection period.
(4) Participant is advised by a study site occupational
health clinician (or other qualified clinician) to not
wear the same or similar respirator or medical
mask models used in ResPECT.
(5) Participant self-identifies as pregnant in the third
trimester during the seasonal study period.
(6) Participant is working in more than one ResPECT
study sites during the seasonal study period.
(7) Participant is working less than 24 hours per week
during the seasonal study period at a ResPECT
study site.
(8) Participant is working less than 75 % of the
seasonal study period at a ResPECT study site.
(9) Participant is a previous ResPECT study participant
who does not consent to have her/his data linked
from a previous viral respiratory season(s).
(10)In the opinion of a principal investigator,
participant may not be able to join the trial for any
other reason.
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
Page 4 of 10
Interventions
N95 respirators and medical masks
Table 1 Study RPD particle penetration and airflow resistance
Participants will be cluster-randomized to one of the following N95 respirators or MM models, selected because
they are commonly used in U.S. medical facilities,
including the ResPECT study sites. Participants who
participate in more than one of the study years will be
cluster-randomized anew each year.
N95 Respirators:
N95 respirators
(1) 3 M Corporation 1860, 1860S, and 1870 models
(St Paul, MN) or
(2) Kimberly Clark Technol Fluidshield PFR95-270,
PFR95-274 (Dallas, TX).
Medical Masks:
(1) Precept 15320 or
(2) Kimberly Clark Technol Fluidshield 47107.
Respirator Fit
All subjects participating in the study will be required
to pass an OSHA-accepted respirator fit test for the N95
respirator model(s) available at the study site. No fit testing of medical masks will be performed as these devices
are not designed to be tight-fitting to the face and
studies [19, 20] have shown that their fit capabilities are
generally low.
Filter Performance
Although medical masks are loose-fitting, they create
a physical barrier that helps prevent splashes and sprays
from reaching the wearer’s mucous membranes. In
addition to passage around the mask, some of the small
particle aerosols are able to pass through the mask’s filter
media. Therefore, in addition to RPDs, filtration testing
was done on medical masks prior to enrollment of subjects to ensure consistency between models across study
locations. The filtration performance of the N95 respirators and medical mask models in the study were tested
in a manner similar to that used by the National
Institute for Occupational Safety and Health (NIOSH).
Devices were attached to a test fixture and placed in a
TSI 8130 automated filter tester operated with an air
flow rate of 85 liters per minute. The TSI 8130 uses a
photometer to measure the flux of light scattering from
aerosol particles. Polydispersed particles (mass median
diameter of ~0.3 microns) were generated from a 2 %
NaCl solution and passed through each device being
tested for 1 min. Each test was repeated 3 times with a
fresh N95 respirator or medical mask. To be certified as
an N95 respirator, filter penetration needs to be less than
5 % (or 95 % efficient). As shown in Table 1, the average
penetration percentages for the NIOSH certified N95
respirators were an order of magnitude lower than those
% penetrationa
Resistance (mmH2O)a
3 M 1860/1860S
0.7
8.9
3 M 1870
0.3
9.6
Kimberly Clark Technol
Fluidshield PFR95-270/274
1.4
11.7
Device name
Medical Masks
Precept 15320
12.9
4.1
Kimberly Clark Technol
Fluidshield 47107
10.3
4.5
a
Average value from 3 replicate measurements
of medical masks, which are not NIOSH certified. Filter
results between N95 respirator models and between
medical mask models were comparable.
Filter airflow resistance was measured simultaneously
using the TSI 8130. As filter airflow resistance increases,
more energy expenditure is required for ventilation during device wear and the greater potential for perception
of discomfort [40]. The medical mask models selected
for this study have filter airflow resistance levels about
half of that of the N95 respirators. However, one study
[40] found that subjective and physiological responses
were not different among subjects exercising while wearing devices purposely made with different filter airflow
resistance levels (3 mm H2O, 6 mm H2O, and 9 mm
H2O) in the range similar to those of the devices in this
study (Table 1).
Adherence to intervention arm and hand hygiene
performance
Participants will be instructed to don a new N95/MM
with each patient interaction, every time a participant
encounter occurs within 6 feet of a patient who has suspected or confirmed respiratory infection. Hand hygiene
will be recommended to all participants in accordance
with CDC guidelines [41] and policies at each study
institution. Trained research assistants will observe participants during study periods to assess adherence to
their assigned intervention arms and hand hygiene. A
portable computer equipped with data recording software (HandyAudit; Toronto, Canada) will be used to
document adherence. Participants will be expected to
complete surveys about their attitudes and opinions concerning personal protective equipment before and after
each seasonal study period.
Estimation of exposure
During the twelve week data collection period each year,
participants will self-document (a) perceived occupational exposures to patients or coworkers who have
symptoms or signs of respiratory infection, (b) perceived
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
non-occupational exposures to persons who have symptoms or signs of respiratory infection, (c) use of personal
protective equipment, and (d) personal symptoms or
signs of respiratory illness.
Study outcome definitions
Collection of specimens
Anterior nasal and pharyngeal swabs [42–45] [FLOQSwabs UTM (99–08024), Diagnostic Hybrids; Athens,
OH] will be collected by research assistants when
symptomatic with study defined respiratory symptoms,
as well as two, randomized asymptomatic swabs during
each seasonal study period. Swabs will be collected when
(a) participants self-report respiratory symptoms within
a 24 h period, and again if participants remain symptomatic after 7 days; and (b) randomly, on all participants,
twice during the active intervention period.
The Primary Outcome Measures will be the incidence of:
Laboratory-confirmed influenza (LCI) A or B infection
in participants, defined as a) detection of influenza virus by
reverse-transcription polymerase chain reaction (RT-PCR)
in an upper respiratory specimen swab collected within
seven days of symptom onset, or b) influenza seroconversion defined as at least a 4-fold rise in hemagglutination
inhibition antibody (HAI) titers to influenza A or B virus
from the pre- to post-season serological samples that is not
deemed attributable to vaccine.
The Secondary Outcome Measures will be the incidence of:
(1) Acute Respiratory Illness (ARI) defined as the
occurrence of one sign or two symptoms (Table 2)
without laboratory confirmation.
(2) Laboratory Confirmed Respiratory Illness (LCRI)
defined as self-reported ARI plus the presence of one
or more RT-PCR confirmed infectious pathogens
(Table 3) in a specimen collected from the upper
respiratory tract and/or a clinically significant rise in
pre- and post-season serum antibody titers to
influenza A or B virus.
(3) Influenza-Like Illness (ILI) defined as temperature
of 100 °F [37.8 °C] or greater plus cough and/or a
sore throat, with or without laboratory
confirmation.
The incidence rate ratios between participants randomly assigned to wear N95 respirators or medical
masks will be estimated for each of the primary and secondary outcomes.
Outcome determination, validation, and adjudication
Investigators will be paired and provided with blinded
information about clinical and laboratory data to
Page 5 of 10
Table 2 Case definition of acute respiratory illness used in the
ResPECT study
Signs
Fever (T > 37.8 °C)
Tachypnea (Respiratory Rate ≥ 25)
Coryza
Lymphadenopathy
Symptoms
Vomiting/Nausea
Diarrhea
Cough
Sputum production
Fatigue
Malaise
Headache
Sore throat
Dyspnea
Chills
Sweats
Arthralgias/Myalgias/Body Aches
Other gastrointestinal symptoms
*Acute respiratory illness (ARI) is defined as: The presence of one sign(s) OR
two symptom(s), as listed. Reported signs or symptoms must represent a
change from baseline
determine if a participant meets a primary or secondary
outcome. If the paired investigators do not agree, a principal investigator will adjudicate the outcome.
Laboratory methods
Respiratory pathogen identification
Assays will be performed at Johns Hopkins University.
Collected respiratory specimens will be stored at −80 °C
until analyzed using multiplex PCR (PLEX-ID, Abbott
Labs, Chicago IL). Automated extraction of nucleic acid
(NA) from respiratory specimens will be performed utilizing NorDiag’s Arrow instrument and the Magna Pure robotic system (Roche Indianapolis, IN) per manufacturer
instructions. Each extraction run will include a quality
control (NATrol Respiratory Validation Panel 3, Zeptometrix Inc., Buffalo NY); runs with control failures will be repeated. Purified NA will be amplified via RT-PCR using a
broad respiratory virus identification kit (PLEX-ID RVS
3.0, Abbott Molecular, Des Plaines, IL). Desalting of RTPCR product and electrospray mass spectrometry-based
NA analysis will be performed on the PLEX-ID analyzer
instrument. If funding is sufficient, samples will also be
assayed by RT-PCR for Bordetella pertussis, Mycoplasma
pneumoniae, and for Chlamydophila pneumoniae.
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
Table 3 Potential influenza like illness pathogens
Influenza A
Influenza B
Respiratory syncytial virus type A
Respiratory syncytial virus type B
Parainfluenza virus type 1
Parainfluenza virus type 2
Parainfluenza virus type 3
Parainfluenza virus type 4 (a)
Parainfluenza virus type 4 (b)
Human Metapneumovirus
Adenoviruses
Coronavirus OC43
Page 6 of 10
emergency department, urgent care or primary care, (c)
patient population served, such as children or adults,
and (d) requirements for participants to wear additional
protective equipment, such as goggles donned by dental
hygienists. For each study season, the clinics in each
matched pair will be randomly assigned to opposing
study arms. For matched pairs participating in multiple
study seasons, random sequences of arm assignments
will ensure each is assigned to both study arms during
the multi-year study. Each study season, an individual
not involved in the study implementation and data
analyses will perform the randomization scheme for each
study site, using a random number generator in Microsoft
Excel. The principal investigators will be blinded to the
randomization scheme prior to assignment.
Coronavirus NL63
Coronavirus 229E
Statistical analyses
Coronavirus HKU1
Incidence rates of LCI, ARI, ILI, and LCRI among
cluster-randomized participants will be compared. The
relationships between incidence of clinically diagnosed
and laboratory-confirmed illnesses will be analyzed with
attention to potential confounders, such as participants’
demographics, study arm compliance, attitudes and
opinions about infection control, receipt of influenza
vaccination, and infectious exposures within and beyond
the workplace. Standard statistics will describe baseline
characteristics and follow-up measures, summarized by
treatment arm and stratified by study site.
To assess the primary outcome, a logistic regression
model will be fit using a dichotomous variable to indicate whether a participant became infected with a respiratory pathogen. The odds of infection between the
two treatment groups will be reported with a 95 % confidence interval. For secondary outcomes, Poisson loglinear mixed effects regression models will assess the difference in seasonal respiratory infection rates between
intervention groups. Cluster- and individual-level random effects will be considered to account for clustered
observations. Additional covariates may be added to the
models to adjust for confounding.
Human Rhinovirus
Cocksackie/echoviruses
Bocavirus
Serologic testing
Each study season, blood samples will be collected twice
from each participant; one sample will be collected
within two weeks of the beginning of the intervention
period and a second within two weeks of the end of the
intervention period. Hemagglutination inhibition (HAI)
antibody assays will be performed on serum for influenza A and B virus strains, dependent on the antigens in
each annual trivalent vaccine using standard methods
[46, 47]. In brief, serial 2-fold dilutions of serum samples
will be incubated with 8 hemagglutinin units of influenza antigen and a turkey red blood cell suspension. The
serum HAI antibody titer will be defined as the dilution
factor of the highest serum dilution that completely
inhibits agglutination of turkey red blood cells in the
presence of type-specific hemagglutinin antigen. Assays
will be performed at the immunology core lab for the
study at the VA Saint Louis Veterans Affairs Healthcare
System.
Missing data
Statistical methods
Randomization
To optimize compliance and generalizability, a clusterrandomized design will be utilized. All participants
working in the same clinical unit will be assigned to
wear the same respiratory protective equipment (i.e., an
N95 or MM) during patient interactions for the entire
12 week seasonal study period. Clusters will be pairmatched within each study site based on the characteristics of each clinical cluster, including the (a) number of
participants (b) occupational location, such as an
Participants will be encouraged to complete the study.
Those who withdraw from an intervention arm will be
encouraged to complete follow-up laboratory specimen
collection. An intent-to-treat analysis, in which all available data on all randomized participants are included,
will be used for the primary comparison of interventions. A per-protocol secondary analysis will compare
treatment effectiveness, accompanied by a planned
sensitivity analysis that accounts for participants from
whom researchers were not able to obtain a second
serological sample.
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
Sample size and power calculations
To detect a 25 % reduction (i.e., a relative risk of 0.75) in
the incidence of laboratory confirmed influenza or
laboratory confirmed respiratory illness among participants wearing an N95 respirator, compared to participants wearing a medical mask, ResPECT will need
to accumulate approximately 10,024 or 5104 personseasons of data over four seasons respectively.
Sample size calculations are based on several assumptions about the incidence rate and levels of withincluster correlation. The attack rate laboratory-confirmed
influenza during a single study season is assumed to be
20 % among unvaccinated individuals in the medical
mask group. We assume 65 % of our population will be
administered a vaccine that is 65 % effective in preventing influenza infection. Vaccine effectiveness at the
higher end of published reports (86 % in health care
workers) will lead to a reduction in the yearly attack rate
to approximately 8.8 %, and effectiveness at the lower
end of published reports (51 % in the general population) would lead to an increased yearly attack rate of approximately 13.4 %. Importantly, the anticipated effect
on the needed sample size of annual variations in influenza incidence is larger than the expected impact of
variation in vaccine effectiveness.
The ResPECT study will need 157 independent clusters with a median size of 16 participants each to achieve
80 % power to detect a relative risk of 0.75 between N95
and surgical masks at preventing laboratory-confirmed
influenza infection, with a Type-I error rate of 0.05. The
total number of individuals participating each season
will need to be approximately 2506, with 10,024 total
person-seasons accumulating over the multi-year study.
For the secondary outcome of laboratory confirmed respiratory illness, the estimated total number of clinics
will need to be 80, the total number of individuals participating each season will need to be 1276, and total
person-seasons accumulated need to be 5104 (Table 4)
over the multi-year study. The sample size are made
using the clusterPower software package for R [48].
Table 4 Sample size and power calculations for primary and
secondary outcome
Laboratory confirmed Laboratory confirmed
influenza
respiratory illness
Annual attack rate,
Medical Mask group
0.12
0.25
Cumulative 4-year attack 0.39
rate, Medical Mask group
0.68
Detectable relative risk
0.75
Page 7 of 10
Power is estimated using an expected annual attack rate
of 12 % {12 % = 0.35*0.2 + 0.65*(1–0.65)*0.2} [13]. This
yearly attack rate translates into a 4-year attack rate of
39 % {39 % = 1-(1-(0.35*0.2 + 0.65*0.35*0.2))4. Accounting for correlation of outcomes within clusters by
assuming the correlation coefficient is 0.1, leads to a design effect of 2.5.
For scenarios representing the lower and higher ends
of anticipated attack rates in the medical mask group,
two quantities were calculated (a) the power to detect a
relative-risk of 0.75 between the N95 group and the
medical mask group and (b) the relative-risk that can be
detected with 80 % power (Table 5). For all of these calculations the two-sided Type I error probability is 0.05.
Sensitivity analysis
Potential outcome analysis for laboratory-confirmed
influenza Some data on the primary outcome may be
missing due to participants withdrawing from the study
early and missing the second serological sample. To account for the unavoidable uncertainty posed by missing
primary outcome data, due to participant withdrawal or
loss of follow-up, a sensitivity analysis will be conducted
that randomly assigns binary outcomes to participants
who did not complete the study. A two-dimensional grid
will be created that varies the influenza attack rates
among participants who withdraw. Withdrawal attack
rates in both arms will be fixed between half and twice
the observed attack rates, based on complete data. By
varying these two parameters across the grid, and for
each combination, the adjusted odds ratio will be calculated by averaging across n = 50 imputed datasets for
each point on the grid.
Analysis of differential withdrawal The characteristics
at the time of randomization for participants without
complete follow-up will be examined. To assess the
potential biases introduced by differential withdrawal
among different N95 respirators, a comparison of withdrawal rates and time to withdrawal will be included as
an ancillary analysis to the analyses of the primary and
secondary outcomes.
Ethical approvals
0.75
Median cluster size
16
16
ICC
0.1
0.1
Total person-seasons of
observation
10,024
5104
ResPECT will be approved by the institutional review
board at each participating study site and the Centers
for Disease Control and Prevention, prior to study initiation. (An unabridged version of the ResPECT protocol
was approved by the intitutional review board at each
study site and the Centers for Disease Control and
Prevention).
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
Page 8 of 10
Table 5 Power analysis of the sensitivity to the 4-year attack rate
Low attack rate scenario
High attack rate scenario
Outcome
Medical mask
attack rate
Power
(RR = 0.75)
Detectable RR
(80 % Power)
Medical mask
attack rate
Power
(RR = 0.75)
Detectable RR
(80 % Power)
Primary
0.2
43 %
0.62
0.5
93 %
0.80
Influenza like illness
0.15
33 %
0.56
0.4
82 %
0.76
Acute respiratory illness
0.5
93 %
0.80
0.95
100 %
0.94
Laboratory confirmed respiratory illness
0.3
91 %
0.79
0.7
100 %
0.90
Data safety monitoring board
A Data Safety Monitoring Board (DSMB) consisting
of three or more members will be convened. Members
with germane expertise in clinical infectious diseases, epidemiology, and clinical trials will be sought, changing in
number and composition to meet study needs. The DSMB
will independently monitor interim data, to which the investigators will be blinded, identifying an appropriate
times for protocol modification or termination.
Sponsors
ResPECT is jointly funded by the U.S. Department of
Veterans Affairs (Veterans Health Administration) and
the U.S. Department of Health and Human Services
(Centers for Disease Control and Prevention, National
Institute for Occupational Safety and Health, and the
Biomedical Advanced Research Project Authority).
Discussion
Viral respiratory infections cause a wide range of
illnesses, varying from mild to severe, in HCPs who may
spread infection to their patients, family members, and
other community members. Healthcare-associated infections cost $10B annually in U.S [49]. Factors influencing
transmission of respiratory infections in healthcare
facilities include the population density of ill patients in
healthcare settings, the types of exposures within healthcare settings, the administrative and physical structures
of healthcare facilities, and intrinsic characteristics of
virulence [3]. Measures to prevent transmission within
healthcare facilities include HCP vaccination, handhygiene, cleaning and disinfection of inanimate surfaces,
pre- and post-exposure antiviral chemoprophylaxis, patient isolation, and personal protective equipment [3, 6].
ResPECT is designed to better understand the extent to
which PPE, specifically represented by differences in exposure reduction afforded by N95s and MMs, reduces
clinical illness among HCPs.
While it may seem that N95 respirators should better
protect HCPs than MM against airborne infections in
the workplace, this notion has not been validated by
objective clinical evidence. Low tolerance to respirator
wear among HCPs may prompt more frequent or longer
periods of removal, compared to MM, to an extent that
the benefits of higher levels of filtration and lower levels
of leakage around the facial seal afforded by respirators
is offset or subjugated.
Key sources of variability in HCP health outcomes are
difficult to control for, even in a rigorously designed
clinical study such as ResPECT. For example, the inability to prevent HCP community exposures to respiratory
infections and the inherent year-to-year variation of viral
respiratory infections provide a challenging setting in
which to evaluate the effectiveness of personal protective
equipment. While community-acquired infections may
pose a significant source of exposure for HCPs, this type
of exposure, if occurring non-differentially between
study arms, would bias the results from ResPECT towards the null hypothesis.
Key reasons for choosing a cluster-randomized
design are (a) to increase compliance by equipping all
members of a healthcare team with the same equipment and (b) to capture indirect effects of the intervention at the cluster-level, such as herd immunity
[50].
A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned
decisions about protection of HCPs against occupationally acquired respiratory infections and prevention of
spread within healthcare systems.
Abbreviations
ARI, acute respiratory illness; CDC, centers for disease control and prevention;
DSMB, data safety monitoring board; HAI, hemagglutination inhibition
antibody; HCP, healthcare personnel; ILI, influenza like illness; LCRI,
Laboratory confirmed respiratory illness; MM, medical mask; N95, N95
respirator; NIOSH, National Institute for Occupational Safety and Health;
OSHA, Occupational Safety and Health Administration; PPE, occupational
protective equipment; ResPECT, respiratory protection effectiveness clinical
trial; RPD, respiratory protective devices; RT-PCR, reverse-transcriptase
polymerase chain reaction; US, United States.
Acknowledgments
We wish to thank the members of the ResPECT Team (complete list to be
provided prior to publication). ResPECT is jointly funded by the U.S.
Department of Veterans Affairs (Veterans Health Administration) and the U.S.
Department of Health and Human Services (Centers for Disease Control and
Prevention, National Institute for Occupational Safety and Health, and the
Biomedical Advanced Research and Development Authority).
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
Authors’ contributions
All Authors read and approved the final manuscript. All authors meet ICMJE
guidelines. LR and TP conceived and designed the study, coordinated and
supervised the study and drafted the manuscript. MB, AE, CN, MR, CS, and
MS designed the study, coordinated and supervised the study and drafted
the manuscript. DC designed the study, conceived and designed the
epidemiologic and statistical analyses and drafted the manuscript. GG and
CG designed the study, conceived and designed laboratory analyses and
drafted the manuscript. NR designed the study, conceived and designed
epidemiologic and statistical analyses, coordinated and supervised the study
and drafted the manuscript. RS designed the study and drafted the
manuscript.
Page 9 of 10
11.
12.
13.
14.
15.
Competing interests
The authors declare that they have no competing interests.
16.
Disclaimer
The findings and conclusions in this manuscript are the authors’ own and do
not necessarily represent the views of the National Institute for Occupational
Safety and Health, the U.S. Department of Veterans Affairs, or other affiliates.
Mention of product names does not imply endorsement.
17.
18.
Author details
1
U.S. Department of Veterans Affairs, National Center for Occupational Health
and Infection Control, 1601 SW Archer Road, Mailstop 151E, Gainesville,
FL 32608, USA. 2Veterans Affairs Eastern Colorado Healthcare System, Denver,
CO, USA. 3Johns Hopkins School of Medicine, Baltimore, MD, USA. 4Veterans
Affairs Medical Center and George Washington University School of Medical
and Health Sciences, Washington, DC, USA. 5Veterans Affairs St. Louis
Healthcare System and Saint Louis University School of Medicine, St. Louis,
MO, USA. 6Children’s Hospital Colorado, Aurora, CO, USA. 7Department of
Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA,
USA. 8Michael E. DeBakey VAMC and Baylor College of Medicine, Houston,
Texas, USA. 9Denver Health, Denver, CO, USA. 10National Personal Protective
Technology Laboratory, National Institute for Occupational Safety and Health,
Pittsburgh, PA, USA. 11Veterans Affairs New York Harbor Healthcare System,
New York, NY, USA. 12University of Colorado School of Medicine, Denver, CO,
USA. 13Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
USA. 14University of Florida, Gainesville, Florida, USA.
Received: 6 October 2015 Accepted: 18 February 2016
19.
20.
21.
22.
23.
24.
25.
References
1. Sepkowitz KA. Occupationally acquired infections in health care workers.
Part I. Ann Intern Med. 1996;125(10):826–34.
2. Sydnor E, Perl TM. Healthcare providers as sources of vaccine-preventable
diseases. Vaccine. 2014;32(38):4814–22.
3. Siegel JD, Rhinehart E, Jackson M, Chiarello L, Health Care Infection Control
Practices Advisory Committee. 2007 guideline for isolation precautions:
preventing transmission of infectious agents in health care settings.
Am J Infect Control. 2007;35 Suppl 2:65–164.
4. Institute of Medicine. Preparing for and influenza pandemic: personal
protective equipment for healthcare workers. Washington: National
Academies Press; 2008.
5. Archibald LK, Jarvis WR. Health care- associated infection outbreak
investigations by the Centers for Disease Control and Prevention,
1946–2005. Am J Epidemiol. 2011;174 Suppl 11:47–64.
6. Bridges CB, Kuehnert MJ, Hall CB. Transmission of influenza: implications for
control in health care settings. Clin Infect Dis. 2003;37:1094–101.
7. Chan LY, Wong JT, Li PK, Lui SF, Fung H, Sung J. Risk of transmission of
severe acute respiratory syndrome to household contacts by infected
health care workers and patients. Am J Med. 2004;116(8):559–60.
8. Torner N, Solano R, Rius C, Domínguez A. Surveillance network of Catalonia
Spain TM. Implication of health care personnel in measles transmission.
Hum Vaccin Immunother. 2015;11(1):288–92.
9. Sartor C, Zandotti C, Romain F, Jacomo V, Simon S, Atlan-Gepner C, et al.
Disruption of services in an internal medicine unit due to a nosocomial
influenza outbreak. Infect Control Hosp Epidemiol. 2002;23:615–9.
10. Miggins M, Hasan A, Hohmann S, Southwick F, Casella G, Schain D, et al.
The potential influence of common viral infections diagnosed during
26.
27.
28.
29.
30.
31.
32.
33.
34.
hospitalization among critically ill patients in the United States. PLoS One.
2011;6, e18890.
Lioka F, Sada R, Maesako Y, Nakamura F, Ohno H. Outbreak of pandemic
2009 influenza A/H1N1 infection in the hematology ward: fatal clinical
outcome of hematopoietic stem cell transplant recipients and emergence
of the H275Y neuraminidase mutation. Int J Hematol. 2012;96:364–9.
Monto AS. Epidemiology of viral respiratory infections. Am J Med.
2002;112(6A):4S–12.
Musher DM. How contagious are common respiratory tract infections?
N Engl J Med. 2003;348(13):1256–66.
Wells WF. Aerodynamics of droplet nuclei. New York: Cambridge University
Press; 1955. p. 13–9.
Cowling BJ, Ip DK, Fang VJ, Suntarattiwong P, Olsen SJ, Levy J, et al.
Aerosol transmission is an important mode of influenza A virus spread.
Nat Commun. 2013;4:1935.
Cowling BJ, Ip DK, Fang VJ, Suntarattiwong P, Olsen SJ, Levy J, et al.
Modes of transmission of influenza B virus in households. PLoS One.
2014;9(9):e108850.
Janssen L, Ettinger H, Graham S, Shaffer R, Zhuang Z. Commentary: the use
of respirators to reduce inhalation of airborne biological agents. J Occup
Environ Hyg. 2013;10(8):D97–103.
Lipp A, Edwards P. Disposable surgical face masks for preventing surgical
wound infection in clean surgery. The Cochrane Library. 2014. http://www.
cochranelibrary.com/.
Oberg T, Brosseau LM. Surgical mask filter and fit performance. Am J Infect
Control. 2008;36(4):276–82.
Loeb M, Dafoe N, Mahony J, John M, Sarabia A, Glavin V, et al. Surgical mask
vs N95 respirator for preventing influenza among health care workers: a
randomized trial. JAMA. 2009;302:1865–71.
MacIntyre CR, Wang Q, Seale H, Yang P, Shi W, Gao Z, et al. A randomized
clinical trial of three options for N95 respirators and medical masks in health
workers. Am J Respir Crit Care Med. 2013;187(9):960–6.
MacIntyre CR, Wang Q, Rahman B, Seale H, Ridda I, Gao Z, et al. Efficacy of
face masks and respirators in preventing upper respiratory tract bacterial
colonization and co-infection in hospital healthcare workers. Prev Med.
2014;62:1–7.
Bessesen MT, Savor-Price C, Simberkoff M, Reich NG, Pavia AT, Radonovich LJ.
N95 respirators or surgical masks to protect healthcare workers against
respiratory infections: are we there yet? Am J Respir Crit Care Med.
2013;187(9):904–5.
Coffey CC, Campbell DL, Shuang Z. Simulated workplace performance of
N95 respirators. Am Ind Hyg Assoc. 1999;60:618–24.
Liverman CT, Harris TA, Rogers MEB, Shine KI. Respiratory protection for
healthcare workers in the workplace against novel H1N1 influenza A: a
letter report. National Academies Press; 2009, p. 1–68. http://www.nap.edu/
Duling MG, Lawrence RB, Slaven JE, Coffey CC. Simulated workplace
protection factors for half-facepiece respiratory protective devices. J Occup
Environ Hyg. 2007;4(6):420–31.
Grinshpun SA, Haruta H, Eninger RM, Reponen T, McKay RT, Lee SA.
Performance of an N95 filtering facepiece particulate respirator and a
surgical mask during human breathing: two pathways for particle
penetration. J Occup Environ Hyg. 2009;6(10):593–603.
Van der Sande M, Teunis P, Sabel R. Professional and home-made face
masks reduce exposure to respiratory infections among the general
population. PLoS One. 2008;3(7), e2618.
Radonovich Jr LJ, Cheng J, Shenal BV, Hodgson M, Bender BS. Respirator
tolerance in health care workers. J Am Med Assoc. 2009;301(1):36–8.
Shenal BV, Radonovich Jr LJ, Cheng J, Hodgson M, Bender BS. Discomfort
and exertion associated with prolonged wear of respiratory protection in a
health care setting. J Occup Environ Hyg. 2012;9:59–64.
Gosch ME, Shaffer RE, Eagan AE, Roberge RJ, Davey VJ, Radonovich LJ.
B95: a new respirator for health care personnel. Am J Infect Control.
2013;41(12):1224–30.
Bailar JC, Brosseau LM, Cohen HJ, et al. Reusability of facemasks during an
influenza pandemic: facing the flu. Washington: Institute of Medicine,
National Academies Press; 2006.
Baig AS, Knapp C, Eagan AE, Radonovich Jr LJ. Health care workers’ views
about respirator use and features that should be included in the next
generation of respirators. Am J Infect Control. 2010;38(1):18–25.
Chor JS, Pada SK, Stephenson I, Goggins WB, Tambyah PA, Medina M, et al.
Differences in the compliance with hospital infection control practices
�Radonovich et al. BMC Infectious Diseases (2016) 16:243
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
during the 2009 influenza H1N1 pandemic in three countries. J Hosp Infect.
2012;81(2):98–103.
Institute of Medicine Committee on Respiratory Protection for healthcare
workers in the workplace against novel H1N1 influenza A. In: Liverman CT,
Harris TA, Rogers MEB, Shine KI, editors. Respiratory protection for
healthcare workers in the workplace against novel H1N1 Influenza A: a
letter report. Washington: National Academies Press; 2009.
SHEA, IDSA, APIC. Letter to President Obama on Federal PPE Guidance.
2009. http://www.idsociety.org/uploadedFiles/IDSA/Policy_and_Advocacy/
Current_Topics_and_Issues/Fair_and_Adequate_Payment/Letters/
SHEAIDSAAPICLetter110509FINAL.PDF. Accessed 28 Sept 2015.
Centers for Disease Control and Prevention. Interim recommendations for
facemask and respirator use to reduce 2009 influenza A (H1N1) virus
transmission. 2009. http://www.cdc.gov/h1n1flu/masks.htm. Accessed 28
Sept 2015.
Centers for Disease Control and Prevention. 2007 guideline for isolation
precautions: preventing transmission of infectious agents in healthcare
settings. 2007. http://www.cdc.gov/hicpac/2007IP/2007ip_appendA.html.
Accessed 28 Sept 2015.
Centers for Disease Control and Prevention. Prevention strategies for
seasonal influenza in healthcare settings, 2013. Available at: http://www.cdc.
gov/flu/professionals/infectioncontrol/healthcaresettings.htm. Accessed 28
Sept 2015.
Roberge RJ, Kim JH, Powell JB, Shaffer RE, Ylitalo CM, Sebastian JM. Impact
of low filter resistances on subjective and physiological responses to
filtering facepiece respirators. PLoS One. 2013;8(12):e84901.
Boyce JM, Pittet D, Healthcare Infection Control Practices Advisory
Committee. Society for Healthcare Epidemiology of America. Association for
Professionals in Infection Control. Infectious Diseases Society of America.
Hand Hygiene Task Force: Guideline for hand Hygiene in Health-Care
Settings: recommendations of the Healthcare Infection Control Practices
Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task
Force. Infect Control Hosp Epidemiol. 2002;23 Suppl 12:3–40.
de la Tabla VO, Masiá M, Antequera P, Martin C, Gazquez G, Buñuel F, et al.
Comparison of combined nose-throat swabs with nasopharyngeal aspirates
for detection of pandemic influenza A/H1N1 2009 virus by real-time reverse
transcriptase PCR. J Clin Microbiol. 2010;48(10):3492–5.
Heikkinen T, Marttila J, Salmi AA, Ruuskanen O. Nasal swab versus
nasopharyngeal aspirate for isolation of respiratory viruses. J Clin Microbiol.
2002;40(11):4337–9.
Heikkinen T, Salmi AA, Ruuskanen O. Comparative study of nasopharyngeal
aspirate and nasal swab specimens for detection of influenza. BMJ.
2001;322(7279):138.
Lambert SB, Whiley DM, O’Neill NT, Andrews EC, Canavan FM, Bletchly C,
et al. Comparing nose-throat swabs and nasopharyngeal aspirates collected
from children with symptoms for respiratory virus identification using
real-time polymerase chain reaction. Pediatrics. 2008;122(3):e615–20.
Schmidt NJ, Emmons RW. Diagnostic procedures for viral, rickettsial, and
chlamydial infections. 6th ed. Washington: American Public Health
Association, Inc.; 1989.
Kendal AP, Pereira MS, Skehel JJ. Concepts and procedures for laboratory
based influenza surveillance. Atlanta: World Health Organization
Collaborating Centers for Reference and Research in Influenza, Centers for
Disease Control; 1982.
Reich NG, Obeng D. ClusterPower: power calculations for cluster-randomized
and cluster-randomized crossover trials. R package version 0.5. 2013.
http://CRAN.R-project.org/package=clusterPower. Accessed 28 Sep 2015.
Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, et al. Health
care-associated infections: a meta-analysis of costs and financial impact on the
US health care system. JAMA Intern Med. 2013;173(22):2039–46.
Hayes RJ, Alexander ND, Bennett S, Cousens SN. Design and analysis issues
in cluster-randomized trials of interventions against infectious diseases.
Stat Methods Med Res. 2000;9(2):95–116.
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Radonovich, Lewis J., Mary T. Bessesen, Derek A. Cummings, Aaron Eagan, Charlotte Gaydos, Cynthia Gibert, Geoffrey J. Gorse, Ann-Christine Nyquist, Nicholas G. Reich, Maria Rodrigues-Barradas, Connie Savor-Price, Ronald E. Shaffer, Michael S. Simberkoff, and Trish M. Perl. 2016. "The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel." BMC Infectious Diseases 16 (1):243.
Abstract
<div>
<h4>BACKGROUND:</h4>
<p>Although N95 filtering facepiece respirators and medical masks are commonly used for protection against <span class="highlight">respiratory</span> infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare <span class="highlight">respiratory</span> protection recommendations from public health organizations, professional societies, and experts.</p>
<h4>METHODS:</h4>
<p>The <span class="highlight">Respiratory</span> Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of <span class="highlight">respiratory</span> protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during <span class="highlight">respiratory</span> virus season. Outcome measures will include laboratory-confirmed viral <span class="highlight">respiratory</span> infections, acute <span class="highlight">respiratory</span> <span class="highlight">illness</span>, and influenza-like <span class="highlight">illness</span>. Participant exposures to patients, coworkers, and others with symptoms and signs of <span class="highlight">respiratory</span> infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team.</p>
<h4>DISCUSSION:</h4>
<p>ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical <span class="highlight">illness</span> among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired <span class="highlight">respiratory</span> infections and prevention of spread within healthcare systems.</p>
<h4>TRIAL REGISTRATION:</h4>
<p>The trial is registered at clinicaltrials.gov, number <a href="http://clinicaltrials.gov/show/NCT01249625" title="See in ClinicalTrials.gov">NCT01249625</a> (11/29/2010).</p>
</div>
<div class="keywords">
<h4>KEYWORDS:</h4>
<p>Healthcare personnel; Influenza; Masks; Respirators; <span class="highlight">Respiratory</span> infections</p>
</div>
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The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel
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Infection Control
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Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices.
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Radonovich, Lewis J., Mary T. Bessesen, Derek A. Cummings, Aaron Eagan, Charlotte Gaydos, Cynthia Gibert, Geoffrey J. Gorse, Ann-Christine Nyquist, Nicholas G. Reich, Maria Rodrigues-Barradas, Connie Savor-Price, Ronald E. Shaffer, Michael S. Simberkoff, and Trish M. Perl.
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2016-06-02
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2022-12-07 general asset review - IPC (change R-PPE)
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2023-12-10
Airborne Transmission
Mask
Masks
N95
Occupational Exposure
R-PPE
R-Res&Pub
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/0509700b1fce34595874223b285e0f4f.pdf
a3049fcd285d0615aec3ae5d6087aba5
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Text
Zayas et al. BMC Public Health 2013, 13:811
http://www.biomedcentral.com/1471-2458/13/811
RESEARCH ARTICLE
Open Access
Effectiveness of cough etiquette maneuvers
in disrupting the chain of transmission
of infectious respiratory diseases
Gustavo Zayas1*, Ming C Chiang1, Eric Wong2, Fred MacDonald3, Carlos F Lange4, Ambikaipakan Senthilselvan5
and Malcolm King1*
Abstract
Background: The effectiveness of recommended measures, such as “cover your mouth when coughing”, in
disrupting the chain of transmission of infectious respiratory diseases (IRD) has been questioned. The objective
of the current study was to determine the effectiveness of simple primary respiratory hygiene/cough etiquette
maneuvers in blocking droplets expelled as aerosol during coughing.
Method: In this study, 31 healthy non-smokers performed cough etiquette maneuvers in an effort to cover their
voluntarily elicited best effort coughs in an open bench format. A laser diffraction system was used to obtain
accurate, non-invasive, quantitative, real time measurements of the size and number of droplets emitted during the
assessed cough etiquette maneuvers.
Results: Recommended cough etiquette maneuvers did not block the release and dispersion of a variety of
different diameter droplets to the surrounding environment. Droplets smaller than one-micron size dominate the
total number of droplets leaked when practicing assessed maneuvers.
Conclusions: All the assessed cough etiquette maneuvers, performed as recommended, do not block droplets
expelled as aerosol when coughing. This aerosol can penetrate profound levels of the respiratory system. Practicing
these assessed primary respiratory hygiene/cough etiquette maneuvers would still permit direct, indirect, and/or
airborne transmission and spread of IRD, such as influenza and Tuberculosis. All the assessed cough etiquette
maneuvers, as recommended, do not fully interrupt the chain of transmission of IRD. This knowledge urges us all to
critically review recommended CE and to search for new evidence-based procedures that effectively disrupt the
transmission of respiratory pathogens. Interrupting the chain of transmission of IRD will optimize the protection of
first responders, paramedics, nurses, and doctors working in triage sites, emergency rooms, intensive care units, and
the general public against cough-droplet-spread diseases.
Study design
Open bench, observational, cough etiquette study.
Background
Canada was among many countries around the world
working in partnership with the World Health
Organization (WHO) in preparation for an influenza
pandemic outbreak when the severe acute respiratory
syndrome (SARS) started to rapidly spread across Asia.
* Correspondence: g.zayas@ualberta.ca; malcolm.king@ualberta.ca
1
Mucophysiology Laboratory, Department of Medicine, Faculty of Medicine
and Dentistry, University of Alberta, Edmonton, AB, Canada
Full list of author information is available at the end of the article
SARS is a disease caused by a coronavirus never before
seen in humans, the SARS coronavirus (SARS-CoV) [1].
Canada was the country hardest hit outside of Asia,
with 438 probable and suspect SARS-CoV cases, including 44 deaths. Canadian health care workers (HCW) endured a high toll during the SARS outbreak while caring
for patients. Approximately one out of every four SARS
cases affected HCW [2,3].
Health care providers and scientists searched for answers to a number of questions brought up by the
SARS-CoV outbreak. The ease of transmission, possibly
enhanced by the volume and speed of human migration,
and the severity of the disease were both characteristics
© 2013 Zayas et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication
waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise
stated.
�Zayas et al. BMC Public Health 2013, 13:811
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of great concern. At the time, this outbreak highlighted
the inadequacy of national preparedness to detect and
respond to emerging infectious diseases, including atypical cases, with neither a curative treatment nor vaccine
available to administer. Moreover, the outbreak of the
highly pathogenic avian influenza H5N1 virus (2005)
brought to the forefront the need to find new, more effective transmission control measures for infectious respiratory diseases (IRD) [4-7]. The most recent example
occurred when the world underwent two waves of a
moderate pandemic outbreak caused by the influenza A
H1N1 virus [8,9].
Vaccination is the main strategy to control outbreaks
of epidemic-prone and pandemic-prone infectious respiratory diseases. However, the mutating capacity of
most viral pathogens often renders vaccinations ineffective or delay their use until clear identification of the genetic makeup has been made, allowing precious time for
the microorganism to spread [10].
Accessing the vaccine against the new strain of influenza virus presented a challenge for countries around
the world; in particular, resource-limited countries were
extremely concerned that they were left to confront the
influenza pandemic largely unprotected.
The WHO, and other agencies, continues to recommend the application of and compliance with basic infection control precautions known as non-pharmaceutical
interventions (NPI) as the cornerstone to prevent transmission of droplet-spread epidemic-prone diseases in
health care facilities [5,10,11]. Reliance on NPI, such as
cough etiquette (CE), demands further inquiries into the
efficacy to block cough droplets and to stop the spread of
outbreaks provided by these interventions. The term
“cough etiquette” has evolved since described by Bone A,
et al. 2000 [12-19].
A literature search did not yield any scientific or empiric information/evidence regarding the effectiveness of
recommended CE maneuvers preventing or blocking the
release of bioaerosol droplets, infectious or not, to the
surrounding environment. We also found no studies that
indicate that CE protects against droplet-spread transmission of IRD.
IRD, including influenza, are transmitted to noninfected subjects when an infected patient expels droplets
of different sizes, potentially loaded with pathogens, to the
surrounding environment as aerosol when coughing.
Cough is a prominent symptom in patients with IRD.
Viral, mycotic, and bacterial IRD gain access to our
bodies via the ocular and oral mucosa, and surface
mucosa of the upper and lower respiratory system when
air is breathed in that carries droplets loaded with
pathogens. Many of these pathogens are emerging
epidemic-prone (SARS-CoV, avian influenza [AI]) and
pandemic-prone (influenza A caused by the H1N1
Page 2 of 11
virus), while others are re-emerging such as Mycobacterium tuberculosis.
Gaps still exist in the current cough etiquette knowledge
and some intervention strategies are suspected to still be
less than optimal. First responders, HCW in emergency
departments, lung specialists in Alberta, Canada and very
likely in many other countries, continue to voice questions
regarding the effectiveness and scientific evidence of CE
and other NPI to protect populations and individuals by
blocking droplets expelled as aerosol when coughing and
preventing outbreaks of IRD [20].
Soon after the SARS and AI outbreaks a new maneuver was added to the definition of respiratory hygiene/
cough etiquette: cover your mouth and nose with your
arm, sleeve, or elbow. We were unable to find who was
the first person to publish and describe this maneuver in
a peer-reviewed journal, and we did not find any scientific study that supports its implementation.
We found that the Central Maine Medical Center, the
Saint Mary’s Regional Medical Center in association with
the Maine Medical Association released a video by Dr.
Ben Lounsbury (Otorhinolounsburgology [ORL] Productions, 2006) that shows how to cough into your elbow.
This seems to be one of the first documented explanations about how to perform the maneuver and the rational to use it [21].
However, this new maneuver is inconsistently
recommended in written publications of global health
authorities. USA-CDC does not include “cough in your
arm/elbow” in its written recommendations, but it appears in the pictorial (poster) recommendation [18].
While no general consensus exists regarding the best
description of the respiratory hygiene/cough etiquette
among the health agencies mentioned in Table 1, it appears that: “Cover your mouth and nose with a tissue
when you cough or sneeze. Dispose the used tissue in a
garbage can. If you don’t have a tissue, cough or sneeze
into your elbow or sleeve, not in your hands” is the most
acceptable recommendation.
Researchers from the Mucophysiology Laboratory at
the University of Alberta have been striving to enhance
the knowledge on human airways droplet breakup and
aerosol emission during coughing. Studying the mucus
layer lining the airways under the effect of high-speed
cough airflow is essential in determining the cough aerosol composition, droplet breakup, and dispersion. The
goal of our research group was to better understand
cough bioaerosol composition and to determine the
magnitude of droplets emitted by the transmissor and
not blocked or controlled while practicing current cough
etiquette maneuvers.
Knowledge of the dynamic process of bioaerosol will be
used to design efficacious evidence-based prevention interventions against droplet-spread epidemic/pandemic-
�Zayas et al. BMC Public Health 2013, 13:811
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Page 3 of 11
Table 1 Chronological modifications to the definition of CE by national and international health organizations
Year
Organization
Cough etiquette developments and important events
1999
WHO [5,10,11]
Regarding problems with influenza pandemic vaccine production and availability, alternative control measures
have to be thought of in advance.
2000
WHO [12]
2003
2005
2006
Cough etiquette: Turning head and covering mouth when coughing, using clothes or spittoons to spit into.
Severe acute respiratory syndrome
Avian influenza
ECDC [13]
Good respiratory hygiene: covering mouth and nose when coughing or sneezing using tissues and disposing
them appropriately.
NPI is an area neglected by research and those that fund research. There is little evidence and almost no
experimental studies to show whether NPI measures work. This topic should receive urgent research attention.
2007
CPIP* [14]
Individuals with respiratory infection should be educated to cover their mouth and nose with a tissue when
coughing and dispose of used tissues in waste containers.
WHO [15]
Recommendations made for cough etiquette have been made more on the basis of plausible effectiveness than
controlled studies.
US-CDC [16]
The components of respiratory hygiene/cough etiquette are 1) covering the mouth and nose during coughing
and sneezing, 2) using tissues to contain respiratory secretions with prompt disposal into a no-touch receptacle, 3)
offering a surgical mask to persons who are coughing to decrease contamination of the surrounding environment,
and 4) turning the head away from others and maintaining spatial separation, ideally >3 feet, when coughing.
Effectiveness of currently recommended infection control measures for individuals is still unknown and additional
research is needed to validate NPI and assess their effectiveness.
CIDAAP** [17]
2009
Respiratory hygiene/cough etiquette: Cover the nose/mouth when coughing or sneezing; cough or sneeze into
elbow rather than hand.
Influenza A H1N1 virus pandemic
US-CDC [18]
Cover your mouth and nose with a tissue when coughing or sneezing; use the nearest waste receptacle to
dispose of the tissue after use, perform hand hygiene.
ECDC [19]
Cover your mouth and nose using tissues when coughing or sneezing; or cough or sneeze into an arm rather
than your hands.
There have never been trials of respiratory hygiene on either respiratory infections generally, or specifically influenza.
Most European countries recommended to adopt the simple public health measures of: respiratory hygiene,
hand washing, and early self-isolation.
2010
ECDC [19]
Personal protective measures (non-pharmaceutical) for reducing the risk of transmitting human influenza are
based in part in evidence from studies and in part on judgment based on public health experience.
*Canadian pandemic influenza plan.
** Committee on infectious diseases of the American Academy of Pediatrics.
prone respiratory pathogens. This would reduce the risks
of health consequences due to IRD.
This study sought to find an evidence-based response
to questions posed by multiple individuals, agencies and
organizations dealing with IRD transmission, regarding
the effectiveness of recommended NPI/CE to block or
control cough droplets to prevent the spread of IRD.
The objective of this study was to assess recommended
simple primary prevention measures such as “cover you
mouth when coughing” to determine their effectiveness in
blocking droplets expelled as aerosol during coughing.
Methods
Study design
This was an observational study with a cross-sectional
design in which all participants, in an open bench format, were encouraged to practice select recommended
cough etiquette maneuvers to cover their voluntarily
elicited best effort cough. Although, global health
authorities discourage using hands to cover a cough, this
maneuver was included to compare its effectiveness with
the recommended maneuvers and because many people
still use it in many countries.
Participants
A total of 31 healthy volunteers, ages 18 years and older,
were invited and accepted to participate. Participants were
recruited through advertised leaflets in public areas around
the university campus and none of them declared having
asthma, Cystic Fibrosis, or other respiratory conditions.
Eligible participants were excluded if they had received
expectorants, mucolytics or natural products for respiratory conditions during the previous 30 days, or had developed flu-like symptoms immediately before the study.
Study site
The study was carried out at the Mucophysiology Laboratory in Heritage Medical Research Centre, University of
�Zayas et al. BMC Public Health 2013, 13:811
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Alberta, Canada. Environmental conditions at the study
site were similar to the indoor conditions found in a hospital reception site with respect to room temperature, humidity and atmospheric pressure.
The University of Alberta Hospital Medical Ethics
Committee and the Office of Environmental Health and
Safety of the University of Alberta approved the study
protocol. Informed consent was obtained from all the
participants.
Study day
The study procedures were explained in detail to all participants by the investigator. Once they had understood
the study requirements, all participants were asked to
sign an informed consent.
Measurements
Participants performed a voluntary cough while covering
the mouth and nose with the hands, sleeve/arm, tissue, or
while wearing a surgical mask. Droplets released or
diverted were quantitatively characterized to assess how effective those maneuvers are in controlling the cough aerosol jet. Measurement time per maneuver was 10 seconds.
Every participant was encouraged to voluntarily elicit a
“real cough” three times while covering the mouth and nose
either with both hands, with a tissue, with the sleeve/arm
or while wearing a surgical mask. If during the performance
researchers considered that the participant did not make an
adequate effort, the participant was asked to repeat the
maneuver until an acceptable effort was obtained.
In addition to the acceptable cough efforts, we consistently selected three parameters provided by the laser diffractometer: valid points, skip values and total mass per
maneuver. From these parameters we selected which of
the three cough efforts was the best. The design
implemented in our study was similar to the protocol
used when performing a spirometry test: three efforts
and select the best effort made. This is a lung mechanics
procedure very well established and accepted worldwide.
Pressure and humidity
Atmospheric pressure sensors (SPC1000, VTI Technologies, Finland) and relative humidity sensors (SHT75,
Sensirion, Switzerland) were placed in predetermined areas
of potential droplet escape for additional assessment of
cough droplets diverted or allowed to flow through barriers.
Droplet size measurement
For accurate, non-invasive, quantitative measurements
in real time of the size and number of droplets as they
are emitted during the assessed cough etiquette maneuvers, a laser diffraction system (Spraytec, Malvern, UK)
was used. The laser diffraction system has 60 size bins
with the capability of measuring the concentration of
Page 4 of 11
droplet sizes from 0.1 micron (μm) to 900 μm every 0.4
millisecond.
The Spraytec He-Ne (Helium-Neon) laser diffractometer is composed of transmitter and receiver modules.
Expelled respiratory aerosols pass through a cylindrical
measurement zone with a volume of 7.85 cm3 through a
path of 100 mm length and 10 mm diameter. The path
length is estimated as the distance through the spray
plume that the laser beam travels. As the droplets pass
through the laser measurement volume zone, laser light
from the transmitter is scattered by the respiratory aerosol
producing light diffraction patterns, which are measured
by optical detectors on the receiver modules. The light signals are then converted into electrical signals to process a
droplet size distribution, under the assumption that each
droplet is a perfect sphere. The angle at which a droplet
diffracts light is inversely proportional to its size.
The He-Ne laser diffractometer was set to measure
the droplet concentration of a single cough event crossing the measurement zone every 0.4 milliseconds
(2.5 GHz) during a manually triggered time of 10 seconds. Units of droplet concentration are expressed as
average rate of # of droplets/cm3/second, averaged from
the beginning to the end of the cough.
For the present study, the laser beam was directed
from left to right at 17 cm in front of the face of the participant when covering mouth/nose using a surgical
mask or using both hands (Figure 1), or at 5 cm below
the chin when covering mouth/nose using the sleeve/
arm or using a tissue (Figures 2 and 3). As the figures indicate, droplets are also diverted in other directions not
captured in our measurement. Because of this, our measurements can be used to indicate if there is or not
emission of droplets, but they cannot be used to assess
the total amount of droplets emitted. Since there were
no precedents regarding the use of a laser diffractometer
in an open bench format to assess cough etiquette and
NPI maneuvers, the 17 cm and 5 cm distances were selected by the researchers. This decision was based
mainly on the grounds of safety: the distance and positioning of the laser beam was selected to reduce potential contact with the eye or face of the participants. This
would maximize the detection of cough airflow droplets
as they were expelled, assuring in a single, complete, and
uninterrupted event that they would cross the centre of
the measurement zone without any interference to the
flow of the aerosol. An open fume hood facing the participants removed airborne dust particles and airborne
cough droplets from the environment. We did not measure evaporation rate. Deposition losses were not a factor
in the open bench design.
To perform the maneuver of “cough in your elbow,
arm, sleeve” the forearm is flexed against the arm and
placed in front of the mouth. Preliminary measurements
�Zayas et al. BMC Public Health 2013, 13:811
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Page 5 of 11
Figure 1 Laser and sensor arrangement for assessment of surgical mask and hand as barriers.
with pressure and humidity sensors indicated that the
cough airflow is diverted mostly below the elbow.
Statistical analysis
The data were expressed as mean ± standard deviation
(SD) unless otherwise stated. No statistical comparison
was carried out in this observational study.
Research procedures
Assessing surgical mask and hands
Participants were instructed to place their face in a
modified device similar to the head brace used by optometrists. This device prevented participants from
interfering with the path of the laser beam.
Four (4) sensors were placed in areas of concern
around the face of the participant: one humidity sensor
was placed close to the nose bridge above the surgical
mask or the hands; two (2) humidity sensors were
mounted on a post which stood approximately 15 cm in
front of the participant mouth, one about 10 degrees
angle below and the second about 30 degrees angle
below in a parallel position; and one pressure sensor was
mounted on the aforementioned post at approximately
30 degrees below in a parallel position (Figure 1).
Sleeve/arm and tissue
Participants were asked to use only the right arm for
practical purposes and were instructed to wear laser He/
Figure 2 Laser and sensor arrangement for assessment of using the arm/sleeve as a barrier.
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Figure 3 Laser and sensor arrangement for assessment of using a tissue as a barrier.
Ne safety eyewear (Sperian, RI, USA). This eyewear
complies with ANSI Z136.1 standards.
Three (3) sensors were placed in areas of concern
around the face of the participant: two (2) sensors, one
pressure and one humidity, were placed close to the
nose bridge above the flexed elbow or above the right
hand holding the tissue; and one humidity sensor was
placed either in the ventral part of the right forearm
about 7–10 cm from the wrist or next to the left cheek
when using a tissue (Figure 2).
In this study we will emphasize results related to covering the mouth/nose using the sleeve and briefly comment about the other public health maneuvers.
Results
During the period of assessment (March – May, 2010)
we detected the following averages (± standard deviation) inside the testing site: atmospheric pressure =
91.8 ± 1.1 kPa, relative humidity =19.0 ±3.9% RH, and
temperature = 22.7 ± 2.0°C.
Cough droplets diverted or dispersed to the surrounding environment while performing cough etiquette maneuvers were assessed in 19 male and 12 female
participants. All participants self-identified as nonsmokers, with the exception of one male who declared
he was a long-term (30+ years) ex-smoker.
Data acquired with pressure and humidity sensors
while performing the procedure of CE is shown in the
Tables 2 and 3. The pressure values are average delta
pressure fluctuations and the humidity values are average delta increments over ambient.
The large number of droplets of different size, generated by the best-effort cough and detected by the laser
diffractometer, were normalized and expressed as the
average rate of number of droplets per cubic centimeter
per second. These averages were grouped into six (6) categories according to droplet size: a) < 0.5 μm, b) 0.5 to
1 μm, c) >1.0 to 2.5 μm, d) >2.5 to 10 μm, e) >10 to
100 μm and f ) >100 μm. The results per category, tabulated and summarized in Table 4, were compared with
their respective control value. Control data of an open
bench cough aerosol obtained from 44 participants was
presented in an article published by Zayas et al. [22].
The average volumetric mean diameter and standard
deviation of the droplets expelled as aerosol when
coughing that crossed the measurement volume zone
per CE maneuver is as follows: sleeve 0.31 ± 0.06 μm, tissue 0.30 ± 0.02 μm, hands 0.30 ± 0.04 μm, and surgical
mask 0.30 ± 0.03 μm. The standard deviation in the size
distribution is of the average volumetric mean diameter.
Discussion
While global health authorities and agencies do not recommend covering the mouth/nose using bare hands
when coughing, this procedure was included in our
study for comparison of droplets released into the environment when using hands. We fully agree that when
using the hands to cover the cough, respiratory pathogens could be transmitted to other individuals if contact
precautions are not followed.
Major findings in this study include: a) recommended respiratory hygiene/cough etiquette maneuvers do not block
or contain cough droplets expelled as aerosol from dispersing towards the surrounding environment. b) Droplets
smaller than one-micron size dominate the total number
of droplets released when practicing cough etiquette. c) All
the assessed cough etiquette maneuvers have the potential
to permit direct, indirect and/or airborne transmission of
respiratory infections. d) Data acquired in this study support the conclusions that all recommended respiratory
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Table 2 Data from pressure and humidity sensors of cough etiquette: using sleeve/arm and tissue
Maneuver
Sleeve/arm
Tissue
Number of subjects
25
24
25
Type
Pressure (kPa)
Location
Nose bridge
Nose bridge
Wrist
Nose bridge
Nose bridge
Left cheek
Variation
0.4
7.13
15.13
0.5
8.95
15.44
Relative humidity (%)
25
24
Pressure (kPa)
25
Relative humidity (%)
Sensors placed around the barrier detect cough airflow redirected by the maneuvers. Values in this table are above the average room value detected during
the experiment.
such size are able to penetrate deep into the respiratory
system.
We can also conclude that due to the size of the droplets moving at high-speed from inside of the respiratory
system and arriving to an external environment with different level of humidity and temperature, evaporation
might occur rapidly. We can also expect that the airborne route is the dominant route in IRD transmission,
independent of pathogen, due to the millions of rapidly
evaporating and nuclei forming droplets.
When the high-speed cough airflow coming out of the
respiratory system encounters a physical barrier, the flow
either goes through the barrier or alongside it towards
the areas that present the lowest resistance. Therefore,
under the light of this data we conclude that assessed
recommended respiratory hygiene/cough etiquette maneuvers are unable to stop or prevent the escape of all
inhalable droplets contained in the cough bioaerosol.
This implies that in the case of a person infected with
an epidemiological important pathogen, recommended
NPI/CE will still permit the dispersion of numerous infectious droplets, increasing the risk of exposure, infection of susceptible individuals.
Data from Figure 4 indicate that while practicing
assessed CE maneuvers the laser diffraction system
detected a larger number of droplets compared to our
control group, which was an unobstructed open bench
cough. This increase in droplet numbers should not be
used to infer an increased total emitted amount, because
the exact relationship between the emitted volume and
the measured volume is not known. In a previous article
[22] we considered that the distance the cough airflow
travels before crossing the measurement zone might
prevent droplets travelling in the periphery of the
expanding plume be accounted for. Another factor for
hygiene/cough etiquette allow the spread of epidemicprone IRD outbreaks, instill a false sense of security, and
merit a critical review.
This study was implemented to close the gaps in knowledge that exist regarding how successful recommended
NPI are in blocking or controlling coughs droplets. During
the expulsive phase of coughing airflow comes from inside
the chest to the external environment at approximately up
to 100 km/h [23,24]. Droplets coming out of the mouth of
a person that coughs will very likely be a mixture of droplets of different sizes generated in different levels of the respiratory systems.
In Table 1 we have summarized the chronological development and recommendation of respiratory hygiene
and cough etiquette maneuvers since its inception, issued by national and multinational health agencies
(WHO, US-CDC, Health Canada, European-CDC). The
summary shows that after the SARS and avian influenza
outbreaks all agencies increased the frequency and emphasis on the use of NPI/CE measures to control the
spread of IRD.
Cough droplets are centerpiece in the chain of transmission of IRD. During the transmission process,
infected individuals expels numerous droplets of different sizes into the air every time they cough. Infectious
respiratory pathogens whether virus, bacteria or fungus,
are dispersed towards the outside environment when
droplets formed in the mucus layer lining the airways of
an infected patient are exposed to the high-speed cough
airflow.
Zayas et al. found in a previous cough aerosol open
bench study [22] that, per cough, healthy non-smokers
expelled millions of droplets of different sizes as aerosol.
Results from that study indicated that droplets smaller
than 10 μm constitute the largest majority. Droplets of
Table 3 Data from pressure and humidity sensors of cough etiquette: using hands and surgical mask
Maneuver
Hands
24
Surgical mask
Number of subjects
24
24
21
Type
Pressure (kPa)
Location
Post
Post
Above post
Nose bridge
Post
Post
Above post
Nose bridge
Measure
1.37
35.9
39.6
24.7
0.10
5.5
22.5
12.1
Relative humidity (%)
24
24
Pressure (kPa)
23
24
Relative humidity (%)
Sensors placed around the barrier detect cough airflow redirected by the maneuvers. Values in this table are above the average room value detected during
the experiment.
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Table 4 Average rate of droplets detected during respiratory hygiene/cough etiquette maneuvers in 31 participants
Size/maneuver
Sleeve
Tissue
Hand
Surgical mask
Control n = 44
N <0.5 μm
4.13E + 07
6.22E + 07
5.13E + 07
4.40E + 07
1.99E + 07
0.5 μm < N <1.0 μm
5.36E + 05
5.78E + 05
5.29E + 05
3.40E + 05
3.58E + 05
1.0 μm < N <2.5 μm
7.76E + 04
8.47E + 04
5.50E + 04
5.05E + 04
4.16E + 04
2.5 μm < N <10 μm
8.52E + 04
1.12E + 05
6.64E + 04
6.53E + 04
4.18E + 04
10 μm < N < 100 μm
4.98E + 03
6.10E + 03
4.66E + 03
6.12E + 03
2.64E + 03
N >100 μm
0
0
0
0
0
Unit: # droplets/cc/second.
Control: Size and number of droplets expelled by healthy non-smokers when coughing. Data acquired from an expanding unobstructed cough aerosol.
CE data: The short distance from the mouth to the barrier prevents the expansion of the cough plume, and the shape of the barrier redirects a more concentrated
flow across the measurement zone. The non-expanding concentrated plume would bring droplets travelling in the periphery closer to the center of the plume
increasing the number of droplets accounted for.
Particles deposited within the fiber network of tissues and surgical masks during the manufacturing process might be dislodged when coughing, hence increasing
the number of items detected by the system.
this increase would be the shape of the barrier in front
of the cough airflow.
The short distance from the opening of the mouth to
the inner surface of the barrier and the barrier in front
of the cough both prevents the conic expansion of the
cough aerosol when exiting the mouth. When a person
covers the cough with the bare hands or with a tissue,
they tend to close all their fingers tightly against each
other, and press closely each hand against the other by
the cubital border of the palm.
Such position of the hands forms a vertically elongated
concave pear-shape space with the tips of the middle
and index fingers pressing against both sides of the nose
bridge, and placing the radial side of the index fingers
alongside the nose and thumbs pressing firmly against
the cheeks and side of the mouth. Placing the hands and
fingers as described form a sort of impermeable seal
leaving a separation between the wrists and below the
chin that creates an open area of low or no resistance,
redirecting a more concentrated flow downward. The
redirected non-expanding plume exiting the hand barrier would lead to a larger number of droplets accounted
for when a concentrated plume crosses the measurement zone.
A similar situation occurs when the cough airflow
strikes the sleeve of a folded arm, albeit leaving more
low resistance areas. Additionally, the distance that the
plume diverted by the barrier has to travel to cross the
measurement zone is shorter, about five centimeters.
This is our initial explanation, yet there may be others.
Coughing into the tissue might also dislodge particles
deposited within the fiber network during the manufacturing process, increasing number of items detected by
the system. In any case, the fact that we measure droplet
concentrations of the same order of magnitude as in the
control case fully supports our major findings.
We agree that practicing any of the recommended maneuvers when coughing may be acceptable during a
Figure 4 Average droplets detected per cough etiquette maneuver. Control: Size and number of droplets expelled by healthy non-smokers
when coughing. Data acquired from an expanding unobstructed cough aerosol. CE data: The short distance from the mouth to the barrier
prevents the expansion of the cough plume, and the shape of the barrier redirects a more concentrated flow across the measurement zone. The
non-expanding concentrated plume would bring droplets travelling in the periphery closer to the center of the plume increasing the number of
droplets accounted for. Particles deposited within the fiber network of tissues and surgical masks during the manufacturing process might be
dislodged when coughing, hence increasing the number of items detected by the system.
�Zayas et al. BMC Public Health 2013, 13:811
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seasonal influenza. However, when facing a deadly and
severe droplet-spread, epidemic/pandemic-prone outbreak, health authorities must consider procedures with
higher effectiveness. Nicoll [13] suggests that personal
(non-pharmaceutical) protective measures should receive urgent attention from researchers and from those
funding research.
A deeper insight into mucus-pathogen interaction and
airways droplet breakup, as well as dispersion and
bioaerosol control, is an essential component in assisting
lung health researchers, mathematicians, computer modelers, epidemiologists, policymakers, public health workers,
and the entire health care system in rich and poor countries alike, in the design of sound, evidence-based IRD dispersion, transmission control and preventative measures. It
will also further advance policies and products to optimize
protection against transmission of epidemic-prone dropletspread respiratory diseases.
It is difficult to critically appraise the results acquired in
this study with respect to other published studies assessing
CE maneuvers, including facemasks, for a number of reasons. Most of them used closed systems with different designs, equipment with much lower resolution, and biased
droplet collection to characterize the size and number of
droplets. This differs from our design: an open cough, real
time measurement in humans. Those that studied cough
aerosol generated by machines based their results on samples taken from a simulated cough plume. Those who
used human volunteers to assess facemasks, like Milton
et al. [25], took non-real time measurements from samples of cough aerosol acquired during a period of 30 minutes with and without the mask.
However, a cluster randomized trial conducted in France
by Canini et al. [26] (PLoS ONE, 2010), assessing the effectiveness of facemasks for limiting influenza transmission in households, was prematurely interrupted after the
control arm and the case arm failed to show the effectiveness of facemasks. Another study in Germany, conducted
by Suess et al. [27] (BMC Infectious Diseases, 2012),
showed that household transmission of influenza can be
reduced when using facemasks plus intensified hand hygiene, not when wearing facemasks alone.
We reiterate that our study was implemented to close
the existing gaps in knowledge regarding the effectiveness of recommended NPI in blocking transmission of
IRD or in controlling coughs droplets coming from inside the chest to the external environment. Although
numerous published articles claim that surgical masks
block cough droplets, the critical question is: do surgical
masks stop IRD transmission?
France and Germany have studies showing that surgical masks are not effective in blocking transmission of
viral diseases or need a lot of help from vigorous hand
washing. The USACDC stated very recently that
Page 9 of 11
"facemasks may be effective in blocking splashes and
large-particle droplets,… a facemask by design, does not
filter or block very small droplets" [28].
Our previous study [22] shows that the majority of droplets released when coughing are smaller than 10 microns
in size. Our current study shows that droplets of similar
magnitude are still released while using surgical masks.
Therefore the French and German studies mentioned
above support our conclusion that all recommended respiratory hygiene/cough etiquette, including facemasks,
allow the transmission of epidemic-prone IRD outbreaks
due to the nature, size, and number of cough droplets.
The new knowledge acquired in this study would provide the scientific support needed to design evidencebased preventative measures and alternatives in existing
technologies to optimize public health practices in
bioaerosol control. Such knowledge might suggest and
lead to new avenues to mitigate the effects of the dropletspread outbreak in protecting health care workers, the
general public and institutions.
Despite the inconsistencies among global health authorities and their cough etiquette recommendations,
the indication of “cover your cough with your elbow/
arm/sleeve” has reached a phenomenal, close to universal acceptance, including elementary school children
who are being successfully trained to practice it. Furthermore, this remarkable compliance around the globe has
occurred in a very short period of time. Society has
adopted this maneuver without asking for or demanding
scientific evidence.
The prompt acceptance, implementation, societal/individual behavior modification, and global dissemination of the maneuver present the scientific community
with a dilemma: why was this maneuver so popular in
light of the lack of evidence to support it? Involved are
several facts and actions: a) no peer review publication
documenting this maneuver, b) no scientific evidence
supporting the effectiveness of such a maneuver, and c)
no scientist author, developer or designer fathering such
a maneuver.
Lounsbury [21] presented this maneuver in a humoristic and entertaining video format. The video was a huge
success in terms of public acceptance and secured the
support of various medical and community associations.
Soon after the release of the video the world was
witnessing people of all ages, including kindergarten
aged children, practicing the maneuver.
The lack of scientific evidence supporting this particular
maneuver is a valid argument for most global health agencies to avoid including it in their set of written recommendations, however it is still conditionally included in pictorial
recommendations, as seen in CDC campaigns [18].
Whether or not this particular maneuver is based on
scientific evidence, the general public accepted it and
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voluntarily adopted a change in behavior. This can serve
as an example for the scientific community to understand how knowledge should be structured, translated,
and communicated to get the message across and subtly
induce positive behavioral change in the population.
In summary, assessed public health maneuvers, including facemasks, do not fully protect against the millions
of smaller cough droplets, as micron size droplets dehydrate rapidly, form nuclei, remain airborne, and penetrate deep in the lung when inhaled, augmenting the risk
of infection, of developing disease, and even increasing
mortality due to transmitted infection.
Conclusions
Researchers at the Mucophysiology Research Centre,
University of Alberta have characterized in an open
bench format the cough aerosol and determined the size
and, more importantly, the number of droplets expelled
when coughing [22]. This achieves a critical step that
could contribute to enhancing control of IRD, like influenza A caused by the H1N1 virus.
The results acquired in this study indicate that all CE
maneuvers assessed do not block droplets expelled as
aerosol when coughing. This aerosol can penetrate profound levels of the respiratory system. Practicing these
assessed primary respiratory hygiene/cough etiquette
maneuvers would still permit direct, indirect, and/or airborne transmission and spread of IRD, such as influenza
and Tuberculosis.
Acquired data suggests that in the case of an individual
infected with a highly pathogenic microorganism, infectious cough droplets would still be released to the surrounding environment when covering the mouth/nose
with any of the assessed respiratory maneuvers, allowing
the probability of infecting susceptible individuals.
Although it remains possible and even logical that transmission is reduced somewhat (some droplets must be captured during those maneuvers), this study was not
designed to carry out rigorous measurements of this reduction. Measurement from our study established that all
maneuvers, as recommended, are equivalently inadequate
at completely blocking cough-droplets, even though we
cannot say how much in terms of percentage reduction.
Furthermore, our results coincide with the assertion previously stated by researchers and global public health authorities, confirming that the assessed non-pharmacological
interventions used during and after the two recent waves of
the pandemic caused by the influenza A H1N1 virus were
based on a very fragile scientific base.
To control the epidemic spread of airborne diseases,
the path from the infected person (transmissor) to a
non-infected person (recipient) must be effectively
interrupted. This study presents us with a serious challenge: the need to search for new procedures that
Page 10 of 11
effectively block cough bioaerosol to interrupt the chain
of transmission and spread of IRD.
Achieving such a challenge would optimize the protection of first responders, paramedics, nurses, and doctors
working in triage sites, emergency rooms, intensive care
units, and the general public.
Therefore we all must strive to design highly effective
maneuvers and/or devices to block cough droplets of all
sizes from dispersing into the surrounding environment,
enhancing the control of transmission of IRD and optimizing protection of all members of our society. We
must also strive to understand how knowledge should
be structured, translated, and communicated to get the
message across and subtly induce positive behavioral
change in the population.
Competing interests
The authors declare that they have no competing interests.
Authors’ contribution
JGZ and MK developed the concept of cough etiquette assessment,
designed the cough etiquette study, interpreted the data and drafted the
manuscript. EW and FM performed clinical assessment of participants,
contributed to develop the basis for the cough etiquette and with clinical
interpretation and review of the manuscript. CL contributed to strengthen
the methodology of the study and determine the best data acquisition
device and revision of the manuscript. AS contributed with analysis of data
and with critical revision and interpretation of the manuscript. MCC made
key contributions by making the laser device to operate according to the
study design, with acquisition of data, and by developing the software to
optimize data acquisition and the database. All authors read and approved
the final manuscript.
Acknowledgement
The authors gratefully acknowledge Caritas Research Centre for making the
facilities of the Centre for Lung Health, Northern Lung Function Laboratory,
Edmonton General Continuing Care Centre available to carry out part of this
study.
The authors gratefully acknowledge the contribution and assistance
provided by Dr. Matthew Tennant, retina specialist for providing the face
holder to carryout the study.
We acknowledge Jose Gustavo Zayas Jr. for editing this document and with
figures design.
Funding for this study was provided in part by the Canadian Institute of
Health Research (CIHR) and by the Public Health Agency in Canada (PHAC),
but the results and conclusions were independently obtained and do not
necessarily represent the views of the Public Health Agency of Canada or
CIHR.
Author details
1
Mucophysiology Laboratory, Department of Medicine, Faculty of Medicine
and Dentistry, University of Alberta, Edmonton, AB, Canada. 2Department of
Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton,
AB, Canada. 3Centre for Lung Health, Northern Lung Function Laboratory,
Edmonton General Hospital, Edmonton, Alberta, Canada. 4Department of
Mechanical Engineering, Faculty of Engineering, University of Alberta,
Edmonton, Alberta, Canada. 5Department of Public Health Sciences, School
of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Received: 27 July 2012 Accepted: 4 September 2013
Published: 8 September 2013
References
1. WHO: Infectious disease report. Geneva: World Health Organization; 2002.
2. Health Canada: Learning Lessons from SARS. Renewal of Public Health in
Canada. Ottawa: A report of the National Advisory Committee on SARS and
Public Health; October 2003.
�Zayas et al. BMC Public Health 2013, 13:811
http://www.biomedcentral.com/1471-2458/13/811
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Centre for Disease Control and Prevention and Health Canada: Cluster of
severe acute respiratory syndrome cases among protected healthcare workers –
Toronto, Canada, Volume 29. Ottawa: WHO, Geneva, Switzerland;
Immunization and Respiratory Infections Division, Centre for Infectious
Disease Prevention and Control, Health Canada, Ottawa, Canada, and CDC
SARS Investigation Team; 2003. Number 08.
WHO: Press Release, Cases of Severe Respiratory Illness May Spread To Hospital.
Geneva: World Health Organization; 2003.
Centers for Disease Control and Prevention: Use of Quarantine to Prevent
Transmission of Severe Acute Respiratory Syndrome – Taiwan. JAMA 2003,
52:680–683. August 27, 2003 – 290, (No. 8), reprinted from MMWR 2003.
WHO: Avian influenza (“bird flu”) and the significance of its transmission to
humans. Geneva: World Health Organization; 2004.
WHO: Avian influenza: assessing the pandemic threat. Geneva: World Health
Organization; 2005. WHO/CDS/2005.29.
WHO: WHO recommendations for the post-pandemic period. Geneva: World
Health Organization; 2010.
Public Health Agency of Canada: Lessons learned review: Public Health
Agency of Canada and Health Canada response to the 2009 H1N1 pandemic.
Ottawa: Public Health Agency of Canada; 2010. Cat: HP5-102/2010e-Pdf.
ISBN 978-1-100-17287-3.
WHO: Influenza pandemic preparedness plan. The role of WHO and guidelines
for national or regional planning. Geneva: World Health Organization; 1999.
Interim Guidelines WHO: Infection prevention and control of epidemic- and
pandemic-prone acute respiratory diseases in health care. Geneva: World
Health Organization; 2007:2007.
Bone A, Aerts A, Grzemska M, Kimerling M, Kluge H, Levy M, Portaels F, Raviglione
M, Varaine F: Tuberculosis control in prisons. A manual for Programme Managers.
Geneva: World Health Organization; 2000. WHO/CDS/TB/2000.281. 2000.
Nicoll A: Personal (Non-pharmacological) protective measures for reducing
transmission of influenza – ECDC interim recommendations, Volume 11.
Stockholm, Sweden – Eurosurveillance Weekly Releases: European Centre
for Disease Prevention and Control; 2006. Issue 10.
The Public Health Agency of Canada: The Canadian Pandemic Influenza Plan
for the Health Sector. Ottawa: the Public Health Agency of Canada; 2006.
Cat. N° HP40-10/2006E-PDF. ISBN 0-662-44409-4.
WHO: Avian influenza, including influenza A (H5N1), in humans: WHO interim
infection control guidelines for health-care facilities. Geneva: World Health
Organization; 2007.
Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection
Control Practices Advisory Committee: Guideline for Isolation Precautions:
Preventing Transmission of Infectious Agents in Healthcare Settings. Atlanta:
CDC. Am J Infect Control 2007, 35:S65–164. doi:10.1016/j.ajic.2007.10.007.
The Committee on Infectious Diseases of the American Academy of
Pediatrics: Infection Prevention and Control in Pediatric Ambulatory
Settings. Pediatrics 2007, 120:650–665.
Center for Disease Control and Prevention: Draft Guideline for Isolation
Precautions: Preventing Transmission of Infectious Agents in Healthcare
Settings. Recommendations of the Healthcare Infection Control Practices
Advisory Committee (HICPAC). Atlanta: CDC; 2009. Respiratory Hygiene/
Cough Etiquette in Health Care Settings.
European Centre for Disease Prevention and Control: Personal protective
measures for reducing the risk of acquiring or transmitting human influenza.
Stockholm: ECDC; 2009. updated July 2010.
US Department of Health and Human Services: Community strategy for
pandemic influenza mitigation. Washington: Flu. Gov; 2007.
ORL Productions: Why don’t we do it in our sleeves? www.coughsafe.com/
contactthanks.html. Date last updated: March 24, 2011. Date last accessed:
July 4, 2012.
Zayas G, Chiang MC, Wong E, MacDonald F, Carlos F, Lange CF, Sentilselvan
A, King M: Cough aerosol in healthy participants: Fundamental
knowledge to optimize droplet-spread infectious respiratory disease
management. BMC Pulm Med 2012, 12:11. doi:10.1186/1471-2466-12-11.
Hertzberg J: Flow Field of a Human Cough. American Physical Society. 58th
Annual Meeting of the Division of Fluid Dynamics, November 20–22, 2005,
abstract #HA.001.
Gupta JK, Lin CH, Chen Q: Flow dynamics and characterization of a
cough. Indoor Air 2009, 19:517–525. doi:10.1111/j.1600-0668.2009.00619.
Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ: Influenza
virus aerosols in human exhaled breath: particle size, culturability, and
effect of surgical masks. PLoS Pathog 2013, 9(3):e1003205.
Page 11 of 11
26. Canini L, Andreoletti L, Ferrari P, D’Angelo R, Blanchon T, et al: Surgical
mask to prevent influenza transmission in households: a cluster
randomized trial. PLoS ONE 2010, 5(11):e13998. doi:10.1371/journal.
pone.0013998.
27. Suess T, Remschmidt C, Schink SB, Schweiger B, Nitsche A, et al: The role of
facemasks and hand hygiene in the prevention of influenza transmission
in households: results from a cluster randomised trial; Berlin, Germany,
2009–2011. BMC Infect Dis 2012, 12:26.
28. Center for Disease Control and Prevention: Prevention Strategies for Seasonal
Influenza in Healthcare Settings. Guidelines and Recommendations. Atlanta:
CDC; 2009. updated Jan 2013.
doi:10.1186/1471-2458-13-811
Cite this article as: Zayas et al.: Effectiveness of cough etiquette
maneuvers in disrupting the chain of transmission of infectious
respiratory diseases. BMC Public Health 2013 13:811.
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An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Zayas, Gustavo, Ming C. Chiang, Eric Wong, Fred MacDonald, Carlos F. Lange, Ambikaipakan Senthilselvan, and Malcolm King. 2013. "Effectiveness of cough etiquette maneuvers in disrupting the chain of transmission of infectious respiratory diseases." BMC Public Health 13 (1):811.
Abstract
<div>
<h4>BACKGROUND:</h4>
<p>The effectiveness of recommended measures, such as "cover your mouth when coughing", in disrupting the chain of transmission of infectious <span class="highlight">respiratory</span> diseases (IRD) has been questioned. The objective of the current study was to determine the effectiveness of simple primary <span class="highlight">respiratory</span> hygiene/cough etiquette maneuvers in blocking droplets expelled as aerosol during coughing.</p>
<h4>METHOD:</h4>
<p>In this study, 31 healthy non-smokers performed cough etiquette maneuvers in an effort to cover their voluntarily elicited best effort coughs in an open bench format. A laser diffraction system was used to obtain accurate, non-invasive, quantitative, real time measurements of the size and number of droplets emitted during the assessed cough etiquette maneuvers.</p>
<h4>RESULTS:</h4>
<p>Recommended cough etiquette maneuvers did not block the release and dispersion of a variety of different diameter droplets to the surrounding environment. Droplets smaller than one-micron size dominate the total number of droplets leaked when practicing assessed maneuvers.</p>
<h4>CONCLUSIONS:</h4>
<p>All the assessed cough etiquette maneuvers, performed as recommended, do not block droplets expelled as aerosol when coughing. This aerosol can penetrate profound levels of the <span class="highlight">respiratory</span> system. Practicing these assessed primary <span class="highlight">respiratory</span> hygiene/cough etiquette maneuvers would still permit direct, indirect, and/or airborne transmission and spread of IRD, such as influenza and Tuberculosis. All the assessed cough etiquette maneuvers, as recommended, do not fully interrupt the chain of transmission of IRD. This knowledge urges us all to critically review recommended CE and to search for new evidence-based procedures that effectively disrupt the transmission of <span class="highlight">respiratory</span> pathogens. Interrupting the chain of transmission of IRD will optimize the protection of first responders, paramedics, nurses, and doctors working in triage sites, <span class="highlight">emergency</span> rooms, intensive care units, and the general public against cough-droplet-spread diseases.</p>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online Open Access
URL
https://www.ncbi.nlm.nih.gov/pubmed/24010919
Read Online
Online location of the resource.
https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-13-811
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Effectiveness of cough etiquette maneuvers in disrupting the chain of transmission of infectious respiratory diseases.
Subject
The topic of the resource
Research
Description
An account of the resource
The effectiveness of recommended measures, such as "cover your mouth when coughing", in disrupting the chain of transmission of infectious respiratory diseases (IRD) has been questioned.
Creator
An entity primarily responsible for making the resource
Zayas, Gustavo, Ming C. Chiang, Eric Wong, Fred MacDonald, Carlos F. Lange, Ambikaipakan Senthilselvan, and Malcolm King.
Date
A point or period of time associated with an event in the lifecycle of the resource
2013-09-08
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (move to research - changed to R-PPE)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Airborne Transmission
Infection Prevention and Control
R-PPE
R-Res&Pub
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/917b14df149118bed8a98ae30a054888.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Bischoff, Werner E., JoLyn Turner, Gregory Russell, Maria Blevins, Engy Missaiel, and John Stehle. 2019. "How well do N95 respirators protect healthcare providers against aerosolized influenza virus?" Infection Control & Hospital Epidemiology 40 (2):232-4.
Abstract
N95 respirator masks are recommended for protection against respiratory viruses. Despite passing fit-testing 10% of N95 respirator users encountered breakthroughs with exposure to influenza virus compared to full protection provided by a powered air purifying respirator. The current recommendation of N95 respirators should be evaluated for endemic and emerging scenarios.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Available through Cambridge online subscription
URL
https://www.ncbi.nlm.nih.gov/pubmed/30558691
Read Online
Online location of the resource.
https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/how-well-do-n95-respirators-protect-healthcare-providers-against-aerosolized-influenza-virus/D7543A718B49777D110A2F43FDAF4F4C
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
How well do N95 respirators protect healthcare providers against aerosolized influenza virus?
Subject
The topic of the resource
Infection Control
Description
An account of the resource
N95 respirator masks are recommended for protection against respiratory viruses.
Creator
An entity primarily responsible for making the resource
Bischoff, Werner E., JoLyn Turner, Gregory Russell, Maria Blevins, Engy Missaiel, and John Stehle.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-12-18
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change R-PPE)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-12-10
Airborne Transmission
N95
Occupational Exposure
R-PPE
R-Res&Pub
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/4a700fd6f96511c080e663c377bb5594.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Brosseau, Lisa M., Lorraine M. Conroy, Margaret Sietsema, Kari Cline, and Kara Durski. 2015. "Evaluation of Minnesota and Illinois Hospital Respiratory Protection Programs and Health Care Worker Respirator Use." Journal of Occupational and Environmental Hygiene 12 (1):1-15.
Abstract
<div class="abstractSection abstractInFull">
<p>The objective of this study was to assess respiratory protection programs for aerosol-transmissible diseases in acute care hospitals for conformance with regulatory requirements and public health guidelines. Twenty-eight representative hospitals were selected by size, location, and ownership in Minnesota and Illinois. Interviews were conducted with 363 health care workers and 171 managers from high-risk departments. Written programs from each hospital were reviewed for required elements. Seventy-seven health care workers were observed donning and doffing a FFR. The most serious deficiency in many written programs was failure to identify a program administrator. Most written programs lacked adequate details about medical evaluation, fit-testing, and training and did not include a comprehensive risk assessment for aerosol transmissible diseases; tuberculosis was often the only pathogen addressed. Employees with the highest probability of tuberculosis exposure were most likely to pick a respirator for close contact, but higher levels of respiratory protection were rarely selected for aerosol-generating procedures. Surgical masks were most commonly selected for close contact with droplet disease- or influenza-infected patients; better protection (e.g., respirator) was rarely selected for higher-risk exposures. Most of the observed health care workers had access to a NIOSH-certified N95 FFR, properly positioned the facepiece, and formed the nose clip. The most frequent deficiencies were failure to correctly place straps, perform a user seal check, and remove the respirator using straps.</p>
</div>
Keywords: aerosol transmissible disease<span class="comma">, </span>health care<span class="comma">, </span>respiratory protection
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Available through Taylor and Francis subscription
URL
https://www.ncbi.nlm.nih.gov/pubmed/24918755
Read Online
Online location of the resource.
https://oeh.tandfonline.com/doi/abs/10.1080/15459624.2014.930560#.Xl2OM0NrzOS
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Evaluation of Minnesota and Illinois hospital respiratory protection programs and health care worker respirator use.
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The objective of this study was to assess respiratory protection programs for aerosol-transmissible diseases in acute care hospitals for conformance with regulatory requirements and public health guidelines.
Creator
An entity primarily responsible for making the resource
Brosseau, Lisa M., Lorraine M. Conroy, Margaret Sietsema, Kari Cline, and Kara Durski.
Date
A point or period of time associated with an event in the lifecycle of the resource
2015
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
Airborne Transmission
Mask
Masks
N95
Occupational Exposure
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Respiratory Pathogen
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Coia, J. E., L. Ritchie, A. Adisesh, C. Makison Booth, C. Bradley, D. Bunyan, G. Carson, C. Fry, P. Hoffman, D. Jenkins, N. Phin, B. Taylor, J. S. Nguyen-Van-Tam, and M. Zuckerman. 2013. "Guidance on the use of respiratory and facial protection equipment." Journal of Hospital Infection 85 (3):170-82.
Abstract
<div>
<p>Infectious micro-organisms may be transmitted by a variety of routes, and some may be spread by more than one route. <span class="highlight">Respiratory</span> and facial protection is required for those organisms that are usually transmitted via the droplet/airborne route, or when airborne particles have been artificially created, such as during 'aerosol-generating procedures'. A range of personal protective equipment that provides different degrees of facial and <span class="highlight">respiratory</span> protection is available. It is apparent from the recent experiences with severe acute <span class="highlight">respiratory</span> syndrome and pandemic (H1N1) 2009 influenza that healthcare workers may have difficulty in choosing the correct type of facial and <span class="highlight">respiratory</span> protection in any given clinical situation. To address this issue, the Scientific Development Committee of the Healthcare Infection Society established a short-life working group to develop guidance. The guidance is based upon a review of the literature, which is published separately, and expert consensus.</p>
<p class="copyright">Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.</p>
</div>
<div class="keywords">
<h4>KEYWORDS:</h4>
<p>Aerosol-generating procedure; Airborne transmission; Droplet transmission; Facial protection equipment; Filtering face piece; Personal protective equipment; <span class="highlight">Respiratory</span> infection; <span class="highlight">Respiratory</span> protection equipment</p>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free on PubMed Central.
URL
https://www.ncbi.nlm.nih.gov/pubmed/24051190
Read Online
Online location of the resource.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7114842/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Guidance on the use of respiratory and facial protection equipment.
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Infectious micro-organisms may be transmitted by a variety of routes, and some may be spread by more than one route.
Creator
An entity primarily responsible for making the resource
Coia, J. E., L. Ritchie, A. Adisesh, C. Makison Booth, C. Bradley, D. Bunyan, G. Carson, C. Fry, P. Hoffman, D. Jenkins, N. Phin, B. Taylor, J. S. Nguyen-Van-Tam, and M. Zuckerman.
Date
A point or period of time associated with an event in the lifecycle of the resource
2013-11
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
Airborne Transmission
Guidance Document
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Respiratory Pathogen
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
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Harber, Philip, Brenda Merz, and Karen Chi. 1999. "Decision Model for Optimizing Respirator Protection." Journal of Occupational and Environmental Medicine 41 (5).
Abstract
Respirators are widely used for protection against inhaled toxins. The emphasis of research and implementation effort has evolved through several stages: the respirator device itself, use situation, respirator program factors under employer control, individual worker factors not under employer control, and occupational health systems. For this study, a computer-simulation decision assistance model was developed to assess the impact of various factors on the number of workers receiving adequate protection. Factors include the respirator protection factor, identification of sites needing respirator protection, selection of proper device, availability when needed, frequency of ever use, regularity of use among users, and variability in personal susceptibility or other factors. This analysis demonstrates that for both moderate-<span class="highlight">risk</span> and high-<span class="highlight">risk</span> (i.e., IDLH, immediately dangerous to life and health) exposures under current circumstances, the actual protection afforded depends upon the optimization of program factors and detection of atypical outlier persons and worksites. Therefore, programs and research must focus on these areas. Occupational medicine specialists should help optimize these areas and, in addition, use each case of <span class="highlight">respiratory</span> protection failure as an index case to improve the overall programs.
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https://www.ncbi.nlm.nih.gov/pubmed/10337605
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https://journals.lww.com/joem/Abstract/1999/05000/Decision_Model_for_Optimizing_Respirator.3.aspx
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Title
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Decision model for optimizing respirator protection.
Subject
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Infection Control
Description
An account of the resource
Respirators are widely used for protection against inhaled toxins. The emphasis of research and implementation effort has evolved through several stages: the respirator device itself, use situation, respirator program factors under employer control, individual worker factors not under employer control, and occupational health systems.
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Harber, Philip, Brenda Merz, and Karen Chi.
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1999-05
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2022-12-07 general asset review - IPC (change R-PPE)
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2023-12-10
Airborne Transmission
Mask
Masks
N95
Occupational Exposure
R-PPE
R-Res&Pub
Respiratory Pathogen
-
https://repository.netecweb.org/files/original/15adee805d1bd0b0dc364ac4a9ed6eea.pdf
98f7717088b430d2869e20581bceeb5d
PDF Text
Text
Article
Applied Biosafety, 9(1) pp. 20-36 © ABSA 2004
Issues Affecting Respirator Selection for
Workers Exposed to Infectious Aerosols:
Emphasis on Healthcare Settings
Steven W. Lenhart1, Teresa Seitz1, Douglas Trout1, and Nancy Bollinger2
1Centers
for Disease Control and Prevention, National Institute for Occupational Safety and Health, Cincinnati, Ohio;
and 2Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Morgantown,
West Virginia
Abstract
The goal of occupational health practice is to protect the health of workers by preventing diseases and
injuries from occurring. When work activities are anticipated, recognized, or found during an investigation
to involve risks to workers’ health, preventive measures
should be taken to control hazardous exposures in the
workplace. Respirators are often used to control inhalational exposures to hazardous airborne contaminants,
including infectious agents. Of the three methods available for selecting a respirator, the expert opinion
method is used most frequently to recommend respirators for controlling exposures to infectious agents. The
size of the particles comprising an infectious aerosol
has received particular attention relating to the selection
of respiratory protection for healthcare workers. Conflicting meanings of the term “droplet” are central to
this issue and may be partly responsible for confusion
concerning the particle sizes that surgical masks are
unlikely to protect against. Although workers caring
for patients with contagious respiratory infections are
at risk of exposure to large-particle droplets greater
than 100 micrometers in diameter, their risks of inhalational exposure to infectious particles are likely to be
predominantly to an aerosol consisting of a mixture of
evaporating droplets and droplet nuclei that remain suspended in room air for prolonged periods. Because surgical masks are intended to be used only as barriers
against large-particle droplets, only respirators certified
20
by the National Institute for Occupational Safety and
Health should be used as part of a strategy for protecting workers against inhalational exposures to infectious
aerosols. The issues outlined in this paper are focused
on workers in healthcare settings, but also apply in
other settings where workers may be exposed to infectious aerosols.
Introduction
The primary goal of occupational health practice
is to protect the health of workers by preventing diseases and injuries from occurring (International
Commission on Occupational Health, 2002). When
work activities are anticipated, recognized, or found
during an investigation (e.g., an outbreak of an infectious disease) to involve risks to workers’ health, preventive measures should be taken to control hazardous exposures. Respirators are often selected as a
means of reducing workers’ inhalational risks when
engineering controls or administrative measures are
insufficient or unavailable for controlling exposures
to hazardous airborne contaminants, including infectious agents. Several different types of respirators
provide varying levels of protection; each type has
different characteristics, advantages, and disadvantages. Knowledge of how to select a respirator is essential for ensuring that a worker’s health is protected.
�Lenhart / Seitz / Trout / Bollinger
The purpose of this article is to review issues
affecting the selection of respirators for reducing
workers’ exposures to infectious aerosols. Aerosols
are dispersions of liquid or solid particles suspended
in air (Baron & Willeke, 2001, p. 1065), and infectious aerosols are defined as dispersions of airborne
particles capable of causing infection. Methods that
can be used to make a respirator selection are addressed first; three selection methods are described.
Next, characteristics of infectious particles and the
potential for airborne spread of infectious agents in
healthcare settings are discussed. These issues are
important to understanding how to determine the
potential effectiveness of respirators in minimizing
exposures to infectious aerosols. Finally, information
is provided demonstrating why surgical masks
should not be worn as protection against infectious
aerosols.
Respirator Selection Methods
Once a decision has been made that respirators
are needed to protect the health of workers, the
process of selecting an appropriate respirator requires an understanding of the work activities associated with potential exposures, the health effects of
overexposure, properties of the air contaminant
(e.g., in healthcare settings, the characteristics and
behavior of an aerosolized infectious disease agent),
and worker and workplace factors that may affect
how effective a respirator will be in protecting workers (Johnson, 2001; McCullough & Brosseau, 1999).
In addition, consideration must be given to whether
wearing a certain type of respirator will adversely
affect a worker’s ability to perform his or her tasks or
will create a risk to the safety of the worker or others
(e.g., the trailing hose of a supplied air respirator can
be a tripping hazard). These latter issues should be
addressed by considering the advantages and disadvantages of the various types of respirators from
which a choice must be made. Table 1 provides examples of the advantages and disadvantages of different types of respirators as they relate to potential
infectious aerosol exposures in healthcare settings.
Because different types of respirators provide
varying levels of protection, having information that
compares their relative protective capabilities is es-
sential when making a selection. This is one of the
functions of an assigned protection factor (APF), a
unitless value that historically has been defined as
representing the minimum level of protection that a
respirator class can be anticipated to provide for a
substantial proportion (usually 95%) of properly fitted and trained respirator users (Guy, 1985; Myers,
Lenhart, Campbell, & Provost, 1983). For example,
an assigned protection factor of 50 means that a respirator having this value will reduce most wearers’
exposures to a contaminant to 2% [(1/APF) x 100%
= 2%] of what they would have been exposed to if
they had not been wearing a respirator—a 98% exposure reduction.
In 2003, the Occupational Safety and Health
Administration (OSHA) proposed the following
definition of assigned protection factor: the workplace level of respiratory protection that a respirator
or class of respirators is expected to provide to employees when the employer implements a continuing, effective respiratory protection program as specified by Title 29 CFR 1901.134 (Occupational Safety
and Health Administration [OSHA], 2003). Assigned protection factors range from 10 for fit-tested,
air-purifying, half-facepiece respirators to 10,000 for
pressure demand self-contained breathing apparatuses (American National Standards Institute
[ANSI], 1992; McCullough & Brosseau, 1999; National Institute for Occupational Safety and Health
[NIOSH], 1987; OSHA, 2003).
Choosing a selection method is the first important decision in a respirator selection process. The
choices are the hazard ratio method, the risk analysis
method, and the expert opinion method.
Hazard Ratio Method
The hazard ratio method, or the industrial hygiene method, is a quantitative method used most
commonly to select respirators for noninfectious
aerosols, gases, and vapors. Using this method requires estimates of the air concentrations of a contaminant measured during a person’s work activities
and knowledge of the established (or recommended)
occupational exposure limits of that contaminant. A
minimum level of respiratory protection is calculated
by dividing the highest air concentration measurement by the most protective occupational exposure
21
�Table 1
Advantages and disadvantages of different respirator types as they
relate to potential infectious aerosol exposures in healthcare settings.
Respirator Type
Advantages
Disadvantages
Filtering Facepiece Respirator
Assigned protection factor = 10;
better-performing models, if fit
tested and used properly, reduce
respiratory exposure to 10% of what
it would be without the respirator.
y�Lightweight.
y�No maintenance, cleaning, or
disinfection needed.
y�No effect on mobility.
y�Only respirator type with models
available without an exhalation
valve. A healthcare worker can wear
such a respirator to protect patients
and others from expired aerosols of
the healthcare worker.
y�Provides no eye protection.
y�Can add to heat burden.
y�Inward leakage at gaps in face seal.
y�Difficult for a user to do a seal check.
y�Level of protection varies greatly among models.
y�Communication may be difficult.
y�Fit testing required to select proper facepiece size.
y�Some eyewear may interfere with the fit.
Elastomeric Half-facepiece Respirator
Assigned protection factor = 10;
most models, if fit tested and used
properly, reduce respiratory
exposure to 10% or less of what it
would be without the respirator.
y�Low maintenance.
y�Reusable facepiece and replaceable
filters and cartridges.
y�No effect on mobility.
y�Provides no eye protection.
y�Can add to heat burden.
y�Facepiece must be cleaned and disinfected before reuse,
which may place workers at risk of contact exposure.
y�Inward leakage at gaps in face seal.
y�Communication may be difficult.
y�Fit testing required to select proper facepiece size.
y�Some eyewear may interfere with the fit.
Elastomeric Full-facepiece Respirator
Assigned protection factor = 50;
most models, if fit tested and used
properly, reduce respiratory
exposure to 2% or less of what it
would be without the respirator.
y�Provides eye protection.
y�Low maintenance.
y�Reusable facepiece and replaceable
filters and cartridges.
y�No effect on mobility.
y�More effective face seal than that of
filtering facepiece or elastomeric
half-facepiece respirators.
y�Can add to heat burden.
y�Diminished field-of-vision compared to half-facepiece.
y�Facepiece must be cleaned and disinfected before reuse,
which may place workers at risk of contact exposure.
y�Inward leakage at gaps in face seal.
y�Fit testing required to select proper facepiece size.
y�Communication may be difficult.
y�Must be quantitatively fit tested to reduce exposures to 2%.
y�Facepiece lens can fog without nose cup or lens treatment.
y�Spectacle kit needed for people who wear corrective glasses.
Powered Air-purifying Respirator with Hood, Helmet, or Loose-fitting Facepiece
Assigned protection factor = 25;
most models, if used properly,
reduce respiratory exposure to 4%
or less of what it would be without
the respirator.
22
y�Protection for people with beards,
missing dentures, or facial scars.
y�Provides eye protection.
y�Low breathing resistance.
y�Flowing air creates cooling effect.
y�Face seal leakage is generally outward.
y�Fit testing is not required.
y�Prescription glasses can be worn.
y�Hoods completely cover head and
neck and may also cover shoulders
and torso, providing extensive
barrier protection.
y�Communication less difficult than
with elastomeric half-facepiece or
full-facepiece respirators.
y�Reusable components and
replaceable filters.
y�Added weight of battery and blower.
y�Awkward for some tasks.
y�Components must be cleaned and disinfected before
reuse, which may place other workers at risk for contact
exposure.
y�Battery requires charging.
y�Noise from a device’s blower may make stethoscope use
difficult.
y�Air flow must be tested with flow device before use.
�Lenhart / Seitz / Trout / Bollinger
Table 1 (Continued)
Advantages and disadvantages of different respirator types as they
relate to potential infectious aerosol exposures in healthcare settings.
Respirator Type
Advantages
Disadvantages
Powered Air-purifying Respirator with Tight-fitting Half-facepiece or Full-facepiece
Assigned protection factor = 50;
most models, if used properly,
reduce respiratory exposure to 2%
or less of what it would be without
the respirator.
y�Provides eye protection with fullfacepiece.
y�Low breathing resistance.
y�Flowing air creates cooling effect.
y�Face seal leakage is generally
outward.
y�Reusable components and
replaceable filters.
y�Added weight of battery and blower.
y�Awkward for some tasks.
y�No eye protection with half-facepiece.
y�Components must be cleaned and disinfected before
reuse, which may place other workers at risk for contact
exposure.
y�Fit testing required to select proper facepiece size.
y�Battery requires charging.
y�Noise from a device’s blower may make stethoscope use
difficult.
y�Communication may be difficult.
y�Spectacle kit needed for people who wear corrective
glasses with full-facepiece respirators.
y�Air flow must be tested with flow device before use.
y�Provides eye protection with fullfacepiece or hood.
y�Does not depend on filters to purify
ambient air.
y�Low breathing resistance.
y�Face seal leakage is outward.
y�Flowing air creates cooling effect.
y�Mobility limited to air-supply hose length and proximity
of the air supply.
y�Trailing hose may be a tripping hazard and may get in
the way of gurneys and other medical equipment on
wheels.
y�Fit testing required to select proper facepiece size.
y�Components must be cleaned and disinfected before
reuse, which may place other workers at risk for contact
exposure.
y�Communication may be difficult.
y�Source of pressure-regulated Grade D breathing air
needed.
y�Source of breathing air must be tested to ensure quality.
Supplied Air Respirator
The three modes of operation of
supplied air respirators are demand
(negative pressure), continuous
flow, and pressure demand.
Pressure demand, full-facepiece
models (assigned protection factor =
2,000), if fit tested and used
properly, reduce respiratory
exposure to 0.05% or less of what it
would be without the respirator.
Self-contained Breathing Apparatus (SCBA)
Assigned protection factor =
10,000; pressure demand, fullfacepiece models, if fit tested and
used properly, reduce respiratory
exposure to 0.01% or less of what it
would be without the respirator.
y�Provides eye protection.
y�Face seal leakage is outward.
y�Does not depend on filters or
cartridges to purify ambient air.
y�Flowing air creates cooling effect.
y�Duration of use limited by service life of air cylinders.
y�Frequent work stoppages needed to change air
cylinders.
y�Fit testing required to select proper facepiece size.
y�SCBA weigh as much as 40 pounds.
y�Components must be cleaned and disinfected before
reuse, which may place other workers at risk for contact
exposure.
y�Communication may be difficult.
y�Supply of replacement air cylinders needed.
y�Facility needed to recharge empty air bottles.
y�Source of breathing air must be tested to ensure quality.
y�SCBA must be returned annually or every 3 years
depending on manufacturer for inspection and repair.
23
�Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols
limit of the contaminant. A respirator from the respirator class having an assigned protection factor
equal to or exceeding this value would then be selected. However, applying this method to respirator
selection decisions for infectious aerosols is difficult
and often impossible.
Two major obstacles limit application of the hazard ratio method to worker exposures to infectious
agents. The first involves uncertainties about the air
concentrations of infectious agents (due in part to
difficulties in sampling air for viable infectious
agents). Second, neither occupational exposure limits nor guidelines for infectious agents are generally
available. This is because the infectious inhalation
dose of most disease agents is poorly characterized
and may extend over a considerable range because of
variations in host susceptibility and related factors.
According to the OSHA respiratory protection standard (Title 29 CFR 1910.134), when exposures cannot be reasonably estimated, an employer is required
to consider the work environment as immediately
dangerous to life or health and to provide to employees either a self-contained breathing apparatus
(SCBA) or a combination supplied-air respirator
with an auxiliary SCBA (OSHA, 1998b). Both of
these types of respirators would be impractical for
use in many work settings, including healthcare.
(Advantages and disadvantages of these respirator
types are described in Table 1.) However, OSHA did
not intend that only these two respirator types could
be selected when workplace-specific exposure measurements did not exist. Rather, OSHA intended that
professional judgment also be used to evaluate all
factors associated with making a respirator selection
and that the most protective respirators needed to be
selected only when a less protective respirator could
not confidently be presumed safe (OSHA, 1998a).
Risk Analysis Method
The risk analysis method of making a respirator
selection is a quantitative modeling approach in
which cumulative risk is calculated. This method has
been applied to respirator selections for protecting
against inhalational exposures to Bacillus anthracis
spores (as a possible bioterrorism agent [Nicas &
Hubbard, 2003; Nicas, Neuhaus, & Spear, 2000]),
Mycobacterium tuberculosis (Nicas, 1995, 1996), and
24
Coccidioides immitis (Nicas & Hubbard, 2002).
The data used to compute the cumulative risk of
an infectious aerosol are estimates of the infectious
inhalational dose of an infectious agent, the air concentration of infectious particles, the respirator
user’s breathing rate, the fractional penetration value
of the user’s respirator, the duration of a respirator
use period, and the number of respirator use periods
(Nicas & Hubbard, 2002, 2003; Nicas et al., 2000).
Limitations of this method are that complete information is seldom available, and, as is true when applying the hazard ratio method to infectious aerosols, that important data—the infectious inhalational
dose and the air concentrations of infectious particles to which workers may be exposed—are usually
quite uncertain. However, advantages of the method
are that all assumptions and data are identified, the
dose-response model is given, and an acceptable level
of risk is specified (Nicas & Hubbard, 2003).
Expert Opinion Method
The expert opinion method is a qualitative approach to making decisions about respirators based
on the subjective professional judgment of one or
more experts. This approach has been used when
the important data needed for quantitative respirator selection methods are either uncertain or unavailable. Respirator selection is made after considering the characteristics of job activities that are recognized or anticipated to involve risks of exposure to
airborne contaminants; consideration of the specific
agent involved; and knowledge of the assigned protection factors, advantages, and disadvantages of various respirators. This approach has been criticized
because, in some cases, details of the method are illdefined, and a rationale for the final decision is typically not provided with respirator recommendations
to explain how decisions were made (Nicas & Hubbard, 2003; Nicas et al., 2000).
The expert opinion method has been used to
recommend respirators for protection against exposures to M. tuberculosis (Centers for Disease Control
and Prevention [CDC], 1994), Histoplasma capsulatum (Lenhart, Schafer, Singal, & Hajjeh, 1997), B.
anthracis (CDC, 2001, November 6), hantavirus pulmonary syndrome (CDC, 2002), and biological
agents of bioterrorism events (CDC, 2001, October
�Lenhart / Seitz / Trout / Bollinger
25). A method using expert opinion and a modification of the hazard ratio method was published to
address respirator selection for healthcare workers
exposed to infectious aerosols (McCullough &
Brosseau, 1999). This approach, which could be
termed a qualitative ranking method, uses qualitative rankings of airborne concentrations (instead of
contaminant measurements themselves) and rankings of “toxicity” or risk (as surrogates for occupational exposure limits) to identify graphically the
level of respiratory protection to which assigned protection factors could be compared.
In some applications of the expert opinion
method, categorical risk estimates are developed
with the levels of recommended respiratory protection increasing as the levels of perceived risk increase. An example of an application of this approach to an infectious aerosol is the CDC guidance
document for protecting workers at risk of exposure
to H. capsulatum spores (Lenhart et al., 1997). Respirators are described in that guide that should be
worn during work activities associated with exposures to spore-contaminated airborne dust. The recommended respirators range from disposable, filtering facepiece respirators for low-risk situations (e.g.,
site surveys of bird roosts) to full-facepiece, powered
air-purifying respirators for extremely dusty work
(e.g., removing accumulated bird or bat manure
from an enclosed area such as an attic).
Another example of an application of the expert
opinion method is the rationale used to select fullfacepiece powered air-purifying respirators for CDC
investigators performing environmental sampling for
B. anthracis in post offices and other environments
(CDC, 2001, November 6). This application differs
from the previous example in that, instead of ranking respirator options according to perceived increases in levels of exposure, acceptable respirators
were described as those respirators that met specific
criteria. Factors considered important in that application of the expert opinion method included the
following:
y The infective dose (the potency) of the B. anthracis spores was unknown. To be conservative, the
spore-containing material in contaminated letters
was considered to have been bioengineered to make
it highly infectious. Also, no reliable estimates of
possible exposure levels were available, and it was
likely that they would have varied considerably by
location, time, and the investigators’ activities. For
these reasons, a higher level of protection than the
90 percent exposure reduction generally associated
with negative-pressure, half-facepiece respirators was
considered essential. Consequently, they were eliminated from further consideration.
y Metropolitan mail processing and distribution
centers are large facilities, and the investigators doing environmental sampling needed a respirator that
allowed mobility and the ability to wear the respirator comfortably for an hour or more. These factors
eliminated supplied air respirators (because hose
lines limit mobility) and self-contained breathing
apparatuses (because of their limited service-life and
weight). The options remaining were air-purifying,
full-facepiece respirators and powered air-purifying
respirators with half- or full-facepieces, hoods, or
loose-fitting facepieces or helmets.
y The final step was selecting the respirator type
having the highest assigned protection factor from
the remaining options. Thus, a NIOSH-certified,
powered air-purifying respirator with a full facepiece
was selected.
Characteristics of Infectious Particles
In certain situations, healthcare workers have
risks of exposure to infectious aerosols that may result in the transmission of infection. Infection control precautions to prevent this method of agent
transmission have been termed airborne precautions
(Garner & Hospital Infection Control Practices Advisory Committee, 1996). Precautions for preventing
the spread of infectious disease agents by other
routes of exposure include contact precautions (to
prevent spread by direct and indirect contact) and
droplet precautions (to prevent spread associated
with deposition of projected droplets, splatter, and
sprays onto conjunctivae, nasal mucosa, and the
mouth) (Garner & Hospital Infection Control Practices Advisory Committee, 1996).
Risks of person-to-person transmission of infectious aerosols in healthcare settings have been associated with actions such as speaking, sneezing, or
spontaneous coughing by patients with contagious
25
�Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols
respiratory infections. Person-to-person transmission
is also associated with cough-inducing or aerosolgenerating procedures such as aerosolized medication administration, diagnostic sputum induction,
bronchoscopy, airway suctioning, and endotracheal
intubation performed on patients. In some cases,
spread of an infectious agent may occur indirectly
from handling contaminated fomites (e.g., smallpox
virus transmission from handling infected bed linens
and clothing contaminated with scabs and vesicle
fluid from skin lesions [Downie et al., 1965; Thomas, 1974]). Methods of protecting healthcare workers from airborne transmission of infectious agents
include engineering and administrative controls,
respirators, disease prevention interventions such as
active immunization or antibiotic prophylaxis, or
combinations of these measures.
Size Distributions of Particles in Aerosols
from Possibly Infectious Persons
The factors influencing whether an infectious
agent will be transmitted by airborne spread to another person include the size of the particles produced by contagious persons, the airborne concentrations and inhalational dose of the microorganism,
characteristics of the microorganism (e.g., infectivity,
pathogenicity, and viability after exposure to environmental stresses), environmental factors (e.g., air
movement, temperature, relative humidity, and
sunlight), and host factors (e.g., susceptibility and
immunization status) (Cole & Cook, 1998; McCullough & Brosseau, 1999). Of these factors, one that
has received particular attention relating to the selection of respirators for healthcare workers concerns
the sizes of the particles comprising an infectious
aerosol.
Conflicting meanings applied to the term
“droplet” are central to the issue of particle sizes produced by persons with contagious respiratory infections and are a source of continuing confusion. For
example, OSHA addressed issues related to infectious aerosols, droplets, and the role of surgical
masks in protecting healthcare workers in the preamble of its bloodborne pathogens standard, Title 29
CFR 1910.1030 (OSHA, 1991). Regarding infectious aerosols and whether a potential for airborne
transmission existed, OSHA wrote that conflicting
26
opinions and a lack of information prevented it
from forming an opinion on the matter, and consequently, the agency did not believe it was justified in
pursuing regulation of aerosols.
Regarding protection against exposure to droplets, the OSHA bloodborne pathogens standard requires that masks in combination with eye protection devices, such as goggles or glasses with solid side
shields, or chin-length face shields, shall be worn
whenever splashes, spray, spatter, or droplets of
blood or other infectious materials may be generated, and eye, nose, or mouth contamination can be
reasonably anticipated. In the preamble, OSHA
clarified further that protection of mucous membranes of the face and upper respiratory tract against
large-droplet spattering could be provided by glasses,
face shields, and surgical masks, alone or in combination as appropriate to the task being performed
(OSHA, 1991).
OSHA did not cite the specific sizes of droplets
against which the use of barrier precautions would
be protective. However, by stating that the bloodborne pathogens standard did not apply to infectious aerosols and by using words such as sprays,
splashes, and spatter, the agency implied that the
droplets addressed in the standard are those particles
sometimes referred to as projectile particles. Projectile particles are large enough to be visible to the naked eye, are essentially unaffected by room air currents, and remain airborne only briefly. They have
ballistic trajectories that do not deviate from their
courses until they collide head-on with or impact a
surface. In physiological terms, droplets created by
sprays, splashes, and spatters are distinguished from
aerosol particles in that they are much too large to
be inhaled; for this reason, they have also been
called nonrespirable particles.
The position of OSHA was that barrier devices
such as glasses, face shields, and surgical masks
would protect healthcare workers from infectious
agents generated as large-particle droplets of sprays,
splashes, or spatters. However, a conflict arises when
comparing the term “droplet” to describe particles
that settle out quickly (as used by OSHA and summarized above) and the term “droplet” as used in
infection control documents. Part II of the Guideline
for Isolation Precautions in Hospitals states that the
�Lenhart / Seitz / Trout / Bollinger
OSHA bloodborne pathogens standard requires the
wearing of masks, eye protection, and face shields to
reduce the risk of exposures to bloodborne pathogens and that healthcare workers generally can wear
surgical masks as protection against the spread of
infectious large-particle droplets (Garner & Hospital
Infection Control Practices Advisory Committee,
1996). However, large-particle droplets were defined
in the guideline as particles larger than 5 micrometer
(m) and generated either by an infected person during coughing, sneezing, or talking or during the performance of procedures such as suctioning and bronchoscopy. Furthermore, particles of 5 m or less
were defined as droplet nuclei (i.e., residues of
evaporated droplets [Wells, 1955]). The rationale
supporting this definition of large-particle droplets
as 5 m and larger and the view that surgical masks
protected against exposures to them are unstated
and, as will be demonstrated below, may be flawed.
Critical to this discussion is the distinction between the size of particles comprising an aerosol and
the size of particles that settle out quickly. From the
principles of aerosol physics, spherical particles settling freely in still air are known to reach an equilibrium or terminal settling velocity. The terminal settling velocity of a particle can be calculated and is a
function of the viscosity and density of air, the particle’s density and its diameter squared, and acceleration due to gravity (Baron & Willeke, 2001).
The terminal settling velocities of particles can
be used to distinguish particles that tend to remain
airborne from those that settle out. For example, the
terminal settling velocity of a particle of unit density
(i.e., 1 gram per cubic centimeter) and a diameter of
100 m is approximately 30 centimeters per second
(cm/sec) (Baron & Willeke, 2001), which suggests
that particles of this size and larger will settle quickly
on surfaces near the point at which they were generated. By comparison, a particle with the same unit
density and a diameter of 5 m (which is the cut-off
used in the infection control guide) has a terminal
settling velocity of only 0.08 cm/sec (Baron &
Willeke, 2001), and thus, it tends to remain airborne for a relatively long time. Therefore, as a ruleof-thumb, airborne particles having diameters of 100
m or less have been defined as comprising an aerosol, and those greater than 100 m are particles that
will settle out quickly (Baron & Willeke, 2001;
Hirshfeld & Laub, 1941; Wells, 1934). Consequently, an assumption that all droplets greater than
5 m are large-particle droplets that do not remain
suspended in the air and generally travel only short
distances, usually 3 feet or less, through the air
(Garner & Hospital Infection Control Practices Advisory Committee, 1996) is inconsistent with wellestablished understanding of how aerosol particles
behave.
Duguid (1946) and Papineni & Rosenthal
(1997) studied the sizes of droplets expelled during
talking, coughing, sneezing, nose breathing, and
mouth breathing. Duguid used a microscope to estimate the size of respiratory droplets by measuring
stain marks on slides exposed directly to mouth
spray. He reported that droplets produced by talking, coughing, and sneezing ranged from 1 to 2,000
m; 95% of the droplets had diameters between 2
and 100 m; and most droplets had diameters between 4 and 8 m (Duguid, 1946). The composition
and bacterial or viral content of droplets and droplet
nuclei are likely to be highly variable, with large aggregate droplets and strings of mucus possibly containing many organisms and droplet nuclei containing one or two organisms at most and sometimes
containing none (Reponen, Willeke, & Nevalainen,
2001; Riley & O’Grady, 1961; Wells, 1955).
More recently, Papineni and Rosenthal (1997)
used an optical particle counter and transmission
electron microscope to characterize the size distribution of droplets exhaled by mouth breathing, nose
breathing, coughing, and talking. They reported that
the diameters of respiratory droplets produced by
healthy persons ranged from 0.3 m (the lower limit
of detection of the sampling method) to approximately 8 m. The findings of a study comparing the
elimination of inhaled 6-m Teflon particles from
the tracheobronchial tract of healthy persons and
patients with respiratory tract disease showed that
only patients with increased respiratory secretions
eliminated test particles from their lungs by coughing (Camner, Mossberg, Philipson, & Strandberg,
1979). Thus, a conclusion was made that increased
respiratory secretions were necessary for coughing to
be an effective means of eliminating particles. Increased secretion of fluids on airway surfaces and
27
�Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols
greater respiratory actions such as coughing and
sneezing by persons with respiratory illnesses may
alter the size distribution of their exhaled droplets
and increase droplet concentrations (Papineni &
Rosenthal, 1997).
Droplets Versus Droplet Nuclei
If expelled droplets remained at their original
size, those having diameters greater than 100 m
would settle rapidly from the air, and only people
close to an infectious patient would be at risk for
exposure to these large aerosolized particles (Burge,
1995; Silverman, Billings, & First, 1971; Wells,
1934). However, droplets do not remain the same
size after being expelled, but rather they begin immediately to evaporate and within seconds, or even fractions of a second, become droplet nuclei (Burge,
1995; Silverman et al., 1971; Wells, 1934).
From a size distribution of the droplets emitted
during sneezing, one researcher concluded that practically all droplets would rapidly evaporate to droplet
nuclei (Riley & O’Grady, 1961). To demonstrate
how rapidly droplets evaporate, Wells (1955) calculated the drying times (total evaporation times) of
water droplets having diameters of 100 and 50 m
falling in unsaturated (50% relative humidity) air
and reported times of 1.3 and 0.3 second, respectively. More recently, Ferron and Soderholm (1990)
calculated the drying time of a water droplet having
a diameter of 50 m in 50% relative humidity air to
be approximately 5 seconds. Despite this latter estimate being more conservative than that of Wells, the
results still demonstrate that small water droplets
evaporate quickly; that is, water droplets having diameters of 20 m and smaller were calculated to
evaporate in less than 1 second (Ferron & Soderholm, 1990). Wells, and Ferron and Soderholm
based their calculations on pure water particles.
Droplets containing dissolved substances, such as
salts and proteins, or containing a microorganism
would likely evaporate less rapidly than a water droplet (Riley & O’Grady, 1961).
Duguid (1946) measured the size of droplet nuclei collected on oiled slides exposed in a slit sampler
and reported that their diameters ranged from 0.25
to 42 m; 97% of the droplet nuclei were between
0.5 and 12 m; and most droplet nuclei had diame28
ters between 1 and 2 m. Duguid’s findings demonstrated also that the most common expired droplets
were between 4 and 8 m, and therefore, for practical purposes, are so small that they may be considered to behave in air like droplet nuclei. Particles in
these size ranges and larger are affected by turbulent
air movement created by worker activities and the
ventilation in a room. The result is that aerosolized
particles smaller than 100 m can remain suspended
in air for prolonged periods of time because typical
room air velocities (10 to 30 cm/sec [Baldwin &
Maynard, 1998; Silverman et al., 1971]) exceed the
terminal settling velocities of the particles.
Applications Concerning Characteristics
of Infectious Aerosols
Recommendations for isolation precautions in
hospitals have defined the sizes of large-particle
droplets as greater than 5 m and the sizes of
droplet nuclei as 5 m or less (Garner & Hospital
Infection Control Practices Advisory Committee,
1996). Whether a healthcare worker is judged to be
exposed to infectious droplets or infectious droplet
nuclei have been controversial and are at the heart
of some debates concerning the level of protection
needed by healthcare workers exposed to infectious
agents. Among the subjects of these debates are two
high-priority infectious disease agents posing a risk
to national security—variola (smallpox) virus and
Yersina pestis (plague) bacteria (CDC, 2000). Because
a terrorist attack involving smallpox or plague is
likely to involve covert dissemination, healthcare
workers would likely be the first to identify exposed
individuals when they became ill. These workers
would be at risk for infection by person-to-person
transmission.
Person-to-person spread of pneumonic plague is
known to occur, and although very uncommon in
the United States, bioterrorism preparedness has
made this a topic of concern (Inglesby et al., 2000).
Guidelines addressing infection control for pneumonic plague state that there is no epidemiological
evidence suggesting person-to-person spread of pneumonic plague by droplet nuclei and that the
mechanism of transmission is via respiratory droplets at close contact, within 6 feet (Garner & Hospital Infection Control Practices Advisory Committee,
�Lenhart / Seitz / Trout / Bollinger
1996; Inglesby et al., 2000; Inglesby, Henderson,
O’Toole, & Dennis, 2000). Because of this, some
researchers consider surgical masks sufficient for protecting healthcare workers from person-to-person
transmission of pneumonic plague and wearing a
respirator to be unwarranted. However, Y. pestis has
been found in oral secretions of infected animals
and humans (Chernin, 1989; Meyer, 1961; Speck &
Wolochow, 1957). As reviewed above, aerosols from
infected patients can, in the course of routine activities and procedures, produce small particles that will
remain airborne for long periods. In fact, some have
argued that the possibility of transmission of pneumonic plague by droplet nuclei should not be dismissed and have recommended that healthcare
workers at risk should wear a respirator (Hawley &
Eitzen, 2001; Levison, 2000).
Regarding smallpox, guidelines have stated that
the smallpox virus is transmitted predominantly by
droplets during close contact with an infectious person. CDC has defined close contact as being within
6 to 7 feet of a smallpox patient (CDC, 2003). However, the findings in one experimental study have
shown that sedimentation plates placed 20 feet from
the bed of a smallpox patient were positive for variola virus (Thomas, 1974), and epidemiological evidence (i.e., the findings of an outbreak investigation)
suggested that droplet-nuclei transmission was responsible for causing a smallpox outbreak in a German hospital (Wehrle, Posch, Richter, & Henderson, 1970). These data suggested that smallpox virus
can be transmitted via an aerosol and are in part the
basis for recommendations that healthcare workers
should wear a respirator when caring for patients
with smallpox (Association for Professionals in Infection Control and Epidemiology, 1999; CDC, 2003).
Surgical Masks Versus Respirators
Despite confusion over what particle size distinguishes large-particle droplets from aerosol particles,
it may be reasonable to assume that a surgical mask
might provide an adequate barrier to large-particle
droplets. However, research has shown that surgical
masks should not be depended upon to protect
healthcare workers from infectious aerosols.
The original purpose of a surgical mask was to
prevent wound contamination by bacteria from the
mouth and upper respiratory tract of surgeons. Surgical masks have also been recommended for patients who are suspected of having or known to have
infectious tuberculosis as a component of routine
infection control practice (CDC, 1994). A 1941
study evaluating surgical masks made of either gauze
or muslin concluded that they were inadequate for
protecting wounds because bacteria-containing particles passed through the filter material and around
the edges of the masks (Hirshfeld & Laube, 1941).
Subsequent studies, in which not only surgical
masks made of gauze and muslin but also ones made
of paper, foam, and synthetic materials were evaluated, resulted in filter efficiencies ranging from the
teens to nearly 100% (Brosseau, McCullough, &
Vesley, 1997; Ford & Peterson, 1963; Ford, Peterson, & Mitchell, 1967; Miller, 1973, 1995; Rogers,
1980). The findings of other studies in which surgical masks were evaluated (with some reported to
have highly efficient filters) have emphasized that a
secure face seal is essential for preventing infectious
particles from escaping (as well as entering) at a
mask’s edges (Ha’eri & Wiley, 1980; Johnson, Martin, & Resnick, 1994; Pippin, Verderame, & Weber,
1987; Tuomi, 1985).
Researchers, who have studied the aerosols and
spatters produced during some dental procedures
and the blood aerosols and spatters generated during
surgeries, defined the size of spatter droplets to be
50 m and larger (Heinsohn & Jewett, 1993; Miller,
1973). However, research has been conducted to
measure the blood-containing particles generated by
common powered dental instruments and to evaluate the effectiveness of surgical masks in protecting
against exposures to these particles (Miller, 1995).
The findings of the study showed that powered dental instruments aerosolized mostly respirable-sized
particles smaller than 10 m in diameter, and the
efficiencies of the tested surgical masks ranged from
17% to 85%. From these findings, Miller (1995)
concluded that “the use of surgical masks for prevention of occupational infection appears to be poorly
founded” (p. 675).
A draft guidance document of the U.S. Food
and Drug Administration (FDA) describes four laboratory tests for measuring the filtration efficiencies
29
�Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols
of surgical masks (Food and Drug Administration,
2003). In lieu of providing the results of one of these
tests to the FDA, the draft proposes that mask
manufacturers can submit the NIOSH certification
number of a model of surgical mask that has been
tested and certified by NIOSH as an N95 respirator.
However, the filtration efficiency tests recommended
by FDA should not be assumed to produce results
that are equivalent to the NIOSH certification tests
of an N95 respirator.
The results of a study comparing the abilities of
a surgical mask and a NIOSH-approved N95 respirator to protect workers against exposures to airborne
latex allergenic particles provide evidence suggesting
that the FDA tests might overestimate the filter efficiencies of surgical masks (Mitakakis et al., 2002).
Latex exposures of 20 healthcare workers were estimated using nasal air samplers (Graham, Pavlicek,
Sercombe, Xavier, & Tovey, 2000) and Institute of
Occupational Medicine filter samplers (Mark & Vincent, 1986). All samples were analyzed for particles
bearing the Hev b 5 latex allergen. The results of the
study showed that wearing a mask did not significantly reduce the number of allergenic particles inhaled and that wearing a respirator reduced the
number of inhaled particles by 17-fold. The mask
and the respirator were made by the same manufacturer and appeared to be identical; however, their
filter materials were different. The particle filtration
efficiencies and bacterial filtration efficiencies of the
mask and the respirator were both reported to be
greater than or equal to 99%, but their differential
pressures differed: less than 2.0 millimeters of water
per square centimeter (mm H2O/cm2) for the mask
and less than 5.0 mm H2O/cm2 for the respirator
(Shalfoon Dental Limited, 2002a, 2002b). Because
the mask and respirator had the same facepiece fitting characteristics, the most likely explanation for
the difference in the levels of protection provided
between the mask and the respirator was penetration
of particles through the mask’s filter material rather
than face seal leakage (C. Solano, Kimberly-Clark
Corporation, N. Richland Hills, TX, personal communication, September 3, 2003).
30
Conclusions and Recommendations
Air concentration measurements and exposure
limits applicable to infectious disease agents to
which workers may be exposed are essentially nonexistent, and the absence of these essential data impedes the process of selecting appropriate respiratory
protection. Until particle-size distributions and the
viability and infectivity of particles comprising infectious aerosols generated in healthcare settings can be
better characterized, the expert opinion method will
likely continue as the method used most frequently
to make respirator selections for healthcare workers.
Specifying the rationale and all data inputs used in a
respirator selection process is essential when using
this method. Important factors to consider include
the known limitations of data, historical experience
with infectious agents in epidemiological evaluations
of outbreak situations, availability of information on
infectious diseases, work tasks perceived to result in
potentially higher risk for aerosol exposure, and the
known properties of and experience with respirators
in healthcare settings and other workplaces.
Outbreaks of new and emerging infectious diseases may present the most difficult challenges to the
selection and use of respirators in healthcare settings
where workers’ risks of exposure to an infectious
agent (e.g., the etiology of the problem, the source or
mode of transmission) are uncertain (Goodman,
Buehler, & Koplan, 1990; Reingold, 1998). Healthcare workers caring for patients in such settings may
be at risk of infection while the data of the outbreak
investigation are being collected and analyzed. The
importance of balancing the need for thorough assessment of causality with the potentially conflicting
need to intervene quickly to protect the health of
workers means, in practice, that implementing control measures will oftentimes be appropriate at any
point in the outbreak investigation sequence
(Reingold, 1998). This public health approach is
consistent with guidance concerning occupational
health practice that states: “When doubts exist about
the severity of an occupational hazard, prudent precautionary action must be considered immediately
and taken as appropriate” (International Commission on Occupational Health, 2002).
�Lenhart / Seitz / Trout / Bollinger
In response to outbreaks of new or emerging
infectious diseases, administrators of respirator programs should use all available data to make respirator selection decisions. Whenever possible, data collected during an outbreak investigation should
include descriptions of respirators (e.g., manufacturer, model number, NIOSH certification number)
worn by healthcare workers when caring for infectious patients; whether respirators with tight-fitting
facepieces were assigned based on facepiece fittesting; whether respirators were worn correctly; the
nature of ventilation conditions in patients’ rooms
(e.g., ventilation effectiveness, air change rates); and
estimates of the air concentration, size, and infectivity of infectious particles generated by a patient or an
aerosol-generating procedure.
In cases where doubt remains about the level of
protection that should be recommended, a respirator type having a higher assigned protection factor
can be selected until additional data are gathered
indicating that protection could be provided by a
respirator having a lower assigned protection factor
or even that respirator use could safely be stopped
entirely. (This approach was used in healthcare settings during the 2003 outbreak of severe acute respiratory syndrome [Twu et al., 2003]). Increased monetary costs of maintaining a respirator program is a
factor to consider with this conservative approach.
Other potential factors to consider in healthcare settings using this approach could include consequences related to infection control (i.e., increased
potential for contact contamination) and interference with patient care.
Evidence is presented in this paper supporting a
position that 100 m, and not 5 m, should be considered the particle size defining the boundary between large-particle droplets and aerosol particles.
Information is also presented demonstrating that,
although healthcare workers caring for patients with
contagious respiratory infections are at risk of exposure to large-particle droplets greater than 100 m in
diameter, their risks of inhalational exposure to infectious particles are likely to be predominantly to
an aerosol consisting of a mixture of rapidly evaporating droplets and droplet nuclei that remain suspended in room air for prolonged periods of time.
Applications of polymerase chain reaction-based
methods for analyzing air samples collected in
healthcare settings have shown promise for providing insight to the nosocomial spread of viral pathogens (Aintablain, Walpita, & Sawyer, 1998; Sawyer,
Chamberlin, Wu, Aintablain, & Wallace, 1994). For
example, contact with contaminated secretions and
large-particle droplets are thought to be the primary
route of transmission of both respiratory syncytial
virus and Bordetella pertussis. However, the possibility
that aerosol particles may contribute to the nosocomial transmission of these agents has been suggested
by the detection of their nucleic acid material in air
at relatively large distances from patients’ beds
(Aintablain et al., 1998). Whether the quantities
detected are sufficient to transmit an infectious dose
or whether the material detected represents viable,
infectious organisms is unknown. These findings
suggest that defining a specific distance as the
boundary of a healthcare worker’s exposure to particles expired by a patient with a contagious respiratory infection may be inappropriate.
Dependence on the findings of outbreak investigations to suggest indirectly whether large-particle
droplets (in which case wearing a surgical mask
would be indicated) or droplet nuclei (in which case
wearing a respirator would be indicated) are responsible for transmission of an infectious agent does not
sufficiently account for other important characteristics of infectious aerosols. Thus, when making a respirator selection, factors in addition to the findings
of outbreak investigations and data concerning the
size distribution of the airborne infectious particles
are likely to be important. These other factors include estimates of the air concentrations of infectious particles generated by different activities, estimates of the amount of time that a healthcare
worker will be near an infectious patient or to procedures likely to generate infectious aerosols, and the
characteristics of the infectious agent (e.g., its infectivity and viability after exposure to evaporation and
other environmental stresses).
A finding that the highest air concentrations of
viable, respirable-size infectious particles most likely
occur during aerosol-generating procedures could
lead to a recommendation that respirators that provide higher levels of protection should be used by
nearby healthcare workers (Singh et al., 2003). For
31
�Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols
example, use of a powered air-purifying respirator
was recommended instead of a negative-pressure airpurifying respirator for situations where healthcare
workers were likely to encounter high levels of infectious aerosols during autopsy, orthopedic procedures, and bronchoscopy (Johnson et al., 1994). The
rationale of this selection included the following
advantages of this respirator: face-seal leakage is essentially prevented by the device’s air flow rate; the
presence of a face shield; and the ability to protect
people with beards. Similarly, wearing a powered
air-purifying respirator has been recommended for
healthcare workers during cough-inducing procedures on patients suspected of having tuberculosis
or during autopsies on deceased persons suspected
of having had tuberculosis (Fennelly, 1997, 1998;
Fennelly & Nardell, 1998; McCullough & Brosseau,
1999; Nicas, 1995).
The filter media of surgical masks allow penetration of small particles, and the poor fitting characteristics of their face seals allow the passage of particles
at the edges of the masks. Thus, only NIOSHcertified respirators should be used as part of a strategy for protecting workers from inhalational exposures to infectious aerosols. Surgical masks may be
useful as barrier devices for protecting the mucous
membranes of a worker’s nose and mouth from inadvertent exposures in situations where the only risk
is to large-particle droplets of splashes, sprays, or
spatters of blood or other potentially infectious material (Mangram et al., 1999). However, surgical
masks cannot be considered respirators.
Finally, preventing the inhalational transmission
of infectious disease agents remains only one component of infection control. Other mechanisms of infectious agent transmission must also be addressed
comprehensively by the application of contact precautions and other preventive measures.
Acknowledgement
The authors gratefully acknowledge the always
outstanding editorial work of Ms. Priscilla Wopat of
the Spokane Research Laboratory of the National
Institute for Occupational Safety and Health.
32
References
Aintablain, N., Walpita, P., & Sawyer, M. H. (1998).
Detection of Bordetella pertussis and respiratory
syncytial virus in air samples from hospital rooms.
Infection Control and Hospital Epidemiology, 19, 918-923.
American National Standards Institute. (1992).
American national standard for respiratory protection
(ANSI Z88.2-1992). New York: American National
Standards Institute.
Association for Professionals in Infection Control
and Epidemiology. (1999, April 13). Bioterrorism
readiness plan: A template for healthcare facilities.
Retrieved January 1, 2004, from www.cdc.gov/
ncidod/hip/Bio/13apr99APIC-CDCBioterrorism.
PDF.
Baldwin, P. E. J., & Maynard, A. D. (1998). A survey
of wind speeds in indoor workplaces. Annals of Occupational Hygiene, 42, 303-313.
Baron, P. A., & Willeke, K. (Eds.). (2001). Aerosol
measurement principles, techniques, & applications (2nd
ed.). New York: John Wiley and Sons, Inc.
Brosseau, L. M., McCullough, N. V., & Vesley, D.
(1997). Mycobacterial aerosol collection efficiency of
respirator and surgical mask filters under varying
conditions of flow and humidity. Applied Occupational and Environmental Hygiene, 12, 435-445.
Burge, H. A. (1995). Airborne contagious disease. In
H. A. Burge (Ed.), Bioaerosols. Boca Raton, FL: Lewis
Publishers.
Camner, P., Mossberg, B., Philipson, K., &
Strandberg, K. (1979). Elimination of test particles
from the human tracheobronchial tract by voluntary
coughing. Scandinavian Journal of Respiratory Diseases,
60, 56-62.
Centers for Disease Control and Prevention.
(October 28, 1994). Guidelines for preventing the
transmission of Mycobacterium tuberculosis in
health-care facilities, 1994. Morbidity and Mortality
�Lenhart / Seitz / Trout / Bollinger
Weekly Report, 43(RR13), 1-132. Retrieved January 1,
2004 from www.cdc.gov/mmwr/preview/
mmwrhtml/00035909.htm.
Centers for Disease Control and Prevention. (2000).
Biological and chemical terrorism: Strategic plan
for preparedness and response. Morbidity and Mortality Weekly Report, 49(RR04), 1-14.
Centers for Disease Control and Prevention. (2001,
October 25). Interim recommendations for the selection and use of protective clothing and respirators
against biological agents. Retrieved January 1, 2004,
from www.bt.cdc.gov/documentsapp/Anthrax/
Protective/10242001Protect.asp.
Centers for Disease Control and Prevention. (2001,
November 6). Protecting investigators performing
environmental sampling for Bacillus anthracis: Personal protective equipment. Retrieved January 1,
2004, from www.bt.cdc.gov/DocumentsApp/
Anthrax/Protective/protective.asp.
Centers for Disease Control and Prevention. (July
26, 2002). Hantavirus pulmonary syndrome B
United States: Updated recommendations for risk
reduction. Morbidity and Mortality Weekly Report,
51(RR09), 1-12. Retrieved January 1, 2004, from
www.cdc.gov/mmwr/preview/mmwrhtml/rr5109a1.
htm.
Centers for Disease Control and Prevention (2003,
October 28). Smallpox response plan and guidelines
(version 3.0). Retrieved January 1, 2004, from
www.bt.cdc.gov/agent/smallpox/response-plan/
index.asp.
Chernin, E. (1989). R. P. Strong and the Manchurian
epidemic of pneumonic plague, 1910-1911. Journal of
the History of Medicine and Allied Sciences, 44, 296-319.
Cole, E. C., & Cook, C. E. (1998). Characterization
of infectious aerosols in healthcare facilities: An aid
to effective engineering controls and preventive
strategies. American Journal of Infection Control, 26,
453-464.
Downie, A. W., Meiklejohn, M., St. Vincent, L.,
Rao, A. R., Sundara Babu, B. V., & Kempe, C. H.
(1965). The recovery of smallpox virus from patients
and their environment in a smallpox hospital. Bulletin of the World Health Organization, 33, 615-622.
Duguid, J. P. (1946). The size and the duration of
air-carriage of respiratory droplets and dropletnuclei. Journal of Hygiene, 44, 471-479.
Fennelly, K. P. (1997). Personal respiratory protection against Mycobacterium tuberculosis. Clinics in Chest
Medicine, 18, 1-17.
Fennelly, K. P. (1998). The role of masks in preventing nosocomial transmission of tuberculosis. International Journal of Tuberculosis and Lung Disease, 2(9
Suppl 1), S103-S109.
Fennelly, K. P., & Nardell, E. A. (1998). The relative
efficacy of respirators and room ventilation in preventing occupational tuberculosis. Infection Control
and Hospital Epidemiology, 19, 754-759.
Ferron, G. A., & Soderholm, S. C. (1990). Estimation of the times for evaporation of pure water droplets and for stabilization of salt solution particles.
Journal of Aerosol Science, 21, 415-429.
Food and Drug Administration. (2003, May 15).
Surgical masks—premarket notification [510(k)] submissions; draft guidance for industry and FDA. Retrieved January 1, 2004, from www.fda.gov/cdrh/
ode/guidance/094.html.
Ford, C. R., & Peterson, D. E. (1963). The efficiency
of surgical masks. American Journal of Surgery, 106,
954-957.
Ford, C. R., Peterson, D. E., & Mitchell, C. R.
(1967). An appraisal of the role of surgical face
masks. American Journal of Surgery, 113, 787-790.
Garner, J. S., & Hospital Infection Control Practices
Advisory Committee. (1996). Guideline for isolation
precautions in hospitals: Parts I and II. Infection Control and Hospital Epidemiology, 17, 53-80, and Ameri-
33
�Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols
can Journal of Infection Control, 24, 24-52. Retrieved
January 1, 2004, from www.cdc.gov/ncidod/hip/
isolat/isolat.htm.
Goodman, R. A., Buehler, J. W., & Koplan, J. P.
(1990). The epidemiologic field investigation: Science and judgment in public health practice. American Journal of Epidemiology, 132, 9-16.
Graham, J. A., Pavlicek, P. K., Sercombe, J. K., Xavier,
M. L., & Tovey, E. R. (2000). The nasal air sampler:
A device for sampling inhaled aeroallergens. Annals of
Allergy, Asthma, and Immunology, 84, 599-604.
Guy, H. P. (1985). Respirator performance terminology. American Industrial Hygiene Association Journal,
46, B22 and B24.
Ha’eri, G. B., & Wiley, A. M. (1980). The efficiency
of standard surgical face masks: An investigation
using “tracer particles.” Clinical Orthopaedics and Related Research, 148, 160-162.
Hawley, R. J., & Eitzen, E. M. (2001). Biological
weapons—a primer for microbiologists. Annual Review of Microbiology, 55, 235-253.
Heinsohn, P., & Jewett, D. L. (1993). Exposure to
blood-containing aerosols in the operating room: A
preliminary study. American Industrial Hygiene Association Journal, 54, 446-453.
Hirshfeld, J. W., & Laube, P. J. (1941). Surgical
masks: An experimental study. Surgery, 9, 720-730.
Inglesby, T. V., Dennis, D. T., Henderson, D. A., et
al. (2000). Plague as a biological weapon--medical
and public health management. Journal of the American Medical Association, 283, 2281-2290.
Inglesby, T. V., Henderson, D. A., O’Toole, T., &
Dennis, D. T. (2000). Safety precautions to limit
exposure from plague-infected patients—in reply.
Journal of the American Medical Association, 284, 1649.
International Commission on Occupational Health
(2002). International code of ethics for occupational
34
health professionals. Retrieved January 1, 2004, from
www.icoh.org.sg/eng/core/code_ethics_eng.pdf.
Johnson, B., Martin, D. D., & Resnick, I. G. (1994).
Efficacy of selected respiratory protective equipment
challenged with Bacillus subtilis subsp. niger. Applied
Environmental Microbiology, 60, 2184-2186.
Johnston, A. R. (2001). Introduction to selection
and use. In C. E. Colton & L. M. Brosseau (Eds.),
Respiratory protection, a manual and guideline (3rd ed.)
(pp. 13-24). Fairfax, VA: AIHA Press.
Lenhart, S. W., Schafer, M. P., Singal, M., & Hajjeh,
R. A. (1997). Histoplasmosis: Protecting workers at risk.
U.S. Department of Health and Human Services,
Public Health Service, Centers for Disease Control
and Prevention, National Institute for Occupational
Safety and Health, DHHS (NIOSH) Publication No.
97-146. Retrieved January 1, 2004, from www.cdc.
gov/niosh/97 146.html.
Levison, M. E. (2000). Safety precautions to limit
exposure from plague-infected patients. Journal of the
American Medical Association, 284, 1648.
Mangram, A. J., Horan, T. C., Pearson, M. L., Silver,
L. C., Jarvis, W. R., & Hospital Infection Control
Practices Advisory Committee. (1999). Guideline for
prevention of surgical site infection, 1999. Infection
Control and Hospital Epidemiology, 20, 250-278.
Mark, D., & Vincent, J. H. (1986). A new personal
sampler for airborne total dust in workplaces. Annals
of Occupational Hygiene, 30, 89-102.
McCullough, N. V., & Brosseau, L. M. (1999). Selecting respirators for control of worker exposure to
infectious aerosols. Infection Control and Hospital Epidemiology, 20, 136-144.
Meyer, K. F. (1961). Pneumonic plague. Bacteriological Review, 25, 249-261.
Miller, R. L. (1973). Studies of the aerobiology of
dentistry. In J. F. Hers & K. C. Winkler (Eds.), Airborne transmission and airborne infection, concepts and
�Lenhart / Seitz / Trout / Bollinger
methods presented at the sixth international symposium on
aerobiology. New York: John Wiley and Sons, Inc.
Miller, R. L. (1995). Characteristics of bloodcontaining aerosols generated by common powered
dental instruments. American Industrial Hygiene Association Journal, 56, 670-676.
Mitakakis, T. Z., Tovey, E. R., Yates, D. H., Toelle,
B. G., Johnson, A., Sutherland, M. F., et al. (2002).
Particulate masks and non-powdered gloves reduce
latex allergen inhaled by healthcare workers. Clinical
and Experimental Allergy, 32, 1166-1169.
Myers, W. R., Lenhart, S. W., Campbell, D., & Provost, G. (1983). Letter to the Editor (topic: Respirator performance terminology). American Industrial
Hygiene Association Journal, 44, B25-B26.
National Institute for Occupational Safety and
Health. (1987). Respirator decision logic. Cincinnati,
OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease
Control, National Institute for Occupational Safety
and Health, DHHS (NIOSH) Publication No. 87108. Retrieved January 1, 2004, from www.cdc.gov/
niosh/87 108.html.
Nicas, M., Neuhaus, J., & Spear, R. C. (2000). Riskbased selection of respirators against infectious aerosols: Application to anthrax spores. Journal of Occupational and Environmental Medicine, 42, 737-748.
Occupational Safety and Health Administration.
(December 6, 1991). Preamble to the OSHA Bloodborne Pathogens Standard (29 CFR 1910.1030),
Section 9, Part IX. Summary and Explanation of the
Standard. Retrieved January 1, 2004, from www.
osha.gov/pls/oshaWeb/owadisp.show_document?
p_table=PREAMBLES&p_id=811&p_text_version=
FALSE.
Occupational Safety and Health Administration.
(1998a). Preamble to the OSHA Respiratory Protection Standard (29 CFR 1910.134), Section 6, Part
VII. Summary and Explanation. Federal Register
63(5):1198-1200. Retrieved January 1, 2004 from
www.osha.gov/pls/oshaWeb/owadisp.show_docume
nt?p_table=PREAMBLES&p_id=1053&p_text_versi
on=FALSE.
Occupational Safety and Health Administration.
(1998b). Respiratory Protection Standard (29 CFR
1910.134). Washington, DC: U.S. Government
Printing Office, Office of the Federal Register.
Nicas, M. (1995). Respiratory protection and the risk
of Mycobacterium tuberculosis infection. American Journal of Industrial Medicine, 27, 317-333.
Occupational Safety and Health Administration.
(June 6, 2003). Assigned protection factors; proposed rule. Federal Register, 68(109), p. 34114.
Nicas, M. (1996). Refining a risk model for occupational tuberculosis transmission. American Industrial
Hygiene Association Journal, 57, 16-22.
Papineni, R. S., & Rosenthal, F. S. (1997). The size
of droplets in the exhaled breath of healthy human
subjects. Journal of Aerosol Medicine, 10, 105-116.
Nicas, M., & Hubbard, A. (2002). A risk analysis for
airborne pathogens with low infectious doses: Application to respirator selection against Coccidioides immitis spores. Risk Analysis, 22, 1153-1163.
Pippin, D. J., Verderame, R. A., & Weber, K. K.
(1987). Efficacy of face masks in preventing inhalation of airborne contaminants. Journal of Oral and
Maxillofacial Surgery, 45, 319-323.
Nicas, M., & Hubbard, A. (2003). A risk analysis
approach to selecting respiratory protection against
airborne pathogens used for bioterrorism. American
Industrial Hygiene Association Journal, 64, 95-101.
Reingold, A. L. (1998). Outbreak investigations—A
perspective. Emerging Infectious Diseases, 4, 21-27. Retrieved January 1, 2004, from www.cdc.gov/ncidod/
eid/vol4no1/reingold.htm.
35
�Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols
Reponen, T., Willeke, K., & Nevalainen, A. (2001).
Biological particle sampling. In P. A. Baron & K.
Willeke (Eds.), Aerosol measurement principles, techniques, & applications (2nd ed.) (p. 752). New York:
John Wiley and Sons, Inc.
Riley, R. L., & O’Grady, F. (1961). Airborne infection.
New York: The Macmillan Company.
Rogers, K. B. (1980). An investigation into the efficiency of disposable face masks. Journal of Clinical
Pathology, 33, 1086-1091.
Sawyer, M. H., Chamberlin, C. J., Wu, Y. N., Aintablain, N., & Wallace, M. R. (1994). Detection of
varicella-zoster virus DNA in air samples from hospital rooms. Journal of Infectious Diseases, 169, 91-94.
Shalfoon Dental Limited. (2002a, September 23).
Kimberly-Clark General Purpose Face Masks. Retrieved January 1, 2004, from www.shalfoon.co.nz/
Web/TechPprs.nsf/7950062053b1bb4fca256a8e00
7e413e/c2f84404591e25dfca256c3e00190b6b
!OpenDocument.
Shalfoon Dental Limited. (2002b, September 23).
Kimberly-Clark Particulate Filter Respirator Masks.
Retrieved January 1, 2004, from www.shalfoon.
co.nz/Web/TechPprs.nsf/7950062053b1bb4fca256
a8e007e413e/351a9a9ea15f491aca256c3e001d63e9
!OpenDocument.
Silverman, L., Billings, C. E., & First, M. W. (1971).
Particle size analysis in industrial hygiene. New York:
Academic Press.
Singh, K., Hsu, L. Y., Villacian, J. S., Habib, A.,
Fisher, D., & Tambyah, P. A. (2003). Severe acute
36
respiratory syndrome: Lessons from Singapore.
Emerging Infectious Diseases, 9, 1294-1298. Retrieved
January 1, 2004, from www.cdc.gov/ncidod/EID/
vol9no10/03-0388.htm.
Speck, R. S., & Wolochow, H. (1957). Studies on the
experimental epidemiology of respiratory infections,
VIII: Experimental pneumonic plague in Macacus
rhesus. Journal of Infectious Diseases, 100, 58-68.
Thomas, G. (1974). Air sampling of smallpox virus.
Journal of Hygiene, 73, 1-7.
Tuomi, T. (1985). Face seal leakage of half masks
and surgical masks. American Industrial Hygiene Association Journal, 46, 308-312.
Twu, S., Chen, T., Chen, C., Olsen, S. J., Lee, L.,
Fisk, T., et al. (2003). Control measures for severe
acute respiratory syndrome (SARS) in Taiwan. Emerging Infectious Diseases, 9, 718-720. Retrieved January
1, 2004, from www.cdc.gov/ncidod/EID/
vol9no6/03-0283.htm.
Wehrle, P. F., Posch, J., Richter, K. H., & Henderson, D. A. (1970). An airborne outbreak of smallpox
in a German hospital and its significance with respect to other recent outbreaks in Europe. Bulletin of
the World Health Organization, 43, 669-679.
Wells, W. F. (1934). On air-borne infection. Study
II. Droplets and droplet nuclei. American Journal of
Hygiene, 20, 611-618.
Wells, W. F. (1955). Airborne contagion and air hygiene. Cambridge, MA: Harvard University Press.
�
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Lenhart, Steven W., Teresa Seitz, Douglas Trout, and Nancy Bollinger. 2004. "Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols: Emphasis on Healthcare Settings." Applied Biosafety 9 (1):20-36.
Abstract
The goal of occupational health practice is to protect the health of workers by preventing diseases and injuries from occurring. When work activities are anticipated, recognized, or found during an investigation to involve risks to workers' health, preventive measures should be taken to control hazardous exposures in the workplace. Respirators are often used to control inhalational exposures to hazardous airborne contaminants, including infectious agents. Of the three methods available for selecting a respirator, the expert opinion method is used most frequently to recommend respirators for controlling exposures to infectious agents. The size of the particles comprising an infectious aerosol has received particular attention relating to the selection of respiratory protection for healthcare workers. Conflicting meanings of the term “droplet” are central to this issue and may be partly responsible for confusion concerning the particle sizes that surgical masks are unlikely to protect against. Although workers caring for patients with contagious respiratory infections are at risk of exposure to large-particle droplets greater than 100 micrometers in diameter, their risks of inhalational exposure to infectious particles are likely to be predominantly to an aerosol consisting of a mixture of evaporating droplets and droplet nuclei that remain suspended in room air for prolonged periods. Because surgical masks are intended to be used only as barriers against large-particle droplets, only respirators certified by the National Institute for Occupational Safety and Health should be used as part of a strategy for protecting workers against inhalational exposures to infectious aerosols. The issues outlined in this paper are focused on workers in healthcare settings, but also apply in other settings where workers may be exposed to infectious aerosols.
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https://www.researchgate.net/publication/291598368_Issues_Affecting_Respirator_Selection_for_Workers_Exposed_to_Infectious_Aerosols_Emphasis_on_Healthcare_Settings
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Issues Affecting Respirator Selection for Workers Exposed to Infectious Aerosols: Emphasis on Healthcare Settings
Subject
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Infection Control
Description
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The goal of occupational health practice is to protect the health of workers by preventing diseases and injuries from occurring.
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Lenhart, Steven W., Teresa Seitz, Douglas Trout, and Nancy Bollinger.
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2004-03-01
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2022-12-07 general asset review - IPC (change R-PPE)
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2023-12-10
Airborne Transmission
Mask
Masks
N95
Occupational Exposure
Occupational Health
R-PPE
R-Res&Pub
Respiratory Pathogen
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https://repository.netecweb.org/files/original/01136687d63170de75eb4db86eb1cd95.png
3f501528330a5195fcab9cad4e0bb714
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
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Cowling, B. J., Y. Zhou, D. K. M. Ip, G. M. Leung, and A. E. Aiello. 2010. "Face masks to prevent transmission of influenza virus: a systematic review." Epidemiology and Infection 138 (4):449-56.
Abstract
<div>
<p>Influenza viruses circulate around the world every year. From time to time new strains emerge and cause global pandemics. Many national and international health agencies recommended the use of face masks during the 2009 influenza A (H1N1) pandemic. We reviewed the English-language literature on this subject to inform public health preparedness. There is some evidence to support the wearing of masks or respirators during <span class="highlight">illness</span> to protect others, and public health emphasis on mask wearing during <span class="highlight">illness</span> may help to reduce influenza virus transmission. There are fewer data to support the use of masks or respirators to prevent becoming infected. Further studies in controlled settings and studies of natural infections in healthcare and community settings are required to better define the effectiveness of face masks and respirators in preventing influenza virus transmission.</p>
</div>
<div class="err">
<h3>Comment in</h3>
<ul><li class="comments"><a href="https://www.ncbi.nlm.nih.gov/pubmed/20447328">Influence of household contacts on the effectiveness of face masks for preventing influenza in a healthcare setting: a comment on Cowling et al. (2010).</a><span class="source"> [Epidemiol Infect. 2010]</span></li>
</ul></div>
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https://www.ncbi.nlm.nih.gov/pubmed/20092668
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https://doi.org/10.1017/S0950268809991658
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Face masks to prevent transmission of influenza virus: a systematic review.
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Infection Control
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Influenza viruses circulate around the world every year. From time to time new strains emerge and cause global pandemics.
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Cowling, B. J., Y. Zhou, D. K. M. Ip, G. M. Leung, and A. E. Aiello.
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2010-04
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2022-12-07 general asset review - IPC (change R-PPE)
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Flu
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https://repository.netecweb.org/files/original/7601fdd3d95a4e97414a871b6d2b2e41.pdf
24a2809b15d28159b21988237671112e
PDF Text
Text
RESEARCH ARTICLE
Healthcare personnel exposure in an
emergency department during influenza
season
Ana M. Rule1, Otis Apau1, Steven H. Ahrenholz2, Scott E. Brueck2, William G. Lindsley3,
Marie A. de Perio2, John D. Noti3, Ronald E. Shaffer4, Richard Rothman5,
Alina Grigorovitch1, Bahar Noorbakhsh3, Donald H. Beezhold3, Patrick L. Yorio4, Trish
M. Perl6, Edward M. Fisher4*
a1111111111
a1111111111
a1111111111
a1111111111
a1111111111
OPEN ACCESS
Citation: Rule AM, Apau O, Ahrenholz SH, Brueck
SE, Lindsley WG, de Perio MA, et al. (2018)
Healthcare personnel exposure in an emergency
department during influenza season. PLoS ONE 13
(8): e0203223. https://doi.org/10.1371/journal.
pone.0203223
Editor: Ginny Moore, Public Health England,
UNITED KINGDOM
Received: May 23, 2018
Accepted: August 16, 2018
Published: August 31, 2018
Copyright: This is an open access article, free of all
copyright, and may be freely reproduced,
distributed, transmitted, modified, built upon, or
otherwise used by anyone for any lawful purpose.
The work is made available under the Creative
Commons CC0 public domain dedication.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: This research was funded by the Centers
for Disease Control and Prevention and in part by
BARDA 1 IDSEP130014-01-00 and NIH
HHSN272201400007C. The funders had no role in
study design, data collection and analysis, decision
to publish, or preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
1 Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, United States of America, 2 Division of Surveillance, Hazard Evaluations, and Field
Studies (DSHEFS), National Institute for Occupational Safety and Health, Cincinnati, Ohio, United States of
America, 3 Health Effects Laboratory Division (HELD, National Institute for Occupational Safety and Health,
Morgantown, West Virginia, United States of America, 4 National Personal Protective Technology Lab
(NPPTL), National Institute for Occupational Safety and Health, Pittsburgh, Pennsylvania, United States of
America, 5 Johns Hopkins Hospital, Adult Emergency Department, Baltimore, Maryland, United States of
America, 6 Division of Infectious Diseases, UT Southwestern Medical Center, Dallas, Texas, United States of
America
* fxw7@cdc.gov
Abstract
Introduction
Healthcare personnel are at high risk for exposure to influenza by direct and indirect contact,
droplets and aerosols, and by aerosol generating procedures. Information on air and surface
influenza contamination is needed to assist in developing guidance for proper prevention
and control strategies. To understand the vulnerabilities of healthcare personnel, we measured influenza in the breathing zone of healthcare personnel, in air and on surfaces within
a healthcare setting, and on filtering facepiece respirators worn by healthcare personnel
when conducting patient care.
Methods
Thirty participants were recruited from an adult emergency department during the 2015
influenza season. Participants wore personal bioaerosol samplers for six hours of their work
shift, submitted used filtering facepiece respirators and medical masks and completed questionnaires to assess frequency and types of interactions with potentially infected patients.
Room air samples were collected using bioaerosol samplers, and surface swabs were collected from high-contact surfaces within the adult emergency department. Personal and
room bioaerosol samples, surface swabs, and filtering facepiece respirators were analyzed
for influenza A by polymerase chain reaction.
Results
Influenza was identified in 42% (53/125) of personal bioaerosol samples, 43% (28/ 96) of
room bioaerosol samples, 76% (23/30) of pooled surface samples, and 25% (3/12) of the
PLOS ONE | https://doi.org/10.1371/journal.pone.0203223 August 31, 2018
1 / 15
�Healthcare personnel exposure to influenza
filtering facepiece respirators analyzed. Influenza copy numbers were greater in personal
bioaerosol samples (17 to 631 copies) compared to room bioaerosol samples (16 to 323
copies). Regression analysis suggested that the amount of influenza in personal samples
was approximately 2.3 times the amount in room samples (Wald χ2 = 16.21, p<0.001).
Conclusions
Healthcare personnel may encounter increased concentrations of influenza virus when
in close proximity to patients. Occupations that require contact with patients are at an
increased risk for influenza exposure, which may occur throughout the influenza season.
Filtering facepiece respirators may become contaminated with influenza when used during
patient care.
Introduction
Healthcare personnel (HCP) are at high risk for exposure to seasonal and novel strains of influenza during patient care and aerosol generating procedure (AGPs) [1]. A systematic review
and meta-analysis of the annual incidence of influenza among healthy adults and HCP found
that, compared to adults working in non-healthcare settings, HCP are at significantly higher
risk of developing influenza [2]. Another study among 70 HCP in 22 states during the 2009
H1N1 pandemic found that 50% of the subjects were most likely infected within the healthcare
facility[3]. These infections likely include patient-to-HCP and HCP-to-HCP transmissions.
Among hospital departments, adult and pediatric emergency departments had the highest
HCP infection rates [4].
Healthcare resources and HCP are in demand during months when influenza is circulating
and such demand is even higher during an influenza epidemic [5]. More HCP are needed
when there are more patients to care for, and during outbreaks of contagious disease, some
HCP become ill and may actually decrease availability. Therefore, protecting HCP from
acquiring influenza is critical to maintain the workforce. Minimizing the risk of transmission
of influenza includes vaccinating HCP and utilizing infection prevention precautions such as
the appropriate use of personal protective equipment (PPE) [6].
Medical masks are often recommended for HCP who are in close contact with a suspected
or laboratory-confirmed seasonal influenza patient [7]. Medical masks are loose-fitting devices
and do not offer protection from infectious aerosols. Filtering facepiece respirators (FFRs) are
tight-fitting devices recommended for use by HCP when aerosol transmission is a concern,
such as when in close contact with patients with novel strain influenza and when performing
aerosol generating procedures on patients with seasonal or novel strain influenza [7, 8].
Because FFRs are disposable, single-use devices, supplies can become scarce during periods of
heightened need such as an influenza pandemic. Reuse and extended use of FFRs has been recommended as a mechanism to conserve supplies during a pandemic, but risks of FFR reuse
have not been fully characterized [8, 9]. Measuring the routes of exposure to influenza within
a healthcare facility and contamination of FFRs can assist in the development of PPE recommendations and pandemic protection plans to protect the estimated 18 million HCP in the
United States.
To further enhance our understanding of influenza transmission in frontline HCP and to
provide data to policy makers, we measured influenza near the breathing zone of HCP, in air
PLOS ONE | https://doi.org/10.1371/journal.pone.0203223 August 31, 2018
2 / 15
�Healthcare personnel exposure to influenza
and on surfaces within a healthcare setting, and on FFRs worn by HCP working in a healthcare
setting. We hypothesized that frequency and concentrations of influenza positive samples
would be greater for personal bioaerosol samplers compared to room samplers given the close
proximity of participants to patients while administering health care services.
Methods
Participant recruitment
A cross-section of 30 HCP with direct patient contact and a variety of job functions (S1 Table)
who worked in a busy, inner-city academic adult emergency department (AED) in Baltimore
City, were enrolled at the peak (as determined by reports from the Hospital Epidemiology and
Infections Control Division) of the 2014–2015 influenza season (29 December 2014 to 9 February 2015). The emergency department was located in a state-of-the-art, new facility with 10
air exchanges per hour on average within patient care areas. The emergency department sees
on average 70,000 patients per year with 67 treatment areas. Participants were eligible to be
included if they were 18 years of age or older, employed full-time at the AED in a job that
required routine close contact with patients presenting with influenza-like illness (ILI) symptoms, and routinely working dayshift hours (7:00 A.M.– 5:00 P.M.). During the 2014–2015
influenza season, the HCP at the AED were to use medical masks during encounters with
patients with ILI symptoms as per hospital policy. FFRs were also available and some AED
employees were participating in another study which required them to wear FFRs for all
encounters with patients exhibiting influenza like illness. For this study, participants had to
be willing and able to use their PPE (FFR or medical masks) when in the presence of patients
exhibiting ILI symptoms and remain clean-shaven during the six weeks of sampling. The
study was approved by both Johns Hopkins University (JHU) and NIOSH Internal Review
Boards. Study participants gave informed consent prior to the study. All participants signed
consent form prior to enrollment in the study (Internal review board# HSRB 14-NPPTL03XP).
Participant requirements
Thirty participants, including nursing supervisors, registered nurses (RNs), certified nursing
assistants (CNAs), shift coordinators, clinical technicians, and support staff, were recruited.
During each sampling day, five to seven of the 30 participants wore a personal bioaerosol sampler that collected air from their breathing zone (volume within a ten inch radius from the
nose/mouth) during six hours of their work shift. Participants were asked to save FFRs and
medical masks used during patient encounters. At the end of the six hour sampling period,
FFRs and medical masks were collected and returned to a laboratory within the JHU School of
Public Health for processing and storage.
Questionnaire
After wearing the personal air sampler, participants completed a questionnaire (S1 Fig) to
assess the frequency and type of interactions with infected patients and coworkers, and
describe the attitudes and practices of the participants when attending to patients with ILI. All
participants were asked the length of time they were exposed to each patient, whether they
used an FFR or medical mask, the occurrence and length of FFR or medical mask use, and
whether they performed aerosol-generating procedures (i.e. intubation, respiratory airway suctioning, nebulizing, or nasopharyngeal aspiration). The data from the questionnaires were
used to determine, in part, which masks to test based on potential exposures from aerosol
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�Healthcare personnel exposure to influenza
generating procedures. The information gained from the questionnaire will be reported in a
separate publication.
Field data collection
Samples were collected three days per week (Monday, Wednesday, and Friday) and consisted
of room and personal bioaerosol samples, used FFRs and medical masks, surface samples, and
daily questionnaires. We were provided with de-identified information about the location of
patients with confirmed influenza (identified by a diagnostic rapid test) as well as the HCP
that had contact with them.
Air samples. Personal and room bioaerosol samplers consisted of an button sampler
[10] (SKC Inc. Eighty Four, PA) that contained a 25 mm filter (Fluorophore™ PTFE, 3.0 μm pore
size, Millipore Sigma, Darmstadt, Germany) connected to a personal sampling pump (XR5000,
SKC Inc, Eighty Four, PA). The personal sampling pump was wrapped in 2.54 cm thick noisedampening material (5692T13, McMaster Carr, Aurora, OH) and housed in a personal backpack
(CamelBak Products, LLC, Petaluma, CA) with the inhalable sampler clipped in the front strap
of the backpack, in the subject’s breathing zone. Room sampling pumps were placed in a modified case (Storm iM2200, Pelican LLC, Torrance, CA) and connected via a 0.9 m Tygon™ tube
(6.35 mm I.D.) to the inhalable sampler, which was taped to a wall approximately 1.5 m above
the floor. Before each sampling period, each of the pumps was calibrated in the lab to 4±0.2 liters
of air per minute (L/min) with an electronic flow calibrator (Bios DryCal, SKC Inc., Eighty Four,
PA); flow rates were checked and recorded at the end of the sampling period.
Assignment of personal bioaerosol samplers was based on participant availability as determined by a shift schedule provided by management of the adult ED. We attempted to equalize
the number of shifts monitored for each participant over the study period. Room air sampler
locations were identified with hospital staff in advance to prevent interfering with daily activities.
Room samplers were located in each of the two waiting areas, two of the four screening rooms,
one of two triage areas and the ED observation unit (emergency acute care unit or EACU) for
the same period of six hours as participants wore the personal air samplers. Immediately after
the six hours of sampling, all samples were transported to a laboratory within the Johns Hopkins
University School of Public Health, where each filter recovered from the sampler was processed
as follows: transferred into a 15 ml tube containing 1 ml modified Hank’s Balanced Salt Solution
(mHBSS) (Invitrogen, Carlsbad, CA) containing 0.1% bovine serum albumin (BSA) (SigmaAldrich, St. Louis, MO), vortexed for 60 seconds, and stored at -20˚C until shipment to a laboratory within NIOSH’s Health Effects Laboratory Division (HELD) for analysis.
Temperature and relative humidity data loggers (HOBO U10-003, Onset Corp, Bourne,
MA) were deployed with each of the six room samplers. Data loggers recorded every minute.
Surface samples. Common high-contact, non-porous hard surfaces (chair surfaces in the
triage area and two screening rooms, and the sink area) in the vicinity of room air samplers
were swabbed using moistened sterile swabs (Copan Diagnostics, Corona, California). A 10
cm x 10 cm template was used to delineate a 100 cm2 swipe area for large surfaces. For non-flat
surfaces (e.g. sink faucet handles), 100 cm2 areas were estimated. Each swab was then placed in
a 15 ml tube containing 1 ml mHBSS, vortexed for 60 seconds, and stored at -20˚C.
FFRs and medical masks. Subjects who were fitted with a personal bioaerosol sampler
were provided with labeled, zip-seal bags and collection bins to place FFRs and medical masks
worn during the sampling interval. All bags were stored at -20˚C until shipment to the NIOSH
(HELD) laboratory.
Quality control. For quality control, one positive and one negative control was prepared
for each sample type (personal bioaerosol, room aerosol and surface samples). For positive
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�Healthcare personnel exposure to influenza
field controls, bioaerosol sampler filters and surface swabs were inoculated with reference
influenza virus H1N1 strain A/WS/33 (catalog number VR-825, American Type Culture Collection, Manassas, VA). Negative field controls for air samples consisted of a filter from a prepared aerosol sampler handled in the same way as all of the other samples except that the
sampler did not have any air drawn through it. Surface swipe negative controls were handled
in the same way as all other surface samples except no surface was swabbed. Positive and negative field control samples served as indicators of field sample integrity associated with handling
and shipment of the samples. All samples were kept at -20˚C.
Analytical methods
All samples (bioaerosol filters and surface samples in mHBSS, and FFRs and medical masks
in plastic bags) were overnighted in weekly batches at 4˚C to the NIOSH HELD laboratory,
where samples were stored at -80˚C until analysis. Before analysis, four 25 mm diameter coupons were punched out from the mouth area of each FFR and placed in 8 ml of mHBSS. Virus
was eluted from all samples by overnight incubation at 4˚C in mHBSS.
After overnight incubation, viral RNA was isolated from all samples using the MagMax™-96
Viral RNA Isolation Kit (Applied Biosystems/Ambion, Austin, TX) as previously described
[11]. The final viral RNA volume was 32 μl. Viral RNA was immediately transcribed into
cDNA using the High Capacity RNA to cDNA Master Mix in accordance with the manufacturer’s instructions (Applied Biosystems, Foster City, CA). The final cDNA volume was 40 μl.
The presence of influenza A was evaluated by quantitative Polymerase Chain Reaction
(qPCR) assays (Applied Biosystems 7500 Fast Real-Time PCR System). For qPCR determination of total matrix gene or hemagglutinin (HA) gene copies of viral RNA, matrix-specific
primers were used as described before [12]. Samples below the qPCR limit of quantification
were further analyzed using gel electrophoresis using NuSieve GTG agarose gel (Lonza Inc.,
Allendale, NJ) along with 10 μl of a 100 base pairs (bp) DNA ladder (N3231L, New England
Biolabs, Ipswich, MA).
Limit of quantification and limit of detection
The limit of quantitation (LOQ) of the qPCR assay was 15 viral copies per PCR reaction tube,
which corresponded to a threshold cycle (Ct) value of 34.5 cycles. The limit of detection
(LOD) by qPCR was 10 viral copies per sample (Ct value of 35.8 cycles). In cases where a PCR
product was detected but the Ct value was higher than the Ct value for the LOQ, the PCR
product was evaluated by electrophoresis in a 4.5% NuSieve GTG agarose gel to verify that the
PCR product was the correct size (101 bp) for the M1 matrix gene. The LOD with this additional step was two viral copies per sample. A sample containing 2–14 PCR copies of the
matrix gene was considered positive for influenza if the product was confirmed to be the correct size by gel electrophoresis. For additional verification, DNA sequence analysis was performed on randomly-chosen samples by a commercial laboratory (Genewiz LLC, South
Plainfield, NJ) using predefined Sanger DNA sequencing.
Calculations
Airborne virus concentrations (Ca) were calculated from copies of influenza virus measured
from bioaerosol sampler filters (Vf) using Eq 1
�
�
Vf
Ca ¼
à 1; 000
ð1Þ
TÃQ
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�Healthcare personnel exposure to influenza
where Ca = aerosol concentration (virus copies/m3); Vf = # of viruses on filter (copies);
T = Sampling time (minutes); Q = pump flow rate (L/min); and 1,000 is a multiplier to convert
from liters to cubic meters.
Surface concentrations (Cs, in units of # of copies/cm2) were calculated from copies of influenza virus measured from pooled swipe samples (Vs) using Eq 2
Cs ¼
ðVs x DFÞ
Sa
ð2Þ
where Cs = surface concentration (virus copies/cm2); Vs = # of viruses on pooled swab samples
(virus copies); DF = dilution factor (16); and Sa = surface area swiped (cm2).
Statistical analysis
The study was powered to detect an 18% difference between personal and room bioaerosol
samplers. These values were estimated from the average min and max detection rates for influenza positive personal and room aerosol samplers reported in the literature [11, 13–19].
Descriptive statistics (median, range, frequency) and inferential statistics were performed
in SPSS version 24 (IBM Corp. Armonk, New York). A regression based Generalized Linear
Model approach assuming a Negative Binomial distribution was used to estimate the mean difference between personal and room bioaerosol samples given the dependent variable (virus
concentration) was log-normally distributed. The Negative Binomial distribution was selected
based on the nature of the data and through superior fit statistics when compared to the normal and Poisson distribution counterpart. Within the statistical model the origin of the sample
(personal or room) was entered as a categorical variable with room bioaerosol as the reference
category.
Results
Influenza was detected on 42% of the personal bioaerosol samplers collected. The quantity of
influenza copy numbers ranged from 17 to 631 copies per sample (Table 1), equivalent to a
6-hour exposure to aerosols with concentrations roughly from 11 viruses/m3 to 438 viruses/
m3. Influenza was detected in 43% of the room bioaerosol samplers. The number of influenza
copies recovered in the sampled rooms ranged from 16 to 323 copies (Table 2), equivalent to
6-hour exposure to aerosols with 13 viruses/m3 to 224 viruses/m3. These descriptive statistics
resulted in a significant difference in the mean influenza virus copies between personal
(M = 173.13) and room samples (M = 74.79), B = 0.84, Incident Risk Ratio (IRR) = 2.32 (95%
OR CI, 1.54–3.48), Wald χ2 = 16.21, p < .001. This IRR suggests that the amount of influenza
in personal samples was approximately 2.3 times the amount in room samples.
The frequency of positive personal bioaerosol samples was greatest for CNAs and RNs
(Table 3). Nursing supervisors had the highest median copy number (440 copies, or 250
viruses/m3) on their personal sampler filters, while sampler filters from CNAs had the lowest
median copy number with 31 copies or 20 viruses/m3. There was a positive correlation
(R = 0.83, P = 0.039) between the ratio of the number of self-reported contacts with patients
and/or coworkers exhibiting ILI per the number of shifts monitored and the frequency of positive filters for each occupation (Table 3).
The frequency of detection, range, and median number of copies of influenza virus measured on room bioaerosol samples for each patient care area and patient waiting areas sampled
(Table 4) ranged from 35% for the observation unit to 56% for screening rooms and 44 to 47%
of triage areas. The observation area had the highest level of contamination with 323 copies/filter (224 viruses/m3), although waiting area one had the highest median of 81 copies/filter (56
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�Healthcare personnel exposure to influenza
Table 1. Influenza concentrations in individual personal bioaerosol samples over the study period.
Copies of influenza RNA/
filter
Estimated 6 hour exposure concentration (viruses/m3)
Date
Observations (n =)
No. of positive samples
12/29/2014
6
1
128
128
89
12/30/2014
7
2
23
17–29
15
1/2/2015
7
0
-
<LOD
-
1/5/2015
6
1
86
86
60
Median
Range
1/7/2015
8
7
249
202–326
172
1/9/2015
8
7
267
31–362
186
1/12/2015
8
3
29
24–261
13
1/14/2015
8
8
235
151–326
164
1/16/2015
4
0
-
<LOD
-
1/19/2015
6
0
-
<LOD
-
1/21/2015
4
0
-
<LOD
-
1/23/2015
7
0
-
<LOD
-
1/26/2015
6
2
54
50–60
38
1/28/2015
7
3
91
40–93
63
1/30/2015
6
3
49
39–210
35
2/2/2015
7
6
40
17–339
28
2/4/2015
7
6
233
63–381
161
2/6/2015
6
2
339
47–631
236
2/9/2015
7
2
39
17–61
28
https://doi.org/10.1371/journal.pone.0203223.t001
Table 2. Room bioaerosol sample results by day.
Date
No. of positive samples
No. of rooms monitoredÃ
Copies of influenza RNA/filter
Range
Ã
Median
12/29/2014
0
4
<LOD
-
12/30/2014
1
4
16
16
1/2/2015
0
4
<LOD
-
1/5/2014
0
4
<LOD
-
1/7/2015
0
1
<LOD
-
1/9/2015
2
2
35–82
59
1/12/2015
2
3
16–31
24
1/14/2015
4
4
20–46
35
1/16/2015
3
3
40–179
83
1/19/2015
2
4
19–24
22
1/21/2015
4
4
37–323
101
1/23/2015
4
4
20–127
39
25
1/26/2015
3
4
23–27
1/28/2015
0
4
<LOD
-
1/30/2015
1
4
43
43
2/2/2015
0
4
<LOD
-
2/4/2015
1
4
159
159
2/9/2015
1
3
44
44
Included only four rooms that had healthcare worker occupancy. Two waiting areas excluded.
https://doi.org/10.1371/journal.pone.0203223.t002
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�Healthcare personnel exposure to influenza
Table 3. Frequency of positive personal bioaerosol samples by occupation.
1
Occupation
No. of positive
samples
Ratio of patients exhibiting ILI / No. shifts
monitored
Total shifts
monitored
Frequency of
positives
Copies of influenza
RNA/filter
Support staff
5
1.19
18
28%
Shift coordinator
1
1.25
4
25%
39
39
Registered nurse
31
2.33
61
51%
140
17 to 381
Nursing supervisor
2
0.17
6
33%
440
249 to
631
Clinical technician1
12
1.10
32
38%
225
17 to 339
Certified nursing
assistant
3
3.00
4
75%
31
29 to 61
Median
Range
212
53 to 269
For a description of all job titles please refer to S1 Table
https://doi.org/10.1371/journal.pone.0203223.t003
viruses/m3). Waiting areas were similar to the other sampled areas, with 41 and 35% frequency
of detection, and between 20 and 307 copies of virus detected per filter.
During eight of the 125 shifts sampled, a participant was in contact with a confirmed influenza patient. Of these eight participants (Table 5), four had positive personal bioaerosol samplers with a copy number ranging from 29 to 321. One participant, a RN, had contact with five
patients with confirmed influenza. The personal bioaerosol sampler for this participant was
positive for influenza with 128 copies (89 copies/m3), while a participant with one contact had
Table 4. Frequency of identifying influenza in room aerosol samples in an adult emergency department.
Room
No. of positive samples
Frequency of positive samples
Copies of influenza RNA/filter
Range
Median
35%
26 to 323
69
47%
19 to 159
23
9
56%
20 to 69
40
16
7
44%
16 to 127
33
Waiting Area 1
17
7
41%
24 to 186
81
Waiting Area 2
17
6
35%
20 to 307
42
1
17
6
Screening room C
15
7
Screening room D
16
Triage Area
Observation Unit
1
No. of samples collected
EACU = Emergency Acute Care Unit
https://doi.org/10.1371/journal.pone.0203223.t004
Table 5. Personal bioaerosol sample results of participants that had contact with influenza positive patients.
Number of contacts
No. of copies of influenza RNA
Copies of influenza/m3
12/29/2014
1
RN
5
128
89
12/30/2014
CT2
1
-
12/30/2014
RN
3
29
20
1/5/2015
RN
1
86
60
1/5/2015
RN
1
-
Date
Occupation
1/5/2015
RN
1
-
1/9/2015
RN
1
321
1/23/2015
CT
1
-
1
RN = Registered Nurse;
2
CT = Clinical Technician
223
https://doi.org/10.1371/journal.pone.0203223.t005
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�Healthcare personnel exposure to influenza
Table 6. Influenza identified in personal bioaerosol samplers after performing aerosol generating procedures.
Occupation
No. of participants
Aerosol generating procedures performed
Influenza identified in personal samples
Intubations Airway suctioning Nebulizer Nasopharyngeal aspirations
Clinical Technicians
3
0
1
2
0
0/3 (0%)
Registered nurses
22
1
3
27
5
10/22 (41%)
Total
25
1
4
29
5
10/25 (36%)
https://doi.org/10.1371/journal.pone.0203223.t006
the highest copy number (321 copies) detected on their personal bioaerosol sampler filter. The
frequency of positive personal bioaerosol samplers was not significantly different (p>0.05)
between participants that had or did not have contact with influenza confirmed patients.
A total of 25 participants performed AGPs while wearing a personal sampler, including an
intubation, four airway suctions, 29 nebulizer treatments, and five nasopharyngeal aspirations
(Table 6). Of the 25 participants who performed an AGP, influenza was isolated from the personal bioaerosol samplers of 10 participants, with copy numbers ranging from 29 to 321 (20 to
223 viruses/m3). None of the bioaerosol samplers worn by the three clinical technicians and all
ten of the samplers worn by the RNs who performed AGP had an influenza positive personal
bioaerosol sampler.
A total of 12 FFRs were analyzed for influenza, eight of which were from participants
exposed to patients with confirmed influenza. Of these, influenza was identified in three
(25%). Four FFRs were tested from a subject who performed an AGP and had a positive personal bioaerosol sampler, yet all four of the FFRs were negative for influenza.
Influenza was identified in 14 of the 30 pooled surface samples (47%) collected from patient
care areas (Table 7). Eight of 12 samples from the screening rooms (66%), and four of 12
(30%) samples from triage chairs were positive. Influenza was also detected in two of six (33%)
of triage sink samples. The samples ranged from 0.5 to 6.1 virus/cm2. The highest concentrations were found in the screening room chairs, with 6.1 and 3.6 virus/cm2, in each of the two
screening rooms.
Discussion
Our data demonstrated that the air and surfaces in the hospital adult emergency department
are contaminated with influenza virus and that the frequency of virus detection was positively
associated with the frequency of contacts with patients or coworkers exhibiting ILI. We identified influenza in the breathing zone of HCP, in room air, and on surfaces within a healthcare
setting, and on FFRs worn by our participants. Our data support that exposure to influenza via
aerosols (small particles that can be transmitted long range) is likely for HCP working in an
emergency room. In addition, the proportion of positive surface samples suggest that contact
exposure is also likely.
Table 7. Influenza virus detected in surface samples by area where sample was collected and type of surface swabbed.
Sample area and surface type
Screening room C Chair
# pooled samples
# positive samples
%
6
6
100%
Copies of influenza RNA/cm2
(median)
(range)
1.9
1.0 to 6.1
3.3 to 3.6
Screening room D Chair
6
2
33%
3.5
Triage back Chair
6
1
17%
0.5
0.5
Triage front Chair
6
3
50%
0.5
0.3 to 1.5
0.8
0.7 to 0.9
Triage sink
6
2
33%
Total
30
14
47%
https://doi.org/10.1371/journal.pone.0203223.t007
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�Healthcare personnel exposure to influenza
The 2014/15 influenza season in the U.S. was moderately severe with influenza A H3N2 circulating as the predominant strain along with H1N1 and influenza B [20, 21]. Influenza vaccination for the 2014/15 flu season offered reduced protection against the influenza A H3N2,
and had the lowest estimated vaccine effectiveness (19%) since the 2004/05 influenza season
[22]. Hospitalization rates for influenza were higher during the 2014/15 influenza season compared to previous seasons [21] and medically attended cases were higher than the previous
four influenza seasons [23]. The peak of the flu season occurred in late December (the week
ending 27 December 2014), which coincided with our initiation of field sampling [20].
Our study is one of the first to detect the presence of influenza in a healthcare setting spanning from the peak (15 patients with confirmed influenza on Dec 29, 2014) to the tail end of
the influenza A season (2 patients with confirmed influenza from February 1-February 9).
Influenza was detected during 17 of 19 sampling sessions (89%). Other studies have detected
influenza using personal and room aerosol samplers, but few report detection of influenza
over multiple days spanning from the peak to the end of the influenza season. Similar to our
study, Lueng et al. conducted sampling during the 2014/15 influenza season from December
16 through February 9 in a hospital in Hong Kong and detected influenza virus in five of 10
(50%) sampling periods where patients with influenza A were present [16]. However, the dates
on which influenza was detected were not reported and cannot be linked to the timing of the
peak of the influenza season in Hong Kong. Lindsley et al. reported influenza positives in air
samples for 10 out of 11 days in an urgent care facility in February 2009 [24]. Influenza RNA
was detected in 19% (four of 21) of personal aerosol samplers and 46 of 264 (17%) of room
samplers, reported to be near the peak of the seasonal influenza season which occurred in
mid-February [25]. Blachere et al. reported 42% (three of seven) influenza positive personal
samplers worn by physicians at the emergency department at the West Virginia University
Hospital during February 2008, on or near the peak of the influenza season [11, 26].
We hypothesized that the personal bioaerosol samples would be positive more often, and
with greater concentrations of virus, compared to room bioaerosol samples due to the close
proximity of the test subjects to influenza patients when administering patient care. The results
were similar for the percentage of positive samples for personal (42%) and room bioaerosol
samplers (43%); however, the concentration levels for personal bioaerosols were much higher
and significantly so, OR = 2.3, p <0.001. In other studies, virus has been detected in higher
concentrations near patients’ heads compared to locations that are more distant to the patient
[13]. To the contrary, Cummings et al. reported that influenza was detected in higher concentrations outside the patient room compared to within the patient room where AGPs were
being conducted [14]. Similarly, Blachere et al. detected higher concentrations of influenza in
the waiting area of a healthcare facility (460 to 16,278 copies/filter) compared to personal
bioaerosol samplers (309 to 4,623 copies/filter) [11]. Our results may differ from those of
Blachere and Cummings due to difference in layouts within the areas sampled, different care
procedures, differences in ventilation, and difference in influenza season characteristics as
mentioned above.
Regarding frequency of exposure by occupation, we found that CNAs and RNs had the
highest exposure, with 75% of CNA personal bioaerosol samplers and 49% of RN bioaerosol
samplers testing positive for influenza respectively. Our results demonstrate a strong positive
correlation (Pearson Correlation, R = 0.83, P = 0.039) between the average number of patients
per shift and the frequency of the number of positive samplers by occupation. CNAs and RNs
had the highest ratio of patient contacts per shift monitored and our results confirm that they
are at higher risk of exposure. Findings from other studies [27] indicate significantly increased
odds for an influenza A (H1N1) infection among HCP with > 5 contacts to suspected infected
patients compared to HCP with < 5 contacts (OR = 1.47, 95% CI = 1.11 to1.94).
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�Healthcare personnel exposure to influenza
Of the eight participants that had contact with patients diagnosed with influenza (Table 5),
four (50%) had influenza detected in the personal bioaerosol samplers. Ten of 25 (40%) of
samples from participants that reported performing AGPs, were collected from RNs. Few studies have looked at exposure risk during AGPs. In one meta-analysis during the SARS epidemic,
Tran and et al. (2012) reported that the most consistent association with increased risk of
SARS transmission across multiple studies was identified with tracheal intubation [28]. During
the six weeks of our study, only one participant reported performing an intubation. The most
common AGP reported by our participants was nebulization. This is consistent with several
papers that find nebulization to be one of the most frequently performed procedures (along
with mechanical ventilation) [29, 30]. (ref). This is clinically and practically important, since
more patients use nebulizers and oxygen masks than undergo bronchoscopy, intubation, sputum induction and CPR. Furthermore, a recent study by Li and colleagues (2017) suggests that
nebulization may be the AGP that generates the largest number of aerosol particles. Further
studies are needed to confirm Li’s findings, characterize particle composition and determine
probability of transmission [29].
We detected influenza contamination of FFRs (3 of 12 analyzed; 25%) used by HCP in an
outpatient, yet high-risk clinical setting while administering patient care. A previous study at a
student health clinic did not find any influenza among the 43 medical masks analyzed that
were worn by HCP [31]. Other studies have reported bacterial and fungal contamination of
medical masks used by HCP [32] and bacterial contamination by cleaning staff within a
healthcare facility [33] The low copy number of influenza present on the FFRs may be due to
the short wear time, which coincides with the length of time the HCP was in close contact with
a patient exhibiting ILI.
Surface sampling for influenza and other viruses has been inconsistent in the few studies
available. Tang et al. [19] were unable to detect influenza virus RNA on surfaces that were
contaminated via direct cough by subjects with confirmed influenza. Killingley et al. (2011)
collected samples from fomites to assess person-to-person transmission and found that 19%
of fomites were PCR positive for influenza virus [34]. An additional study by Killingley et al.
(2016) found that 33 of 671 (4.9%) of the surface swabs detected influenza Type A (H1N1
pandemic 09) by PCR [35]. In contrast, our study found an average 60% positive surface
samples, although our detection rate was likely improved because samples were pooled over
a week. This strategy may better reflect the risk of cross contamination to HCP. Furthermore, negative room samples could be explained by previous and recent environmental
cleaning, which is performed frequently at the Hospital, but we do not have available data
per room.
Our study has several limitations. We used PCR technology to identify influenza virus and
hence could not differentiate whether the virus identified was viable or not—a consideration
when policy recommendations are developed. In addition, the threshold of airborne influenza
virus that needs to be inhaled to cause infection is not known definitively and likely varies
between individuals based on their previous exposure/immunological history [36, 37]. We
only analyzed 12 of 128 FFRs (9%) and none of the 205 medical masks collected due to budget
and timing limitations. We analyzed FFRs that had the greatest potential to be contaminated,
by selecting FFRs worn by participants who had contact with patients with confirmed influenza, had positive personal bioaerosol samplers, and performed an AGP. Our data are incomplete, but these low levels of influenza contamination on FFRs supports the recommended
guidance for the use of FFRs in healthcare settings [8, 38]. It should be noted that although low
levels of influenza contamination were detected on FFRs that were used during AGPs, CDC’s
current recommendation is to discard FFRs if they were worn during an AGP [38]. Furthermore, we did not use a random sample (participants are not representative of the makeup of
PLOS ONE | https://doi.org/10.1371/journal.pone.0203223 August 31, 2018
11 / 15
�Healthcare personnel exposure to influenza
the AED), and we had small number of participations by some of our occupational groups. It
is likely that we identified some populations such as nurses who were more likely exposed. In
addition, the sampler used collects all airborne particles capable of penetrating the respiratory
tract (inhalable fraction), including large droplets. Therefore, we are not able to assess if exposure is predominantly to droplets or aerosols. Finally, we could not determine the source of
the virus (whether it came from the environment or the participant) and we could not link
whether the contamination led to infection in these HCP.
Still this study is important for a number of reasons. One of the main strengths of our
study is the large number of samples collected and analyzed and the fact that we had access
to an emergency department and personnel throughout the influenza season, which made
possible sampling during the peak of the season. Furthermore, samples were collected during normal operation of an emergency department, reflecting real-life exposures, and use
of personal bioaerosol samplers on HCP allowed us to get close to the source (patients).
Another strength of our study was having access to results of a rapid test program carried
out in the adult emergency department that let us know which patients had confirmed
influenza, which HCP had interaction with that patient, and which room(s) the patient was
seen in within the emergency department. Also, the layout of this emergency department
allowed us to sample in an area where patients with influenza like illness are held for daylong observations, increasing our chance to monitor during patient encounter. Finally, we
were able to recruit a wide range of occupations, which allowed us to assess the risk of different job titles and job tasks. Participant feedback to the use of the personal samplers was very
positive.
Our findings suggest that influenza transmission in healthcare may be multi-modal, as we
observed opportunities for exposures via airborne and contact routes. Exposure to influenza
can occur throughout the influenza season for a variety of HCP occupations and locations
within a healthcare facility. We found certain occupations were at higher risk of exposure and
should be targeted for training about appropriate infection prevention activities. FFRs may
become contaminated with influenza when used; however, high levels of contamination are
unlikely given low aerosol concentrations and short wear times.
Supporting information
S1 Table. Job titles and job descriptions.
(DOCX)
S1 Fig. Participants’ daily survey.
(DOCX)
Acknowledgments
We would like to thank the staff of the Johns Hopkins Hospital adult emergency department
and the ResPECT team and investigators for their help and support in this study. Dr. Rothman
is supported in part by BARDA 1 IDSEP130014-01-00 and NIH HHSN272201400007C. The
findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the National Institute for Occupational Safety and Health, Centers
for Disease Control and Prevention. Mention of any company, product, policy, of the inclusion of any reference does not constitute endorsement by NIOSH. We would also like to thank
our reviewers, Dr. Raymond Roberge, Dr. Lewis Radonovich, Michael Bergman, and Judi
Coyne.
PLOS ONE | https://doi.org/10.1371/journal.pone.0203223 August 31, 2018
12 / 15
�Healthcare personnel exposure to influenza
Author Contributions
Conceptualization: Ana M. Rule, Steven H. Ahrenholz, Scott E. Brueck, William G. Lindsley,
Marie A. de Perio, John D. Noti, Ronald E. Shaffer, Donald H. Beezhold, Trish M. Perl,
Edward M. Fisher.
Data curation: Ana M. Rule, Steven H. Ahrenholz, Scott E. Brueck, John D. Noti, Alina Grigorovitch, Edward M. Fisher.
Formal analysis: Ana M. Rule, Otis Apau, John D. Noti, Ronald E. Shaffer, Patrick L. Yorio,
Edward M. Fisher.
Funding acquisition: Ronald E. Shaffer, Edward M. Fisher.
Investigation: Ana M. Rule, Otis Apau, Steven H. Ahrenholz, Scott E. Brueck, William G.
Lindsley, Marie A. de Perio, John D. Noti, Ronald E. Shaffer, Richard Rothman, Alina Grigorovitch, Bahar Noorbakhsh, Edward M. Fisher.
Methodology: Ana M. Rule, Steven H. Ahrenholz, Scott E. Brueck, William G. Lindsley, Marie
A. de Perio, John D. Noti, Ronald E. Shaffer, Richard Rothman, Donald H. Beezhold, Trish
M. Perl, Edward M. Fisher.
Project administration: Ana M. Rule, Ronald E. Shaffer, Edward M. Fisher.
Resources: Richard Rothman.
Supervision: Ronald E. Shaffer.
Validation: John D. Noti.
Writing – original draft: Ana M. Rule, John D. Noti, Edward M. Fisher.
Writing – review & editing: Ana M. Rule, Otis Apau, Steven H. Ahrenholz, Scott E. Brueck,
William G. Lindsley, Marie A. de Perio, John D. Noti, Ronald E. Shaffer, Richard Rothman,
Alina Grigorovitch, Bahar Noorbakhsh, Donald H. Beezhold, Patrick L. Yorio, Trish M.
Perl, Edward M. Fisher.
References
1.
OSHA. Pandemic influenza preparedness and response guidance for healthcare workers and healthcare employers 2007. [cited 21 May 2018]. https://www.osha.gov/Publications/3328-05-2007-English.
html#Contents.
2.
Kuster SP, Shah PS, Coleman BL, Lam PP, Tong A, Wormsbecker A, et al. Incidence of influenza in
healthy adults and healthcare workers: a systematic review and meta-analysis. PLoS One. 2011; 6(10):
e26239. https://doi.org/10.1371/journal.pone.0026239 PMID: 22028840
3.
Wise ME, De Perio M, Halpin J, Jhung M, Magill S, Black SR, et al. Transmission of pandemic (H1N1)
2009 influenza to healthcare personnel in the United States. Clin Infect Diseases. 2011; 52(suppl 1):
S198–S204.
4.
Santos CD, Bristow RB, Vorenkamp JV. Which health care workers were most affected during the
spring 2009 H1N1 pandemic? Disaster Med Public Health Prep. 2010; 4(1):47–54. PMID: 20389195
5.
Glaser CA, Gilliam S, Thompson WW, Dassey DE, Waterman SH, Saruwatari M, et al. Medical care
capacity for influenza outbreaks, Los Angeles. Emerg Infect Dis. 2002; 8(6):569–74. https://doi.org/10.
3201/eid0806.010370 PMID: 12023911
6.
Peterson K, Novak D, Stradtman L, Wilson D, Couzens L. Hospital respiratory protection practices in 6
U.S. states: a public health evaluation study. Am J Infect Control. 2015; 43(1):63–71. https://doi.org/10.
1016/j.ajic.2014.10.008 PMID: 25564126
7.
Centers for Disease Control and Prevention. Interim Guidance for the Use of Masks to Control Seasonal
Influenza Virus Transmission. [cited 21 May 2018]. https://www.cdc.gov/flu/professionals/
infectioncontrol/maskguidance.htm.
PLOS ONE | https://doi.org/10.1371/journal.pone.0203223 August 31, 2018
13 / 15
�Healthcare personnel exposure to influenza
8.
Fisher EM, Shaffer RE. Considerations for recommending extended use and limited reuse of filtering
facepiece respirators in health care settings. J Occup Environ Hyg. 2014; 11(8):D115–28. https://doi.
org/10.1080/15459624.2014.902954 PMID: 24628658
9.
Brady TM, Strauch AL, Almaguer CM, Niezgoda G, Shaffer RE, Yorio PL, et al. Transfer of bacteriophage MS2 and fluorescein from N95 filtering facepiece respirators to hands: Measuring fomite potential. J Occup Environ Hyg. 2017; 14(11):898–906. https://doi.org/10.1080/15459624.2017.1346799
PMID: 28650715
10.
Aizenberg V, Grinshpun SA, Willeke K, Smith J, Baron PA. Performance characteristics of the button
personal inhalable aerosol sampler. AIHAJ. 2000; 61(3):398–404. PMID: 10885891
11.
Blachere FM, Lindsley WG, Pearce TA, Anderson SE, Fisher M, Khakoo R, et al. Measurement of airborne influenza virus in a hospital emergency department. Clin Infect Dis. 2009; 48(4):438–40. https://
doi.org/10.1086/596478 PMID: 19133798
12.
Blachere FM, Cao G, Lindsley WG, Noti JD, Beezhold DH. Enhanced detection of infectious airborne
influenza virus. J Virol Methods. 2011; 176(1–2):120–4. https://doi.org/10.1016/j.jviromet.2011.05.030
PMID: 21663766
13.
Bischoff WE, Swett K, Leng I, Peters TR. Exposure to influenza virus aerosols during routine patient
care. J Infect Dis. 2013; 207(7):1037–46. https://doi.org/10.1093/infdis/jis773 PMID: 23372182
14.
Cummings KJ, Martin SB, Lindsley WG, Othumpangat S, Blachere FM, Noti JD, et al. Exposure to influenza virus aerosols in the hospital setting: is routine patient care an aerosol generating procedure? J
Infect Dis. 2014:jiu127.
15.
Killingley B, Greatorex J, Digard P, Wise H, Garcia F, Varsani H, et al. The environmental deposition of
influenza virus from patients infected with influenza A(H1N1)pdm09: Implications for infection prevention and control. J Infect Public Health. 2016; 9(3):278–88. https://doi.org/10.1016/j.jiph.2015.10.009
PMID: 26653976
16.
Leung NH, Zhou J, Chu DK, Yu H, Lindsley WG, Beezhold DH, et al. Quantification of Influenza Virus
RNA in Aerosols in Patient Rooms. PLoS One. 2016; 11(2):e0148669. https://doi.org/10.1371/journal.
pone.0148669 PMID: 26849130
17.
Lindsley WG, Blachere FM, Davis KA, Pearce TA, Fisher MA, Khakoo R, et al. Distribution of airborne
influenza virus and respiratory syncytial virus in an urgent care medical clinic. Clin Infect Dis. 2010; 50
(5):693–8. https://doi.org/10.1086/650457 PMID: 20100093
18.
Mubareka S, Granados A, Naik U, Darwish I, Cutts TA, Astrakianakis G, et al. Influenza virus emitted by
naturally-infected hosts in a healthcare setting. J Clin Virol. 2015; 73:105–7. Epub 2015/11/23. https://
doi.org/10.1016/j.jcv.2015.11.002 PMID: 26590688
19.
Tang JW, Gao CX, Cowling BJ, Koh GC, Chu D, Heilbronn C, et al. Absence of detectable influenza
RNA transmitted via aerosol during various human respiratory activities—experiments from Singapore
and Hong Kong. PLoS One. 2014; 9(9):e107338. https://doi.org/10.1371/journal.pone.0107338 PMID:
25208000
20.
Appiah GD, Blanton L, D’Mello T, Kniss K, Smith S, Mustaquim D, et al. Influenza activity—United
States, 2014–15 season and composition of the 2015–16 influenza vaccine. MMWR Morb Mortal Wkly
Rep. 2015; 64(21):583–90. PMID: 26042650
21.
Review of the 2014–2015 influenza season in the northern hemisphere. Wkly Epidemiol Rec. 2015; 90
(23):281–96. PMID: 26050269
22.
Centers for Disease Control and Prevention. Seasonal influenza vaccine effectiveness, 2005–
2018. [cited 13 August 2018]. https://www.cdc.gov/flu/professionals/vaccination/effectiveness-studies.
htm.
23.
Centers for Disease Control and Prevention. Estimated Influenza Illnesses and Hospitalizations Averted
by Vaccination—United States, 2014–15 Influenza Season. [cited 21 May 2018]. https://www.cdc.gov/
flu/about/disease/2014-15.htm.
24.
Lindsley WG, Blachere FM, Davis KA, Pearce TA, Fisher MA, Khakoo R, et al. Distribution of airborne
influenza virus and respiratory syncytial virus in an urgent care medical clinic. Clin Infec Dis. 2010; 50
(5):693–8.
25.
Centers for Disease Control and Prevention. FluView. 2008–2009 influenza season week 39 ending
October 3, 2009. [cited 21 May 2018]. https://www.cdc.gov/flu/weekly/pdf/External_F0939.pdf.
26.
Centers for Disease Control and Prevention. 2007–2008 Influenza (Flu) Season 2008 [cited 15 May
2018]. https://www.cdc.gov/flu/pastseasons/0708season.htm.
27.
Lietz J, Westermann C, Nienhaus A, Schablon A. The Occupational Risk of Influenza A (H1N1) Infection among Healthcare Personnel during the 2009 Pandemic: A Systematic Review and Meta-Analysis
of Observational Studies. PLoS One. 2016; 11(8):e0162061. https://doi.org/10.1371/journal.pone.
0162061 PMID: 27579923
PLOS ONE | https://doi.org/10.1371/journal.pone.0203223 August 31, 2018
14 / 15
�Healthcare personnel exposure to influenza
28.
Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PloS one. 2012; 7
(4):e35797. https://doi.org/10.1371/journal.pone.0035797 PMID: 22563403
29.
Li J, Leavey A, Yang W, O’Neil C, Wallace M, Boon A, et al. Defining Aerosol Generating Procedures
and Pathogen Transmission Risks in Healthcare Settings. Open Forum Infect Dis. 2017; 4(Suppl 1):
S34–S5.
30.
Thompson K-A, Pappachan JV, Bennett AM, Mittal H, Macken S, Dove BK, et al. Influenza Aerosols in
UK Hospitals during the H1N1 (2009) Pandemic—The Risk of Aerosol Generation during Medical Procedures. PLoS ONE. 2013; 8(2):e56278. https://doi.org/10.1371/journal.pone.0056278 PMID:
23418548
31.
Ahrenholz SH, Brueck SE, Rule AM, Noti JD, Noorbakhsh B, Blachere FM, et al. Assessment of Environmental and Surgical Mask Contamination at a Student Health Center– 2012–2013 Influenza Season. J Occup Environ Hyg. 2018:Forthcoming.
32.
Luksamijarulkul P, Aiempradit N, Vatanasomboon P. Microbial contamination on used surgical masks
among hospital personnel and microbial air quality in their working wards: A hospital in Bangkok. Oman
Med J. 2014; 29(5):346. https://doi.org/10.5001/omj.2014.92 PMID: 25337311
33.
Heimbuch BK, Wallace WH, Balzli CL, Laning ML, Harnish DA, Wander JD. Bioaerosol exposure to personnel in a clinical environment absent patients. J Occup Environ Hyg. 2016; 13(2):D11–D5. https://doi.
org/10.1080/15459624.2015.1091966 PMID: 26375496
34.
Killingley B, Enstone JE, Greatorex J, Gilbert AS, Lambkin-Williams R, Cauchemez S, et al. Use of a
human influenza challenge model to assess person-to-person transmission: proof-of-concept study. J
Infect Dis. 2011:jir701.
35.
Killingley B, Greatorex J, Digard P, Wise H, Garcia F, Varsani H, et al. The environmental deposition of
influenza virus from patients infected with influenza A (H1N1) pdm09: Implications for infection prevention and control. J Infect Public Health. 2016; 9(3):278–88. https://doi.org/10.1016/j.jiph.2015.10.009
PMID: 26653976
36.
Nikitin N, Petrova E, Trifonova E, Karpova O. Influenza virus aerosols in the air and their infectiousness.
Adv Virol. 2014; 2014.
37.
Tang JW, Hoyle E, Moran S, Pareek M. Near-Patient Sampling to Assist Infection Control—A Case
Report and Discussion. Int J Environ Res Publ Health. 2018; 15(2):238.
38.
Centers for Disease Control and Prevention. Recommended guidance for extended use and limited
reuse of N95 filtering facepiece respirators in healthcare settings 2014 [cited 21 May 2018]. https://
www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
PLOS ONE | https://doi.org/10.1371/journal.pone.0203223 August 31, 2018
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�
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Title
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Discover
Description
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
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<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
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<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
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<a href="#click">Skip timeline</a>
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Rule, Ana M., Otis Apau, Steven H. Ahrenholz, Scott E. Brueck, William G. Lindsley, Marie A. de Perio, John D. Noti, Ronald E. Shaffer, Richard Rothman, Alina Grigorovitch, Bahar Noorbakhsh, Donald H. Beezhold, Patrick L. Yorio, Trish M. Perl, and Edward M. Fisher. 2018. "Healthcare personnel exposure in an emergency department during influenza season." PLoS One 13 (8):e0203223-e.
Abstract
<div class="abstr">
<h3>Abstract</h3>
<div>
<h4>INTRODUCTION:</h4>
<p>Healthcare personnel are at high risk for exposure to <span class="highlight">influenza</span> by direct and indirect contact, droplets and aerosols, and by <span class="highlight">aerosol</span> generating procedures. Information on air and surface <span class="highlight">influenza</span> contamination is needed to assist in developing guidance for proper prevention and control strategies. To understand the vulnerabilities of healthcare personnel, we measured <span class="highlight">influenza</span> in the breathing zone of healthcare personnel, in air and on surfaces within a healthcare setting, and on filtering facepiece respirators worn by healthcare personnel when conducting patient care.</p>
<h4>METHODS:</h4>
<p>Thirty participants were recruited from an adult emergency department during the 2015 <span class="highlight">influenza</span> season. Participants wore personal bioaerosol samplers for six hours of their work shift, submitted used filtering facepiece respirators and medical masks and completed questionnaires to assess frequency and types of interactions with potentially infected <span class="highlight">patients</span>. Room air samples were collected using bioaerosol samplers, and surface swabs were collected from high-contact surfaces within the adult emergency department. Personal and room bioaerosol samples, surface swabs, and filtering facepiece respirators were analyzed for <span class="highlight">influenza</span> A by polymerase chain reaction.</p>
<h4>RESULTS:</h4>
<p><span class="highlight">Influenza</span> was identified in 42% (53/125) of personal bioaerosol samples, 43% (28/ 96) of room bioaerosol samples, 76% (23/30) of pooled surface samples, and 25% (3/12) of the filtering facepiece respirators analyzed. <span class="highlight">Influenza</span> copy numbers were greater in personal bioaerosol samples (17 to 631 copies) compared to room bioaerosol samples (16 to 323 copies). Regression analysis suggested that the amount of <span class="highlight">influenza</span> in personal samples was approximately 2.3 times the amount in room samples (Wald χ2 = 16.21, p<0.001).</p>
<h4>CONCLUSIONS:</h4>
<p>Healthcare personnel may encounter increased concentrations of <span class="highlight">influenza</span> virus when in close proximity to <span class="highlight">patients</span>. Occupations that require contact with <span class="highlight">patients</span> are at an increased risk for <span class="highlight">influenza</span> exposure, which may occur throughout the <span class="highlight">influenza</span> season. Filtering facepiece respirators may become contaminated with <span class="highlight">influenza</span> when used during patient care.</p>
</div>
</div>
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Free online (open access)
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https://www.ncbi.nlm.nih.gov/pubmed/30169507
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https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203223
Dublin Core
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Healthcare personnel exposure in an emergency department during influenza season
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Infection Control
Description
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Healthcare personnel are at high risk for exposure to influenza by direct and indirect contact, droplets and aerosols, and by aerosol generating procedures.
Creator
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Rule, Ana M., Otis Apau, Steven H. Ahrenholz, Scott E. Brueck, William G. Lindsley, Marie A. de Perio, John D. Noti, Ronald E. Shaffer, Richard Rothman, Alina Grigorovitch, Bahar Noorbakhsh, Donald H. Beezhold, Patrick L. Yorio, Trish M. Perl, and Edward M. Fisher.
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2018-08-31
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2022-01-10 by Shawn Gibbs
Coverage
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2025-01-10 (3 years)
Airborne Transmission
Flu
Infection Prevention and Control
Influenza
N95
Occupational Exposure
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Respiratory Pathogen
-
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3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Lindsley, William G., John D. Noti, Francoise M. Blachere, Jonathan V. Szalajda, and Donald H. Beezhold. 2014. "Efficacy of Face Shields Against Cough Aerosol Droplets from a Cough Simulator." Journal of Occupational and Environmental Hygiene 11 (8):509-18.
Abstract
<div class="abstr">
<h3>Abstract</h3>
<div>
<p>Health care workers are exposed to potentially infectious airborne particles while providing routine care to coughing patients. However, much is not understood about the behavior of these <span class="highlight">aerosols</span> and the risks they pose. We used a coughing <span class="highlight">patient</span> simulator and a breathing worker simulator to investigate the exposure of health care workers to cough aerosol droplets, and to examine the efficacy of face shields in reducing this exposure. Our results showed that 0.9% of the initial burst of aerosol from a cough can be inhaled by a worker 46 cm (18 inches) from the <span class="highlight">patient</span>. During testing of an <span class="highlight">influenza</span>-laden cough aerosol with a volume median diameter (VMD) of 8.5 μm, wearing a face shield reduced the inhalational exposure of the worker by 96% in the period immediately after a cough. The face shield also reduced the surface contamination of a respirator by 97%. When a smaller cough aerosol was used (VMD = 3.4 μm), the face shield was less effective, blocking only 68% of the cough and 76% of the surface contamination. In the period from 1 to 30 minutes after a cough, during which the aerosol had dispersed throughout the room and larger particles had settled, the face shield reduced aerosol inhalation by only 23%. Increasing the distance between the <span class="highlight">patient</span> and worker to 183 cm (72 inches) reduced the exposure to <span class="highlight">influenza</span> that occurred immediately after a cough by 92%. Our results show that health care workers can inhale infectious airborne particles while treating a coughing <span class="highlight">patient</span>. Face shields can substantially reduce the short-term exposure of health care workers to large infectious aerosol particles, but smaller particles can remain airborne longer and flow around the face shield more easily to be inhaled. Thus, face shields provide a useful adjunct to respiratory protection for workers caring for patients with respiratory infections. However, they cannot be used as a substitute for respiratory protection when it is needed. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: tables of the experiments performed, more detailed information about the aerosol measurement methods, photographs of the experimental setup, and summaries of the experimental data from the aerosol measurement devices, the qPCR analysis, and the VPA.].</p>
</div>
</div>
<div class="keywords">
<h4>KEYWORDS:</h4>
<p>airborne particulate matter; health care workers; infectious disease transmission; protective devices; respiratory infections/prevention; universal precautions</p>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free author manuscript on PubMed Central, published version through Taylor and Francis
URL
https://www.ncbi.nlm.nih.gov/pubmed/24467190
Read Online
Online location of the resource.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734356/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Efficacy of face shields against cough aerosol droplets from a cough simulator
Subject
The topic of the resource
Research
Description
An account of the resource
Health care workers are exposed to potentially infectious airborne particles while providing routine care to coughing patients.
Creator
An entity primarily responsible for making the resource
Lindsley, William G., John D. Noti, Francoise M. Blachere, Jonathan V. Szalajda, and Donald H. Beezhold.
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
Airborne Transmission
Infection Prevention and Control
Mask
Masks
N95
Occupational Exposure
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Respiratory Pathogen
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Lore, Michael B., Brian K. Heimbuch, Teanne L. Brown, Joseph D. Wander, and Steven H. Hinrichs. 2011. "Effectiveness of Three Decontamination Treatments against Influenza Virus Applied to Filtering Facepiece Respirators." The Annals of Occupational Hygiene 56 (1):92-101.
Abstract
<div class="abstr">
<h3>Abstract</h3>
<div>
<p>Filtering facepiece respirators (FFRs) are recommended for use as precautions against airborne pathogenic microorganisms; however, during pandemics demand for FFRs may far exceed availability. Reuse of FFRs following decontamination has been proposed but few reported studies have addressed the feasibility. Concerns regarding biocidal efficacy, respirator performance post decontamination, decontamination cost, and user safety have impeded adoption of reuse measures. This study examined the effectiveness of three energetic decontamination methods [ultraviolet germicidal irradiation (UVGI), microwave-generated steam, and moist heat] on two National Institute for Occupational Safety and Health-certified N95 FFRs (3M models 1860s and 1870) contaminated with H5N1. An aerosol settling chamber was used to apply virus-laden droplets to FFRs in a method designed to simulate respiratory deposition of droplets onto surfaces. When FFRs were examined post decontamination by viral culture, all three decontamination methods were effective, reducing virus load by > 4 log median tissue culture infective dose. Analysis of treated FFRs using a quantitative molecular amplification assay (quantitative real-time polymerase chain reaction) indicated that UVGI decontamination resulted in lower levels of detectable viral RNA than the other two methods. Filter performance was evaluated before and after decontamination using a 1% NaCl aerosol. As all FFRs displayed <5% penetration by 300-nm particles, no profound reduction in filtration performance was caused in the FFRs tested by exposure to virus and subsequent decontamination by the methods used. These findings indicate that, when properly implemented, these methods effectively decontaminate H5N1 on the two FFR models tested and do not drastically affect their filtering function; however, other considerations may influence decisions to reuse FFRs.</p>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online through Oxford Academic
URL
https://www.ncbi.nlm.nih.gov/pubmed/21859950
Read Online
Online location of the resource.
https://academic.oup.com/annweh/article/56/1/92/166111
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Effectiveness of three decontamination treatments against influenza virus applied to filtering facepiece respirators.
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Filtering facepiece respirators (FFRs) are recommended for use as precautions against airborne pathogenic microorganisms; however, during pandemics demand for FFRs may far exceed availability.
Creator
An entity primarily responsible for making the resource
Lore, Michael B., Brian K. Heimbuch, Teanne L. Brown, Joseph D. Wander, and Steven H. Hinrichs.
Date
A point or period of time associated with an event in the lifecycle of the resource
2011-08-22
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10 (3 years)
Decontamination
Flu
Influenza
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/dca73031fbbc6c342e084bc2929732ef.pdf
0b450a0f7f400a49bae80f24e65ddcaa
PDF Text
Text
2019-nCoV PPE
COVID-19 PPE: Donning and Doffing
Items Required
2
1
Gown - Standard Isolation
N95 Respirator
Eye Protection
- Face Shield or Goggles
Gloves
3
4
Donning Order
5
1.
2.
3.
4.
5.
Hand
Hygiene
Doffing Order 1
1
2
Hand
Hygiene
3
4
Hand
Hygiene
5
6
Hand
Hygiene
7
Hand
Hygiene
FUNDED BY ASPR & CDC
Hand Hygiene
Gown
Respirator
Eye Protection
Gloves
Doffing Order 1
Doffing Order 2
1.
2.
3.
4.
5.
6.
7.
1.
2.
3.
4.
5.
6.
7.
8.
Hand Hygiene
Gown w/ Gloves
Hand Hygiene
Eye Protection
Hand Hygiene
N95
Hand Hygiene
Hand Hygiene
Gown
Gloves
Hand Hygiene
Eye Protection
Hand Hygiene
N95
Hand Hygiene
�COVID-19 PPE: Donning and Doffing
Items Required
Donning Order
1.
2.
3.
4.
5.
Hand Hygiene
Gown
Respirator
Eye Protection
Gloves
1
2
Gown - Standard isolation
N95 Respirator
Eye protection - Face Shield or Goggles
Gloves
3
4
5
Hand
Hygiene
FUNDED BY ASPR & CDC
�2019-nCoV PPE
COVID-19 PPE: Donning and Doffing
Doffing Order 1
1
1.
2.
3.
4.
5.
6.
7.
2
Hand Hygiene
Gown with Gloves
Hand Hygiene
Eye Protection
Hand Hygiene
N95
Hand Hygiene
Doffing Order 2
4
3
1.
2.
3.
4.
5.
6.
7.
8.
5
6
Hand Hygiene
Gown
Gloves
Hand Hygiene
Eye Protection
Hand Hygiene
N95
Hand Hygiene
7
Doffing Order 1
Hand
Hygiene
Hand
Hygiene
Hand
Hygiene
FUNDED BY ASPR & CDC
Hand
Hygiene
�
https://repository.netecweb.org/files/original/69c8c15ef5ad8f675d21481bde793154.pdf
b7fee993abb2fddf090172a9526925cb
PDF Text
Text
2019 NOVEL CORONAVIRUS COMPETENCY VALIDATION
CHECKLIST
Name:
Unit:
Date: __________________
___________
TOPIC: Proper Donning and Doffing of PPE to Care for a patient with 2019 Novel Corona Virus
Competency Statement:
The staff member will demonstrate the ability to safely don and
doff PPE to care for patients with 2019 Novel Corona Virus and
avoid contamination.
Performance Criteria
1.
2.
3.
Met
Not
Met
Comments
Identifies the proper PPE to gather and verbalize that all
appropriate PPE is available at point of use
Verbalizes proper steps in examining PPE for defects
Demonstrates the ability to follow the proper steps for
donning PPE in correct order:
Ø Hand hygiene using hand sanitizer for 20 seconds
cleansing all parts of hands, fingers and nail beds
Ø Dons isolation gown
Ø Dons N95 respirator while ensuring air-tight fit
Ø Perform seal check
Ø Dons Face shield
Ø Dons gloves covering wrist of gown
4.
Demonstrates the ability to follow the proper steps for
doffing PPE in correct order:
Ø Performs hand hygiene using hand sanitizer on
gloves
Ø Doffs gloves using glove in glove technique
Ø Doffs gown without contamination using arm cross
method
Ø Performs hand hygiene
Ø Doffs face shield
Ø Exits patient room
Ø Hand Hygiene
Ø Doffs N95 respirator
Ø Hand hygiene
5.
Verbalizes steps to take for suspected contamination of
staff member
Validator Signature__________________________________
FUNDED BY ASPR & CDC
�
https://repository.netecweb.org/files/original/b1abd8f26ee3739f72e62718691f663b.pdf
0836f0933cd206781ce3b42e87475057
PDF Text
Text
2019 NOVEL CORONAVIRUS COMPETENCY VALIDATION
CHECKLIST
Name:
Unit:
Date: __________________
___________
TOPIC: Proper Donning and Doffing of PPE to Care for a patient with 2019 Novel Corona Virus
Competency Statement:
The staff member will demonstrate the ability to safely don and
doff PPE to care for patients with 2019 Novel Corona Virus and
avoid contamination.
Performance Criteria
Met
Not
Met
Comments
1.
Identifies the proper PPE to gather and verbalize that all
appropriate PPE is available at point of use
Isolation gown
Gloves
Face shield or goggles
N95 Respirator- that has been fit tested from annual fit testing
2. Verbalizes proper steps in examining PPE for defects
Check each item to ensure there are no defects such as rips in
the gown seams or creases on the face shield
3. Demonstrates the ability to follow the proper steps for
donning PPE in correct order:
Donning PPE must always take place in an area where it is safe
to be without PPE and all items of PPE must be worn prior to
entering the patient care area
Ø Hand hygiene using hand sanitizer for 20 seconds
cleansing all parts of hands, fingers and nail beds
Refer to CDC Hand Hygiene poster at bottom
Ø Dons isolation gown
Don the gown following the manufacturer’s instructions
Ø Dons N95 respirator while ensuring air-tight fit
Ø Perform seal check
Place the top strap on the crown of your head and the bottom on
at the nape of your neck
Then mold the nose piece to the bridge of your nose and perform
a seal check by breathing in deep and exhaling while feeling with
your fingers for air leaking from the edges
Ø Dons Face shield
Put on the face shield so that the foam headpiece rests on your
forehead
Ø Dons gloves covering wrist of gown
Ensure that no skin is exposed
FUNDED BY ASPR & CDC
�4.
Demonstrates the ability to follow the proper steps for doffing
PPE in correct order:
All of your PPE with the exception of your N95 respirator is to be
doffed by the door inside the patient care area
Ø Performs hand hygiene using hand sanitizer on gloves
Refer to CDC Hand Hygiene poster at the end of this document
Ø Doffs gloves
Using technique chosen by the facility
Ø Doffs gown
Using technique chosen by the facility
Ø Performs hand hygiene
Using technique chosen by the facility
Ø Doffs face shield
Using technique chosen by the facility
Ø Exits patient room
Ensure the door is completely closed
Ø Hand Hygiene
Using technique chosen by the facility
Ø Doffs N95 respirator
To remove the N95 pull one strap at a time over your head,
beginning with the bottom strap
As the top strap is removed, keep hold of the strap and use it to
guide the N95 respirator into the trash
Ø Hand hygiene
Using technique chosen by the facility
5.
Verbalizes steps to take for suspected contamination of staff
member
If at any point you feel that you contaminated yourself, notify your
nurse leader
Validator Signature__________________________________
FUNDED BY ASPR & CDC
�FUNDED BY ASPR & CDC
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 PPE Guidance
Subject
The topic of the resource
Infection Control
Description
An account of the resource
COVID-19: <br />
<ol>
<li><a href="https://repository.netecweb.org/files/original/990a7390ef46288fd7fe8df94bc2e2e4.pdf" target="_blank" rel="noreferrer noopener">PPE-Flyer</a> (pdf file, printable flyer, infographic)</li>
<li><a href="https://repository.netecweb.org/files/original/69c8c15ef5ad8f675d21481bde793154.pdf" target="_blank" rel="noreferrer noopener">PPE Competency Validation Checklist</a> (pdf file)</li>
<li><a href="https://repository.netecweb.org/files/original/b1abd8f26ee3739f72e62718691f663b.pdf" target="_blank" rel="noreferrer noopener"> PPE Competency Validation Checklist - Instructor Guide.</a> (pdf instructor guide)</li>
</ol>
PPE/Glove removal: For step-by-step instructions on the beak method visit <a href="https://repository.netecweb.org/items/show/691" target="_blank" rel="noreferrer noopener">Contaminated Glove Removal instructions</a>.<br /><br />Video: See the <a href="https://repository.netecweb.org/exhibits/show/netec-education/item/688" target="_blank" rel="noreferrer noopener">Just in Time (JIT) Training video on Personal Protective Equipment for the 2019 Novel Coronavirus (COVID-19)</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-03-16
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-04
Identifier
An unambiguous reference to the resource within a given context
Infection Prevention and Control; PPE
2019-nCoV
Contingency and crisis capacities
Coronavirus
COVID-19
Donning and Doffing
Gloves
Gown
Infection Prevention and Control
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/4796a8f2f7f27772b0eec4addcf5c494.pdf
3b65929281f9c01e47eab800480cace3
PDF Text
Text
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
http://www.ehso.emory.edu/documents/contaminated-glove-removal-poster.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contaminated Glove Removal
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Poster showing the process for removing contaminated gloves.
Creator
An entity primarily responsible for making the resource
Emory Environmental Health and Safety Office
Date
A point or period of time associated with an event in the lifecycle of the resource
2020
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Doffing
Example
Gloves
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/4da5a2de22ddb0c1a3cf41c61334f68a.pdf
f087f47893d55dfe51ad579a682f972b
PDF Text
Text
Hospital Personal Protective Equipment Planning Tool
Purpose: The Hospital Personal Protective Equipment (PPE) Planning Tool is designed to
help hospitals determine approximate minimum PPE needs based on special pathogen
category and a number of facility specific variables. Calculators are included for Ebola
Virus Disease/Viral Hemorrhagic Fever (EVD/VHF) as well as special respiratory
pathogens such as Middle East Respiratory Syndrome/Severe Acute Respiratory
Syndrome (MERS/SARS), and for pandemic influenza. The tool does not provide
information for less virulent pathogens. It is not intended as a clinical tool and should be
used as a pre-incident planning tool and NOT during an outbreak.
The Hospital PPE Planning Tool is not proscriptive nor definitive. It is intended as a
starting point for facility planners to estimate the minimum PPE that may be needed
based upon the role the hospital has in the community (does the hospital provide
screening only or screening and hospitalization) and adjusts for the number and types of
personnel involved in patient management, length of shifts, duration of hospital stay or
outbreak, and the types of PPE commonly used by the facility. The Hospital PPE Planning
Tool is meant to be considered in conjunction with other planning tools, resources,
information, and facility and community-wide preparedness efforts. This tool provides
the minimum amounts of PPE used and additional will be required for training and to
replace PPE that is contaminated, damaged, or otherwise rendered unusable in the
course of patient care. It also does not consider that higher levels of PPE may be
warranted in selected situations (such as during airway management). Therefore, based
on the size of the facility and number of personnel, additional supplies will be needed.
Page 1
�The tool's outputs are based on the inputs in Section 1 of each page about staffing and
types of PPE commonly used by the facility and the assumptions in Section 2 of each
page about the types and amounts of PPE needed for the type of special pathogen and
patient status. Users of the Hospital PPE Planning Tool should make adjustments to the
assumptions when warranted based on their knowledge of their facility, community,
and their level of preparedness. They should also understand that pre-incident
assumptions may not hold true during an incident. Changes to the assumptions may
dramatically affect the accuracy of the outputs in Section 3 of each page. The outputs
of the tool may be used to discuss appropriate cache levels of PPE at the facility and
coalition level and to discuss potential needs with vendors in advance of an incident to
assure supply chain continuity.
Usage Notes: For an Excel version of this tool, copy and paste this link into your
browser: https://files.asprtracie.hhs.gov/documents/aspr-tracie-hospital-ppe-planningtool.xlsx. For questions, comments, or assistance with this spreadsheet, contact ASPR
TRACIE at asprtracie.hhs.gov or 1-844-5-TRACIE (587-2243).
With which disease do you need assistance?
1. Ebola Virus Disease / Viral Hemorrhagic Fever (EVD/VHF)
a. Initial evaluation / stable patient
b. Hospitalized / unstable patient
2. Special Respiratory Pathogen (MERS/SARS/Novel Influenza)
a. Initial evaluation
b. Hospitalized patient(s)
3. Pandemic
a. Inpatient
b. ED
Page 2
�Acknowledgements: Portions of this tool are based on the Centers for Disease Control
and Prevention (CDC) PPE Calculator (https://www.cdc.gov/vhf/ebola/healthcareus/ppe/calculator.html), which was developed to assist healthcare facilities in
estimating their PPE needs when managing a patient with Ebola virus disease. ASPR
TRACIE expanded upon the CDC PPE Calculator and added additional variables and
scenarios to provide healthcare facilities a broader tool.
Disclaimer: The predictions are highly dependent on assumptions (listed in Section 2 on
each page) that can dramatically affect the outputs of the calculator. Users should
understand the implications of the assumptions and the caveats. In some cases, though
expert advice and review was the basis for the calculations, the calculations may not
reflect actual clinical practices. This tool should not replace other planning and facilityspecific considerations. The authors, HHS/ASPR, and ASPR TRACIE take no responsibility
and bear no liability for any clinical care outcomes, provider injury/illness, or
inaccuracies in or resulting from this calculator. The tool reflects current knowledge of
existing scientific guidance and operational experience; users should be aware that the
evidence base for the management of patients suspected or known to be infected with a
special pathogen continues to evolve. All recommendations were current at the time of
publication and vetted to the best of our ability.
Considerations for Stockpiling:
1. Because the role and capabilities of each hospital differ (e.g., a sample hospital might
plan to transfer all potential EVD/VHF cases and is likely to transfer MERS for intensive
care, but needs to plan for assessment care for these conditions as well as for
pandemics) it is not possible to develop a unifying PPE cache recommendation. Hospital
emergency management, infectious disease, infection prevention and control, and
administration should work together to determine change out frequency of use per shift
to help determine what is reasonable to stock at the facility. Please pay careful
attention to CDC recommendations cited at the bottom of each page.
Page 3
�2. Healthcare coalitions should consider caches of PPE to be managed at the
coalition/regional level, particularly to rapidly augment a frontline facility's PPE stocks
for EVD/VHF suspect cases, but also to support hospitals caring for multiple MERS
patients or other situations where there are disproportionate effects on coalition
member hospitals. During a pandemic, this cache will not be as helpful as all facilities
will have needs. The policies for request, allocation, and logistics of accessing and
moving these caches is important if they are to succeed.
3. Federal stockpiles contain significant quantities of N95 respirators and other PPE that
may be helpful in a situation where a single or few jurisdictions are affected. However,
in a pandemic these stockpiles will be insufficient. Healthcare coalitions should work
with their states to understand what is available and the process for activating and
receiving the supplies as well as the timeline. Federal assets will take time to activate
and mobilize, and once delivered will still require time to get to the bedside.
4. Though the filter media of N95 respirators does not substantially degrade, the
flocking and elastic components can, and therefore careful planning should be done
with suppliers and hospital administration to determine how large a cache is in the
interest of the facility knowing that it is not a durable asset. After a manufacturers'
listed "use by" dates, the manufacturer cannot guarantee that the product will perform
as a newly produced item. Outdated masks and supplies must be kept separate from
daily stock and clearly labeled 'for emergency use' if they are kept in caches for
pandemics or epidemics. The same issues apply to gloves and other components of PPE
caches. Rotation of stock is an excellent goal, though at the levels needed to be
prepared for a pandemic is not possible at the hospital level. Agreements with
suppliers may be able to be made that allow rotation at a regional level. Cached
supplies should be stored within manufacturers' recommended storage conditions and
checked at least yearly to assure they are safe and appropriate for use. Supplies should
be used in the following order: first use PPE within the manufacturer's 'use by' dates,
but the oldest first, then use the very recently expired supplies, then the oldest or
longest expired. While all PPE must be inspected before use, expired PPE should have
heightened inspection. Prior to using expired PPE, facilities should contact the
manufacturer to discuss the conditions in which the supplies have been maintained and
discuss potential issues.
Page 4
�5. Training PPE will be needed every year and is not accounted for in the estimates.
Theft is also a significant concern. Accelerated consumption due to contamination,
damage, early discarding by providers, and other causes on shift are also not included
and as stated in the notes may require an adjustment. Depending on the role and size of
the facility this may be in the range of 25%. There should be supervised/regulated
dispensing of respirators during scarcity/pandemic situations.
6. A few facilities in the United States use elastomeric half-face respirators with
appropriate HEPA filters (usually P100 are included as these respirators are commonly
used for industrial and painting applications). Though information about the use of these
devices in the healthcare setting is limited, they are an attractive potential option and
during a pandemic would rapidly pay for themselves. When the frequency of use of
disposable respirators becomes high, the accumulated cost of their use during an
incident may become equivalent to elastomeric facepieces. At this breakeven point,
they may have particular relevance in intensive care environments, for instance. The
elastomeric facepieces must be decontaminated after every use. These respirators
should be inspected, maintained, and stored as per manufacturer recommendations.
Some users may find the elastomeric respirators to be more irritating to the skin than
filtering facepiece mask respirators though others may feel more comfortable with the
seal of the elastomeric masks. Because the elastomeric masks are not in common
healthcare use, their appearance will be unfamiliar and perhaps intimidating to patients
and families.
7. Note that the assumptions for respirators in this tool do not include the increased
requirements for simple fabric masks to be used by patients, family members, and
those at low risk of exposure. Consumption of these masks will increase significantly and
perhaps be as much as 5 times greater than usual use during a pandemic. Planners
should consider the number of staff, patients, and loved ones who will require simple
masks.
Page 5
�8. The calculations for pandemic assume that facilities will be operating under crisis
standards of care, which may include the re-use of N95s. While re-use is not
recommended, it is understood that it may be necessary under certain scenarios. Rather
than focus only on quantities, planners should consider the risk profile of the facility
under scenarios when re-use may be needed. This includes identifying which areas of the
facility, care environments, and staff require a higher level of protection and recognizing
that ASTM certified simple masks afford significant protection for healthcare workers not
directly engaged in patient care. Manufacturer and CDC guidance on re-use should be
sought and utilized when available.
9. Mask production is just-in-time - in some cases manufacturers have substantially
different capacity to increase the production of certain respirators and not others. This
may be worth discussing with your current vendor/manufacturer so that you can plan for
the most likely models available during a pandemic/epidemic situation.
Page 6
�Ebola Virus Disease / Viral Hemorrhagic Fever
Initial Evaluation / Stable Patient
X
Directions
Input your staff and PPE changes per 24 hours and what type of PPE you primarily use into the tan cells in Section 1. This should reflect the number of caregivers/personnel with the patient at one time. It is critical that the PPE changes per 24 hours reflect your
facility staffing plan for how long personnel will be in the patient's room without a break/change in PPE. Section 2 shows the assumptions about the type and amount of PPE used per shift/change. Assumptions can be adjusted depending on your facility plan.
Section 3 shows the calculations for your selected staff and duration of care. PPE calculations are minimums. PPE should always be changed earlier if it becomes soiled or contaminated or when masks become too moist and higher levels or changes of PPE may
be required for airway interventions and other high risk procedures. The calculations do not account for these additional needs.
Section 1 - Inputs
Do you primarily use disposable gowns or coveralls?
Do you primarily use PAPR or N95 respirators for your providers?
Do you use elastomeric respirators?1
Coveralls
N95
No
→
→
If PAPR, are shrouds reusable or disposable?
If yes, what percentage of staff have elastomeric respirators?
→
→
→
→
Assume 4 hour shift with patient (then may rotate to support/other role) = 6 PPE changes/24 hours. (see notes below)
Reusable
0
→
How many filters are on the PAPR unit?
Staff
PPE changes/24 hours 2
Nurse with patient
Doctor with patient
Trained Observer
Environmental Services
1
1
1
1
6
4
6
2
PPE sets
per day
6
4
6
2
Lab Tech
1
2
2
→
Enter '0' staff if RN obtains labs. Assume 2 draws in 24 hours; may adjust PPE changes/24 hours to account for more or less frequent lab testing.
Other personnel
Total Team
1
6
1
1
21
→
Includes family, spiritual care, biomedical, and other personnel required by hospital plan.
3
Total days (enter value 1-3)4
1
Notes and assumptions - IMPORTANT - please read and change values if needed to be consistent with facility personnel plans.
Assume 4 visits/day of 1-4 hours each. Optimally, time entry/exit to correspond with RN exits to minimize observer PPE use.
Parallels RN rotation needs. If RNs or MDs are rotating in or out between shift changes must adjust observer PPE changes accordingly.
Enter '0' staff if RN assumes these duties. Assume 2 visits/cleaning in 24 hours; if single visit, adjust PPE changes to '1'.
3
SECTION 1 NOTES
1. Facilities that use elastomeric respirators reduce their predicted N95 usage according to the percent of caregivers equipped. Providers should generally be issued their own elastomeric respirator. Facilities using these must assure
appropriate donning, doffing, cleaning, and handling protocols as per OSHA respiratory protection standards including safe storage between shifts. Facilities should also have replacement particulate filter cartridges available in the event of
contamination, splash exposure, etc.
2. Calculations assume an RN shift of 4 hours in room with in-room sit down breaks not requiring PPE changes (likely rotating 4 hours with external support RN for total 8 hour shift). If breaks requiring PPE change are taken every 2 hours,
adjust PPE changes/24 hours to 12 for nurses and trained observers (who should be assisting the entering RN with PPE, then donning PPE and assisting the exiting RN with doffing, then doffing themselves). This assures there is always a
provider wearing PPE and ready to provide care.
3. For a stable patient, only one RN should be required. If additional are required, adjust RN number upwards. During the rotation of staff, two person jobs can be accomplished if needed duirng a brief overlap period.
4. Total days should be between 1 and 3 as by that point the patient should be ruled in/out and either transferred to another facility, moved to inpatient status for continued care, or taken off precautions.
Section 2 - PPE Assumptions
Items in tan may be changed if needed based on PPE use assumptions by the facility. Note: if using PAPRs, assumptions about shroud/filter changes will dramatically affect calculations.
ESTIMATED PPE Needed by Role per Shift1
Either Gowns OR Coveralls
3
Needed
All needed 2
Glove, long
cuff
6
2
2
2
2
2
Nurse
Doctor
Trained Observer
Environmental Services
Lab Tech
Other
Glove,
inner
2
2
2
2
2
2
Boot/shoe
cover
2
2
2
2
2
2
4
PAPRs
Apron,
disposable
Gown,
disposable
Coverall
PAPR
1
1
0
1
1
0
1
1
1
1
1
1
1
1
N/A
1
1
0
2
1
N/A
1
1
0
5
N95 Respirators Needed 3
or
PAPR
Shroud
2
1
N/A
1
1
0
PAPR
Battery
4
1
N/A
1
1
0
PAPR
Filter
2
1
N/A
1
1
0
6
N95
1
1
1
1
1
1
Surgical
Hood
1
1
1
1
1
1
Face
Shield
1
1
1
1
1
1
SECTION 2 NOTES
1. Quantity of product per shift may vary based on multiple factors including patient acuity, length of shifts, breaks, etc.
2. Assumptions include two glove changes/shift of outer gloves by RN and no glove changes for other provider types due to shorter durations in the care environment. Impermeable apron is optional but should be strongly considered for 'wet'
patients with bleeding, vomiting, or diarrhea.
3. Either of these products may be used per CDC PPE guidance. Gowns and coveralls must be impermeable (e.g., surgical gowns, coated coveralls) not simply fluid resistant when used for 'wet' suspect patient care (e.g., vomiting, diarrhea,
bleeding). OSHA advises impermeable be used for all suspect patients and state OSHA may have requirements that are stricter. Hospitals should be familiar with state OSHA standards.
4. Boot/shoe covers must be knee high and impermeable if used with gown. Dedicated boots or waterproof booties may be used in conjunction with coveralls. Booties must be able to tolerate abrasion from the floors. Reusable boots must
have a decontaminantion process defined and followed.
5. Powered air purifying respirator (PAPR) blower units/systems may be reused post decontamination. Therefore, the quantity of PAPRs needed per shift and per day should be based on the number of persons that may be using a PAPR and
the time needed to decontaminate and ensure that these products are ready for use. One PAPR will be needed for each staff member per shift who will be in direct contact with the patient. Facilities should consider having 1.5 to 2 shifts
worth of PAPR blower units/systems on hand to account for changing of staff and decon time. Calculations reflect 2 PAPRs for RNs as they are unable to 'hand off' units when changing shifts. PAPR battery maintenance and assuring that
enough charged batteries are always avaialble is another key consideration when using PAPRs. Facility policy for decontaminaiton of the units should be considered when determing needs.
6. Follow the manufacturer's guidance to determine the need to replace/dispose of a filter during PAPR decontamination. FIlters must have a HEPA component. Several manufacturers have added specific instructions for cleaning, disinfecting,
and decontamination after use with a known or suspected Ebola patient. Estimate in the table assumes filter is being changed only when filtering capacity reached (airflow falls below minimums).
Section 3 - Outputs
Either Gowns OR Coveralls
Needed
All needed
Totals days:
3
Nurse
Doctor
Trained Observer
Environmental Services
Lab Tech
Other
Total PPE Needed for Total Days
PPE changes
for total days
Glove, long
cuff
Glove,
inner
Boot/shoe
cover
Apron,
disposable,
(optional for
'dry' patient)
18
12
18
6
6
3
108
24
36
12
12
6
198
36
24
36
12
12
6
126
36
24
36
12
12
6
126
18
12
0
6
6
0
42
PAPR/hood
or
N95 Respirators/splash protection
Gown,
disposable
Coverall
PAPR
PAPR
Shroud
PAPR
Battery
PAPR
Filter
N95
Surgical
Hood
Face
Shield
0
0
18
0
0
0
18
12
N/A
6
6
0
0
0
N/A
0
0
0
0
0
N/A
0
0
0
0
0
N/A
0
0
0
0
0
N/A
0
0
0
18
12
18
6
6
3
18
12
18
6
6
3
18
12
18
6
6
3
18
42
0
0
0
0
63
63
63
References
Cleaning Reusable Respirators and Powered Air Purifying Respirator Assemblies
3M
ASPR TRACIE
The process for cleaning and disinfecting respirators is model-specific. This link provides cleaning and disinfection guidelines for commonly-used 3M respirators. Users should review the guidelines for the models of respirators used in their facilities.
EMS Infectious Disease Playbook
For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who are Clinically Stable and Do Not Have Bleeding, Vomiting or Diarrhea
CDC
Halyard
NETEC
OSHA
The National Academies of
Sciences, Engineering, and
Medicine
Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patient with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea in U.S.
Hospitals, Including Procedures for Donning and Doffing PPE
10 Questions to Ask Before You Stockpile
PPE 201: Critically Thinking about PPE
PPE Selection Matrix for Occupational Exposure to Ebola Virus
Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use
Page 7
�X
Ebola Virus Disease / Viral Hemorrhagic Fever
Hospitalized / Unstable Patient
Directions
Input your staff and PPE changes per 24 hours and what type of PPE you primarily use into the tan cells in Section 1. This should reflect the number of caregivers/personnel with the patient at one time. It is critical that the PPE changes/24 hours reflect
your facility staffing plan for how long personnel will be in the patient's room without a break/change in PPE. Section 2 shows the assumptions about the type and amount of PPE used per shift/change. Assumptions can be adjusted depending on the
facility plans. Section 3 shows the calculations for your selected staff and duration of care. PPE calculations are minimums. PPE should always be changed earlier if it becomes soiled or contaminated or when masks become too moist and higher levels or
changes of PPE may be required for airway interventions and other high risk procedures. The calculations do not account for these additional needs.
Section 1 - Inputs
Do you primarily use disposable gowns or coveralls?
Gowns
Do you primarily use PAPR or N95 respirators for your providers?
Do you use elastomeric respirators?1
PPE changes/24
Staff
hours
2
N95
No
PPE sets
per day
→
→
If PAPR, are shrouds reusable or disposable?
If yes, what percentage of staff have elastomeric respirators?
Reusable
0
→
How many filters are on the PAPR unit?
Notes and assumptions - IMPORTANT - please read and change values if needed to be consistent with facility personnel plans.
2
6
12
→
Doctor with patient
Trained Observer
Environmental Services
1
1
0
4
6
2
4
6
0
→
→
→
Assume 2 RN per 4 hour shift with patient (then rotate to support/other role) = 6 PPE changes/provider/24 hours. Both RNs may not be in room at all
times. (see notes below)
Assume 4 visits/day of 1-4 hours each. Optimally, time entry/exit to correspond with RN exits to minimize observer PPE use.
Parallels RN rotation needs - if RNs or MDs are rotating in or out between shift changes, must adjust observer PPE changes accordingly.
Enter '0' staff if RN assumes these duties. Assume 2 visits/cleaning in 24 hours; if single visit, adjust PPE changes to '1'.
Lab Tech
0
2
0
→
Enter '0' staff if RN obtains labs. Assume 2 draws in 24 hours; may adjust PPE changes/24 hours to account for more or less frequent lab testing.
Other personnel
Total Team
0
4
0
20
0
22
→
Includes family, spiritual care, biomedical, and other personnel required by hospital plan.
Nurse with patient
3
Total days (enter value - default 7) 4
1
7
SECTION 1 NOTES
1. Facilities that use elastomeric respirators reduce their predicted N95 usage according to percent of caregivers equipped. Providers should generally be issued their own elastomeric respirator. Facilities using these must assure
appropriate donning, doffing, cleaning, and handling protocols as per OSHA respiratory protection standards including safe storage between shifts. Facilities should also have replacement particulate filter cartridges available in the event of
contamination, splash exposure, etc.
2. Calculations assume an RN shift of 4 hours in room with in-room sit down breaks not requiring PPE changes (likely rotating 4 hours with external support RN for total 8 hour shift). If breaks requiring PPE changes are taken every 2 hours,
adjust PPE changes/24 hours to 12 for nurses and trained observers (who should be assisting the entering RN with PPE, then donning PPE and assisting the exiting RN with doffing, then doffing themselves). This assures there is always a
provider wearing PPE and ready to provide care.
3. For a stable patient, only one RN may be required, but assumption for inpatient care is two nurses will be needed at least some times during the shift.
4. Total days are difficult to predict as patient course is highly variable. Default is 7 days but facility can adjust based on patient acuity/prior experience.
If multiple patients, adjust staff numbers to number of personnel providing patient care in each room/isolation area (assume some may be in separate rooms and some cohorted). For example, physicians would not need to change PPE
except gloves within the same room, but would have to make a full change to move between rooms.
Section 2 - PPE Assumptions
Items in tan may be changed if needed based on PPE use assumptions by the facility. NOTE: if using PAPRs, assumptions about shroud/filter changes will dramatically affect calculations.
ESTIMATED PPE Needed by Role per Shift1
All needed
Glove, ex
cuff
Glove,
Exam4
12
2
2
2
2
2
4
2
2
2
2
2
Nurse
Doctor
Trained Observer
Environmental Services
Lab Tech
Other
Either Gowns OR
Coveralls Needed 3
2
Boot/
shoe
cover
4
2
2
2
2
2
Either PAPRs.
OR
N95 Respirators Needed 3
Apron,
Disposable
Gown,
Disposable,
Impermeable
Coverall,
impermeable
PAPR5
PAPR
Shroud
PAPR
Battery
PAPR
Filter6
N95
Surgical
Hood
Face
Shield
2
1
0
1
1
0
1
1
1
1
1
1
1
1
N/A
1
1
0
2
1
N/A
1
1
0
2
1
N/A
1
1
1
4
1
N/A
1
1
0
2
1
N/A
1
1
0
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
SECTION 2 NOTES
1. Quantity of product per shift may vary based on multiple factors including patient acuity, length of shifts, breaks, etc.
2. Assumptions include two glove changes/shift of outer gloves by RN and no glove changes for other provider types due to shorter durations in the care environment. Aprons should be disposable and impermeable.
3. Either of these products may be used per CDC PPE guidance. Gowns and coveralls must be impermeable (e.g., surgical gowns, coated coveralls) when used for 'wet' suspect patient care (e.g., vomiting, diarrhea, bleeding).
4. Boot/shoe covers must be knee high and impermeable if used with gown. Dedicated boots or waterproof booties may be used in conjunction with coveralls. Booties must be able to tolerate abrasion resistance on the floors. Reusable boots must have
a decontaminantion process defined and followed.
5. Powered air purifying respirator (PAPR) blower units/systems may be reused post decontamination. Therefore, the quantity of PAPRs needed per shift and per day should be based on the number of persons that may be using a PAPR and the time
needed to decontaminate and ensure that these products are ready for use. One PAPR will be needed for each staff member per shift who will be in direct contact with the patient. Facilities should consider having 1.5 to 2 shifts worth of PAPR blower
units/systems on hand to account for changing of staff and decon time. Calculations reflect one PAPR per provider.
6. Follow the manufacturer's guidance to determine the need to replace/dispose of a filter during PAPR decontamination. Several manufacturers have added specific instructions for cleaning, disinfecting, and decontamination after use with a known or
suspected Ebola patient. Estimate in the table assumes filter is being changed only when filtering capacity reached (airflow falls below minimum).
Section 3 - Outputs
Either Gowns OR
Coveralls Needed
All needed
Totals days:
7
Nurse
Doctor
Trained Observer
Environmental Services
Lab Tech
Other
Total PPE needed for total days
Total staff
Glove, ex
for total
cuff
days
84
1008
28
56
42
84
0
0
0
0
0
0
1148
Glove,
Exam
Boot/shoe
cover
Apron,
Disposable
Gown,
Disposable,
Impermeable
Coverall,
impermeabl
e
336
56
84
0
0
0
336
56
84
0
0
0
168
28
0
0
0
0
84
28
42
0
0
0
476
476
196
154
PAPR/hood
OR
N95 Respirators/splash protection
PAPR
PAPR
Shroud
PAPR
Battery
PAPR
Filter
N95
Surgical
Hood
Face
Shield
0
0
N/A
0
0
0
0
0
N/A
0
0
0
0
0
N/A
0
0
0
0
0
N/A
0
0
0
0
0
N/A
0
0
0
84
28
42
0
0
0
84
28
42
0
0
0
84
28
42
0
0
0
0
0
0
0
0
154
154
154
References
Cleaning Reusable Respirators and Powered Air Purifying Respirator Assemblies
3M
ASPR TRACIE
CDC
Halyard
NETEC
OSHA
The National Academies of
Sciences, Engineering, and
Medicine
The process for cleaning and disinfecting respirators is model-specific. This link provides cleaning and disinfection guidelines for commonly-used 3M respirators. Users should review the guidelines for the models of respirators used in their facilities.
EMS Infectious Disease Playbook
For U.S. Healthcare Settings: Donning and Doffing Personal Protective Equipment (PPE) for Evaluating Persons Under Investigation (PUIs) for Ebola Who are Clinically Stable and Do Not Have Bleeding, Vomiting or Diarrhea
Guidance on Personal Protective Equipment (PPE) To Be Used By Healthcare Workers during Management of Patient with Confirmed Ebola or Persons under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or Diarrhea
in U.S. Hospitals, Including Procedures for Donning and Doffing PPE
10 Questions to Ask Before You Stockpile
PPE 201: Critically Thinking about PPE
PPE Selection Matrix for Occupational Exposure to Ebola Virus
Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use
Page 8
�Special Respiratory Pathogen (MERS/SARS/Novel Influenza)
Initial Evaluation / Stable Patient
Directions
Input your staff and PPE changes per 24 hours and what type of PPE you primarily use into the tan cells in Section 1. This should reflect the number of caregivers/personnel with the patient at one
time. It is critical that the PPE changes/24 hours reflect your facility staffing plan for how long personnel will be in the patient's room without a break/change in PPE. Section 2 shows the
assumptions about the type and amount of PPE used per shift/change. Assumptions can be adjusted depending on the facility plans. Section 3 shows the calculations for your selected staff and
duration of care. PPE calculations are minimums. PPE should always be changed earlier if it becomes soiled or contaminated or when masks become too moist and higher levels or changes of PPE
may be required for airway interventions and other high risk procedures. The calculations do not account for these additional needs.
Section 1 - Inputs
Do you primarily use PAPRs or N95s for your
providers?
N95
→
Do you use elastomeric respirators?1
No
→
Person/Shift
PPE changes/ Persons
per day
24 hours 2
6
6
If PAPR, are shrouds reusable or
Reusable
disposable?
If yes, what percentage of staff have elastomeric
respirators?
How many filters are on the
PAPR unit?
→
0
Notes and assumptions - IMPORTANT - please read and change values if needed to be consistent with facility
personnel plans.
Nurse with patient
1
→
Assume 1 RN per 4 hour shift with patient, then rotate to support role.
Doctor with patient
1
4
4
→
Assume 4 visits/day of 1-4 hours each.
Environmental Services
0
2
0
→
Lab Tech
0
2
0
→
Other personnel
Total Team
0
2
0
14
0
10
→
Total days (enter value 1-3)3
1
Enter '0' person/shift if RN assumes these duties. Assume 2 visits/cleaning in 24 hours; if single visit, adjust PPE
changes to '1'.
Enter '0' person/shift if RN obtains labs. Assume 2 draws in 24 hours; may adjust PPE changes/24 hours to account for
more or less frequent lab testing.
Includes family, spiritual care, biomedical, and other personnel required by hospital plan.
3
SECTION 1 NOTES
1. Facilities that use elastomeric respirators may reduce their predicted N95 usage according to percentage of caregivers equipped. Providers should generally be issued their
own elastomeric respirator. Facilities using these must assure appropriate donning, doffing, cleaning, and handling protocols as per OSHA respiratory protection standards
including safe storage between shifts. Facilities should also have replacement particulate filter cartridges available in the event of contamination, splash exposure, etc.
2. Calculations assume an RN shift of 4 hours in room with in-room sit down breaks not requiring PPE changes (likely rotating 4 hours with external support RN for total 8 hour
shift). If breaks are taken every 2 hours, adjust rotations to 12 for nurses. This assures there is always a provider wearing PPE and ready to provide care.
3. Total days should reflect that by day three the patient should be ruled out or transferred to another facility or inpatient status.
4. If multiple patients, adjust staff numbers to number providing patient care in each room/area (assume some may be in separate rooms and some cohorted). For example,
physicians would not need to change PPE except gloves within the same room, but would have to make a full change to move between rooms.
Section 2 - PPE Assumptions
Items in tan may be changed if needed based on PPE use assumptions by the facility. Note: if using PAPRs, assumptions about shroud/filter changes will dramatically affect calculations.
ESTIMATED PPE Needed by Role per Shift1
All needed2
Nurse
Doctor
Envi ronmental
Servi ces
Lab Tech
Other
PAPR/hood
Gown, disposable fluidresistant5
PAPR6
6
2
Shoe Cover
(optional)4
2
2
1
1
2
2
2
0
2
0
Glove, long cuff
2
1
PAPR
Shroud
2
1
PAPR
Battery
4
1
1
1
1
1
0
1
1
1
1
OR
N95 Respirators/splash protection3
PAPR Filter7
N95
2
1
1
1
Headcover
(optional)
1
1
1
1
1
1
1
1
1
1
1
1
0
1
0
1
0
Face Shield
1
1
SECTION 2 NOTES
1. Quantity of product per shift may vary based on multiple factors including patient acuity, length of shifts, breaks, etc.
2. Assumptions include two glove changes/shift of outer gloves by RN and no glove changes for other provider types due to shorter durations in the care environment.
3. Either of these products may be used per CDC PPE guidance.
4. Optional - Not included in CDC or WHO guidance, but included in OSHA guidance for MERS.
5. CDC specifies "disposable" for MERS, "standard isolation" for SARS, and "clean" gown for avian influenza. OSHA states "fluid-resistant" gown. Because agents and recommendations are
mixed, the facility should decide on an appropriate level of isolation gown in conjunction with their infection prevention practitioners. For simplicity, a disposable, fluid-resistant gown is likely
preferred.
6. Powered air purifying respirator (PAPR) blower units/systems may be reused post decontamination. Therefore, the quantity of PAPRs needed per shift and per day should be based on the
number of persons that may be using a PAPR and the time needed to decontaminate and ensure that these products are ready for use. One PAPR will be needed for each staff member per shift
who will be in direct contact with the patient. Facilities should consider having 1.5 to 2 shifts worth of PAPR blower units/systems on hand to account for changing of staff and decon time.
Calculations reflect one PAPR per provider.
7. Follow the manufacturer's guidance to determine the need to replace/dispose of a filter during PAPR decontamination. Several manufacturers have added specific instructions for cleaning,
disinfecting, and decontamination.
Section 3 - Outputs
All needed
Totals days:
3
Nurse
Doctors
Environmental Services
Lab Tech
Other
Total PPE needed for total days
18
12
0
0
0
Either PAPRs
Shoe Cover
(optional)
Gown, Disposable Fluid
resistant
PAPR
PAPR Shroud
108
24
0
0
0
216
48
0
0
0
18
12
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
132
264
30
0
0
0
Total staff for Glove, long
total days
cuff
OR
N95 Respirators Needed
N95
Headcover
(optional)
Face Shield
0
0
0
0
0
18
12
0
0
0
18
12
0
0
0
18
12
0
0
0
0
30
30
30
PAPR Battery PAPR Filter
References
3M
ASPR TRACIE
CDC
Halyard
OSHA
The National Academies of
Sciences, Engineering, and
Medicine
WHO
Cleaning Reusable Respirators and Powered Air Purifying Respirator Assemblies
The process for cleaning and disinfecting respirators is model-specific. This link provides cleaning and disinfection guidelines for commonly-used 3M respirators. Users should review the
guidelines for the models of respirators used in their facilities.
EMS Infectious Disease Playbook
Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Infection Control in Healthcare, Home, and Community Settings (Supplement I to Public Health Guidance for Community-Level Preparedness and Response to SARS)
Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation with Novel Influenza A Viruses Associated with
Severe Disease
10 Questions to Ask Before You Stockpile
MERS Control and Prevention
Avian Influenza Control and Prevention
Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use
Infection Prevention and Control During Health Care for Probable or Confirmed Cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection
Page 9
�Special Respiratory Pathogen (MERS/SARS/Novel Influenza)
Hospitalized Patient(s)
Directions
Input your staff and PPE changes per 24 hours and what type of PPE you primarily use into the tan cells in Section 1. This should reflect the number of caregivers/personnel with the patient at one time. It is critical that the
PPE changes/24 hours reflect your facility staffing plan for how long personnel will be in the patient's room without a break/change in PPE. Section 2 shows the assumptions about the type and amount of PPE used per
shift/change. PPE requirements depend on the number of staff, not the number of patients. For example, caring for two patients in the same room does not increase PPE requirements aside from a small increase in glove
changes, providing care for patients in two rooms doubles the PPE requirements. Cohorting of patients is recommended to decrease the number of staff and therefore PPE needs when clinically possible. Assumptions can be
adjusted depending on the facility plans. Section 3 shows the calculations for your selected staff and duration of care. PPE calculations are minimums. PPE should always be changed earlier if it becomes soiled or
contaminated or when masks become too moist and higher levels or changes of PPE may be required for airway interventions and other high risk procedures. The calculations do not account for these additional needs.
Section 1 - Inputs
Do you primarily use PAPRs or N95s for your
providers?
N95
1
No
Do you use elastomeric respirators?
→
If PAPR, are shrouds reusable or disposable?
→
If yes, what percentage of staff have elastomeric
respirators?
Disposable
→
How many filters are on the PAPR
unit?
1
0
Nurse with patient
1
Shifts per
day2
6
→
Assume 1 RN per 4 hour shift with patient, then rotate to support role.
Doctor with patient
1
4
4
→
Assume 4 visits/day of 1-4 hours each.
Environmental Services
1
2
2
→
Enter '0' person/shift if RN assumes these duties. Assume 2 visits/cleaning in 24 hours; if single visit, adjust PPE changes to '1'.
Lab Tech
1
2
2
→
Other personnel
1
1
1
→
5
15
15
Person/
Shift
Total Team
3
Persons
per day
6
Notes and assumptions - IMPORTANT - please read and change values if needed to be consistent with facility personnel plans.
Enter '0' person/shift if RN obtains labs. Assume 2 draws in 24 hours; may adjust PPE changes/24 hours to account for more or less
frequent lab testing.
Includes family, spiritual care, biomedical, and other personnel required by hospital plan.
7
Total days (enter value 1-20)
SECTION 1 NOTES
1. Facilities that use elastomeric respirators reduce their predicted N95 usage according to the percent of caregivers equipped. Providers should generally be issued their own elastomeric respirator.
Facilities using these must assure appropriate donning, doffing, cleaning, and handling protocols as per OSHA respiratory protection standards including safe storage between shifts. Facilities should
also have replacement particulate filter cartridges available in the event of contamination, splash exposure, etc.
2. Calculations assume an RN shift of 4 hours in room with in-room sit down breaks not requiring PPE changes (likely rotating 4 hours with external support RN for total 8 hour shift). If breaks are taken
every 2 hours and another provider cycles in adjust shifts per day to 12 for nurses. Assure there is always a provider wearing PPE and ready to provide care.
3. Total days depend on how ill the patient is - average of 7 days assumed.
4. If multiple patients, adjust staff numbers to number providing patient care in each room/area (assume some may be in separate rooms and some cohorted). For example, physicians would not need
to change PPE except gloves within the same room, but would have to make a full change to move between rooms.
Section 2- PPE Assumptions
Items in tan may be changed if needed based on PPE use assumptions by the facility. NOTE: if using PAPRs, assumptions about shroud/filter changes will dramatically affect calculations.
ESTIMATED PPE Needed by Role per Shift1
All needed
PAPR/hood
Glove, long
cuff
Shoe cover
(optional)3
Gown
PAPR
Nurse
Doctor
12
2
4
2
2
1
Environmental
Services
4
2
Lab Tech
Other
4
4
2
2
N95 Respirator/splash protection 2
or
PAPR
Shroud
PAPR
Battery
PAPR Filter
N95
Headcover
(optional)7
Face
Shield
2
1
2
1
4
1
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
4
5
6
SECTION 2 NOTES
1. Quantity of product per shift may vary based on multiple factors including patient acuity, length of shifts, breaks, etc.
2. Either of these products may be used per CDC PPE guidance. Use of PAPR may be preferred during aerosol-generating procedures.
3. Optional - Not included in CDC or WHO guidance, but included in OSHA guidance for MERS.
4. CDC specifies "disposable" for MERS, "standard isolation" for SARS, and "clean" gown for avian influenza. OSHA states "fluid-resistant" gown. Because agents and recommendations are mixed, the facility should
decide on an appropriate level of isolation gown in conjunction with their infection prevention practitioners. For simplicity, a disposable, fluid-resistant gown is likely preferred.
5. Powered air purifying respirator (PAPR) blower units/systems may be reused post decontamination. Therefore, the quantity of PAPRs needed per shift and per day should be based on the number of persons that
may be using a PAPR and the time needed to decontaminate and ensure that these products are ready for use. One PAPR will be needed for each staff member per shift who will be in direct contact with the patient.
Facilities should consider having 1.5 to 2 shifts worth of PAPR blower units/systems on hand to account for changing of staff and decon time.
6. Follow the manufacturer's guidance to determine the need to replace/dispose of a filter during PAPR decontamination. Several manufacturers have added specific instructions for cleaning, disinfecting, and
decontamination. Estimate in the table assumes filter is being changed only when filtering capacity reached.
7. Not included in CDC or WHO guidance, but included in OSHA guidance.
Section 3 - Outputs
All needed
Totals days:
7
Nurse
Doctor
Environmental Services
Lab Tech
Other
Total PPE needed for total days
Either PAPRs
Total staff for
total days
Glove, long cuff
Shoe Cover
(optional)
Gown
PAPR
PAPR
Shroud
42
504
168
84
0
0
0
28
56
56
0
0
56
56
28
28
28
14
28
14
14
0
14
14
7
7
0
0
0
0
0
0
0
0
0
700
294
147
0
0
0
OR
N95 Respirators Needed
N95
Headcover
(optional)
Face Shie ld
0
42
42
42
0
28
28
28
0
0
0
14
14
7
14
14
7
14
14
7
0
105
105
105
PAPR Battery PAPR Filter
References
3M
ASPR TRACIE
CDC
Halyard
OSHA
The National Academies of
Sciences, Engineering, and
Medicine
WHO
Cleaning Reusable Respirators and Powered Air Purifying Respirator Assemblies
The process for cleaning and disinfecting respirators is model-specific. This link provides cleaning and disinfection guidelines for commonly-used 3M respirators. Users should review the guidelines for the models of
respirators used in their facilities.
EMS Infectious Disease Playbook
Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Infection Control in Healthcare, Home, and Community Settings (Supplement I to Public Health Guidance for Community-Level Preparedness and Response to SARS)
Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation with Novel Influenza A Viruses Associated with Severe Disease
10 Questions to Ask Before You Stockpile
MERS Control and Prevention
Avian Influenza Control and Prevention
Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use
Infection Prevention and Control During Health Care for Probable or Confirmed Cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection
Page 10
�Pandemic Influenza
Inpatient
X
Directions
This section assumes that staff will be wearing PPE for the entire shift on ALL inpatient units. If patients are cohorted to infectious units you may enter the number of staff for those
1
units, but this is likely to be possible only early in the pandemic and not during a majority of the weeks. This assumes that N95 masks will be used and re-used during the shift. PPE
calculations are minimums. PPE should always be changed earlier if it becomes soiled or contaminated or when masks become too moist and higher levels or changes of PPE may be
required for airway interventions and other high risk procedures. The calculations do not account for these additional needs nor for theft from stock which may be a significant issue.
Hospitals will need to plan on a modifier (perhaps 25%) to compensate for these losses. Section 2 shows the assumptions about the type and amount of PPE used per shift/change.
PPE requirements depend on the number of staff, not the number of patients. Section 3 shows the calculations for your selected staff and duration of the pandemic.
NOTES
1. Re-use of N95 respirators is not advised by manufacturers nor by CDC or other expert groups. Though CDC recommends using a mask for each patient
encounter, there may be no alternative to re-use during a pandemic if shortages preclude recommended infection prevention practices. Providers could
each use 20-40 masks/shift, depending on their responsibilities and how often they enter patient rooms. Most institutions plan on assigning a tray for each
provider so that the N95 can be removed and set on its front, then picked up by the straps again to re-apply. Hand hygiene is critical. The masks must be
disposed of if they become contaminated, are worn during procedures likely to generate significant aerosols, are damaged, etc. as outlined in CDC
guidance at: https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html. A faceshield or surgical mask may be worn over the N95
to prevent surface contamination.
Section 1 - Inputs
Please assure cells in Section 1 reflect your surge staffing and not daily staffing
What is the total number of MDs at your hospital?1
What is the total number of RNs at your hospital?1
Do you plan to reuse (launder) gowns?2
50
40
No
Does your staff use elastomeric respirators?3
No
Roles
Person/ Shifts per
Shift
day
Persons
per day
→
What percentage of inpatient care staff have elastomeric
respirators?
0
Notes and assumptions - IMPORTANT - please read and change values if needed to be consistent with facility
personnel plans.
Floor Nurses
20
2
40
→
RNs required to staff all floor, monitored, and step down beds including surge beds at usual staffing ratios.
ICU Nurses
10
2
20
→
RNs required to staff all ICU beds including surge beds at usual ratios.
Doctors
6
2
12
→
Include inpatient admitting physicians and consulting physicians (and trainees/residents).
Healthcare Assistants
15
2
30
→
All healthcare assistants (does not include clerical and other non-clinical staff).
4
2
8
4
2
2
1
2
2
2
2
2
2
8
4
4
2
4
→
→
→
→
→
All lab personnel collecting patient samples at bedside.
Respiratory therapists providing bedside care.
Radiology techs with direct exposure to patients.
ECG techs with direct exposure to patients.
Includes spiritual care, biomedical, and other medical/surgical personnel as required.
Environmental
Services
Lab Tech
Respiratory Therapy
Radiology
ECG Tech
Other4
Total Team
66
132
5
Projection 1- Total days (42 - 168)
84
SECTION 1 NOTES
1. Eye protection is reusable and estimated 2 per provider during a pandemic calculated off total providers (RN/physician/APP). Full face flexible
faceshields are preferred to reduce contamination of the mask but are far less durable. If a hospital plans to use these, they should consider restricting use
to certain environments (e.g., ICU) where the risk and exposure may be highest or to situations likely to generate aerosols. If using faceshields, may need
to assume 1/shift and plan stock from the grid in Section 3. Policies and education for appropriate cleaning of the faceshields and goggles are critical to
prevent them from acting as fomites.
2. Laundered gowns assumes a 72 hour cycle time (that is, gowns/24 hours required x3 is supply required).
3. Facilities that use elastomeric respirators reduce their predicted N95 usage according to the percentage of caregivers equipped. Providers should
generally be issued their own elastomeric respirator. Facilities using these must assure appropriate donning, doffing, cleaning, and handling protocols as
per OSHA respiratory protection standards including safe storage between shifts. Facilities should also have replacement particulate filter cartridges
available in the event of contamination, splash exposure, etc.
4. As the pandemic progresses, crisis care strategies such as conservation of gloves and gowns (for body fluid contact only) and re-use of N95 masks for
additional time periods, may have to be implemented based on available resources and prioritization of need for protection.
5. Duration of a pandemic wave is assumed to be 12 weeks (84 days). This may be adjusted from 6 weeks (42 days) up to 24 weeks (168 days).
Contingency and crisis staffing patterns may affect these calculations, e.g., for 8 hour shifts rather than 12, change shifts per day to 3 rather than 2.
Section 2 - PPE Assumptions
Items in tan may be changed by the hospital to account for their pandemic plans
ESTIMATED PPE Needed by Role per Shift
Floor Nurse
ICU Nurse
Doctors
Healthcare Assistant
Env Services
1
Gloves
Shoe cover
Gown 2
N95
8
12
12
8
16
2
2
2
2
4
2
2
2
2
4
1
1
1
1
1
Page 11
�Lab Tech
Respiratory Therapy
Radiology
ECG Tech
Other
12
8
8
8
2
2
2
2
2
2
2
2
2
2
1
1
1
1
1
1
SECTION 2 NOTES
1. Calculations assume the provider uses the same N95 for the whole shift (e.g., has designated location to doff/don mask). Note that this is a crisis standards of care
situation and appropriate only if adequate masks are not available to follow usual infection prevention guidelines. If providers wear N95 only to their next break, change
masks required to 3-4 depending on the number of breaks/shift. PPE consumption may be higher early in the pandemic when cohorting is not performed and providers
must make multiple PPE changes during a shift. Calculations do NOT account for simple masks for patients and family members nor for any PPE for ancillary staff
(nutrition services, pharmacy, etc.) to prevent transmission. Some personnel (e.g., outpatient pharmacy, physical therapy) may need to wear at least some PPE some of
the time. Assumes all staff will be caring for cohorted patients and floor nurses and HCA, RT, radiology, and ECG techs change gloves 4 times to take breaks or for glove
contamination or damage (otherwise use alcohol-based hand hygiene products). Physicians, ICU nurses, and lab change gloves 6 times/shift and environmental services
change 8 times/shift. Use of PAPR and other re-usable (e.g., elastomeric) respirators will decrease N95 use. Use of more than 1 N95/shift will increase use
dramatically.
2. CDC specifies "clean" gowns. Facilities should determine what type of gown will be used, including clean isolation gowns vs. disposable fluid-resistant, etc.
Section 3 - Outputs
Total Eye Protection: 1
180
Totals days:
84
PPE changes
for total
days
Floor Nurse
ICU Nurse
Doctors
Healthcare Assistant
Environmental Services
Lab Tech
Respiratory Therapy
Radiology
ECG Tech
Other
Total PPE needed for total days
3360
1680
1008
2520
672
672
336
336
168
336
Gloves
Shoe cover
Gown
N95
26880
20160
12096
20160
10752
8064
2688
2688
1344
672
105504
6720
3360
2016
5040
2688
1344
672
672
336
672
23520
6720
3360
2016
5040
2688
1344
672
672
336
336
23184
3360
1680
1008
2520
672
672
336
336
168
336
11088
SECTION 3 NOTES
1. Reusable eye protection must be decontaminated per manufacturer recommendations. Face shields and other disposable eye protection may be used
but will require large quantities. Full face flexible faceshields are preferred to reduce contamination of the mask but are far less durable. If a hospital plans
to use these, they should consider restricting use to certain environments (e.g., ICU) where the risk and exposure may be highest or to situations likely to
generate aerosols. If using faceshields, may need to assume 1/shift and plan stock from the grid in Section 3. Policies and education for appropriate
cleaning of the faceshields and goggles are critical to prevent them from acting as fomites.
Contingency and crisis plans may reduce the need for PPE but further increase provider risk - for example, glove and gown use could be restricted to higher
risk exposure patient encounters or limited to certain job classes depending on the availability of PPE and the relative risk of exposure.
References
CDC
Halyard
OSHA
The National Academies
of Sciences, Engineering,
and Medicine
WHO
Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation with Novel Influenza A Viruses
Associated with Severe Disease
Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings
10 Questions to Ask Before You Stockpile
Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers
Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use
Infection Prevention and Control During Health Care for Confirmed, Probably, or Suspected Cases of Pandemic (H1N1) 2009 Virus Infection and Influenza-Like Illnesses
Page 12
�Pandemic Influenza
Emergency Department
X
Directions
Enter your staff for the ED into Section 1 tan cells. This section assumes that staff will be wearing PPE each shift throughout the ED. Early in the pandemic PPE may be used
1
for specific patient encounters but this will not be possible during the majority of the weeks. This assumes that N95 masks will be used and re-used during the shift. PPE
calculations are minimums. PPE should always be changed earlier if it becomes soiled or contaminated or when masks become too moist and higher levels or changes of PPE
may be required for airway interventions and other high risk procedures. The calculations do not account for these additional needs nor for theft from stock which may be a
significant issue. Hospitals will need to plan on a modifier (perhaps 25%) to compensate for these losses. Section 2 shows the assumptions about the type and amount of PPE
used per shift/change. PPE requirements depend on the number of staff, not the number of patients. ED providers will have higher turnover of gloves and gowns compared
to inpatient units. Section 3 shows the calculations for your selected staff and duration of the pandemic.
NOTES
1. Re-use of N95 respirators is not advised by manufacturers nor by CDC or other expert groups. Though CDC recommends using a mask
for each patient encounter, there may be no alternative to re-use during a pandemic if shortages preclude recommended infection
prevention practices. Providers could each use 20-40 masks/shift, depending on their responsibilities and how often they enter patient
rooms. Most institutions plan on assigning a tray for each provider so that the N95 can be removed and set on its front, then picked up by
the straps again to re-apply. Hand hygiene is critical. The masks must be disposed of if they become contaminated, are worn during
procedures likely to generate significant aerosols, are damaged, etc. as outlined in CDC guidance at:
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html. A faceshield or surgical mask may be worn over the
N95 to prevent surface contamination.
Section 1 - Inputs
Please assure cells in section 1 reflect your surge staffing
What is the total number of MD/APPs on your ED staff roster?1
1
What is the total number of RNs on your ED staff roster?
2
Do you plan to reuse (launder) gowns?
10
20
Yes
Does your staff use elastomeric respirators?3
No
ED Nurses
ED Physicians/Advanced
Practice Providers
Healthcare Assistant
Environmental Services
Lab Tech
Respiratory Therapy
Radiology
Other4
Total Team
Shifts per
day
Persons
per day
12
2
24
→
8
2
16
→
10
2
2
2
2
4
42
2
2
2
2
2
2
16
20
4
4
4
4
8
84
→
→
→
→
→
→
5
What percentage of inpatient care staff have
elastomeric respirators?
0
Notes and assumptions - IMPORTANT - please read and change values if needed to be consistent
with facility personnel plans.
Person/
Shift
Projection 1- Total days (42 - 168)
→
RNs required to staff ED at surge levels per shift (may include urgent care/acute clinic staff)
MD/APP required to staff ED at surge levels per shift (may include urgent care/acute clinic staff
also in addition to trainees)
All healthcare assistants (does not include clerical and other non-clinical staff)
Assigned to the ED
All lab personnel collecting patient samples at bedside in the ED
Respiratory therapists providing ED care
ED radiology techs
Includes spiritual care, biomedical, and other medical/surgical personnel as required.
84
SECTION 1 NOTES
1. Eye protection is reusable and estimated 2 per provider during a pandemic calculated off total providers (RN/physician/APP). Full face flexible
faceshields are preferred to reduce contamination of the mask but are far less durable. If a hospital plans to use these, they should consider restricting
use to certain environments (e.g., resuscitation area) where the risk and exposure may be highest or to situations likely to generate aerosols. If using
faceshields, may need to assume 1/shift and plan stock from the grid in Section 3. Policies and education for appropriate cleaning of the faceshields
and goggles are critical to prevent them from acting as fomites.
2. Laundered gowns assumes a 72 hour cycle time (that is, gowns/24 hours required x3 is supply required).
3. Facilities that use elastomeric respirators may reduce their predicted N95 usage according to percentage of caregivers equipped. Providers should
generally be issued their own elastomeric respirator. Facilities using these must assure appropriate donning, doffing, cleaning, and handling protocols
as per OSHA respiratory protection standards including safe storage between shifts. Facilities should also have replacement particulate filter
cartridges available in the event of contamination, splash exposure, etc.
4. As the pandemic progresses, crisis care strategies such as conservation of gloves and gowns (for body fluid contact only) and re-use of N95 masks
for additional time periods, may have to be implemented based on available resources and prioritization of need for protection.
5. Duration of a pandemic wave is assumed to be 12 weeks (84 days). This may be adjusted from 6 weeks (42 days) up to 24 weeks (168 days).
Contingency and crisis staffing patterns may affect these calculations, e.g., for 8 hour shifts rather than 12, change shifts per day to 3 rather than 2.
Section 2 - PPE Assumptions
Items in tan may be changed by the hospital to account for their pandemic plans
ESTIMATED PPE Needed by Role per Shift1
Gloves
Nurses
Doctor
Healthcare Assistant
24
24
12
Shoe
Gown
cover
Impervious
(optional)
4
4
4
4
4
2
Page 13
N95
1
1
1
�Env Services
Lab Tech
Respiratory Therapy
Radiology
Other
12
8
6
6
4
4
2
2
2
2
4
4
2
2
1
1
1
1
1
1
SECTION 2 NOTES
1. Calculations assume provider uses same N95 for whole shift (e.g., has designated location to doff/don mask). Note that this is a crisis standards of care
situation and appropriate only if adequate masks are not available to follow usual infection prevention guidelines. If providers wear N95 only to their next break,
change masks required to 3-4 depending on the number of breaks/shift. PPE consumption may be higher early in the pandemic when suspect cases are managed
individually and providers must make multiple PPE changes during a shift. Calculations do NOT account for simple masks for patients and family members nor for
any PPE for ancillary staff (nutrition services, pharmacy, etc.) to prevent transmission. Some personnel (e.g., outpatient pharmacy, physical therapy) may need to
wear at least some PPE some of the time. Assumes ED staff will have higher glove use due to procedures/body fluid exposures as well as to take breaks or for glove
damage (otherwise use alcohol-based hand hygiene products). Use of PAPR and other re-usable (e.g., elastomeric) respirators will decrease N95 use. Use of more
than 1 N95/shift will increase use dramatically.
Section 3 - Outputs
60
Total Eye Protection: 1
Total Days
PPE changes
for total
days
84
Nurses
Doctor
Healthcare Assistant
Env Services
Lab Tech
Respiratory Therapy
Radiology
Other
Total PPE needed for total days
2016
1344
1680
336
336
336
336
672
Gloves
Boot/ shoe
Gown
cover
Impervious
48384
32256
20160
4032
2688
2016
2016
2688
114240
8064
5376
6720
1344
672
672
672
1344
24864
288
192
120
48
48
24
24
24
768
N95
2016
1344
1680
336
336
336
336
672
7056
SECTION 3 NOTES
1. Reusable eye protection must be decontaminated per manufacturer recommendations. Face shields and other disposable eye protection may be
used but will require large quantities. Full face flexible faceshields are preferred to reduce contamination of the mask but are far less durable. If a
hospital plans to use these, they should consider restricting use to certain environments (e.g., resuscitation area) where the risk and exposure may be
highest or to situations likely to generate aerosols. If using faceshields, may need to assume 1/shift and plan stock from the grid in Section 3. Policies
and education for appropriate cleaning of the faceshields and goggles are critical to prevent them from acting as fomites.
Contingency and crisis plans may reduce the need for PPE items - for example, if gloves and gowns are worn only for body fluid exposures or limited to
certain job classes depending on the availability of PPE and the relative risk of exposure.
References
CDC
Halyard
OSHA
The National Academies of
Sciences, Engineering, and
Medicine
WHO
Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation with Novel
Influenza A Viruses Associated with Severe Disease
Recommended Guidance for Extended Use and Limited Reuse of N95 Filtering Facepiece Respirators in Healthcare Settings
10 Questions to Ask Before You Stockpile
Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers
Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use
g
y
p
Illnesses
Page 14
(
)
�
https://repository.netecweb.org/files/original/2e6c13dc7b070e14c2f88c696b83a419.xlsx
b94228cb69ee90fc3d7205a9e94425cb
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://files.asprtracie.hhs.gov/documents/aspr-tracie-hospital-ppe-planning-tool.pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Hospital Personal Protective Equipment (PPE) Planning Tool / Calculator
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Purpose: The Hospital Personal Protective Equipment (PPE) Planning Tool is designed to help hospitals determine approximate minimum PPE needs based on special pathogen category and a number of facility specific variables. Calculators are included for Ebola Virus Disease/Viral Hemorrhagic Fever (EVD/VHF) as well as special respiratory pathogens such as Middle East Respiratory Syndrome/Severe Acute Respiratory Syndrome (MERS/SARS), and for pandemic influenza. The tool does not provide information for less virulent pathogens. It is not intended as a clinical tool and should be used as a pre-incident planning tool and NOT during an outbreak.<br /><br />You can find it in <a href="https://asprtracie.hhs.gov/technical-resources/72/responder-safety-and-health/0#plans-tools-and-templates" target="_blank" rel="noreferrer noopener">Plans, Tools, and Templates</a>.
Creator
An entity primarily responsible for making the resource
ASPR TRACIE
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Coronavirus
Ebola
Infection Prevention and Control
MERS-CoV
Personal Protective Equipment (PPE)
R-PPE
SARS
Special Pathogens
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/f7e7de79f7d94c72186a450eb97d92f1.png
3f6144ef4196e1951dfc978a39bcacee
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="COVID-19 PPE" src="https://www.youtube.com/embed/bG6zISnenPg" frameborder="0"></iframe>
URL
https://repository.netecweb.org/pdfs/NETEC_Personal_Protective_Equipment_for_COVID-19.mp4
Dublin Core
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Title
A name given to the resource
NETEC: Personal Protective Equipment for COVID-19
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for the donning and doffing of Personal Protective Equipment (PPE) for 2019-nCoV/COVID-19 following the CDC guidelines: Standard, Contact, and Airborne Precautions.
<p><a href="https://repository.netecweb.org/pdfs/NETEC_Personal_Protective_Equipment_for_COVID-19.mp4"><button style="background-color:#575757;color:#fff;border:2px solid #28aae2;padding:0.2em;">CLICK HERE</button></a> to get a downloadable version of this video.<br /><br />See the video on <a href="https://www.youtube.com/watch?v=bG6zISnenPg" target="_blank" rel="noreferrer noopener">Youtube</a> here: <a href="https://www.youtube.com/watch?v=bG6zISnenPg" target="_blank" rel="noreferrer noopener">https://www.youtube.com/watch?v=bG6zISnenPg</a></p>
For further COVID-19 PPE Guidance:<br />
<ul>
<li><a href="https://repository.netecweb.org/items/show/697" target="_blank" rel="noreferrer noopener">PPE-Flyer</a></li>
<li><a href="https://repository.netecweb.org/items/show/697" target="_blank" rel="noreferrer noopener">PPE Competency Validation Checklist</a></li>
<li><a href="https://repository.netecweb.org/items/show/697" target="_blank" rel="noreferrer noopener">PPE Competency Validation Checklist - Instructor Guide.</a></li>
</ul>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-02-10
Relation
A related resource
Y - PPE pos 81 qualtrics 302
Y - D0.1PPE/D0.2PPE Qualtrics # 302
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group - RT-Covid-19 video proper hand hygiene and donning and doffing of PPE. Information is relavant but this video could likely be archived. Does this still belong in the SPORSA?
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-04
Contingency and crisis capacities
Coronavirus
COVID-19
Infection Prevention and Control
Just in Time training (JIT)
Personal Protective Equipment (PPE)
R-PPE
Skills Video
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Roos, Robert. 2013. Study: Full-time N95 use offers best respiratory protection. CIDRAP.
Abstract
In a new study, Chinese hospital staffers who wore N95 respirators all the time enjoyed significantly lower rates of clinical respiratory illnesses (CRIs) than workers who wore surgical masks or used N95s only for high-risk procedures.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free Online
URL
http://www.cidrap.umn.edu/news-perspective/2013/02/study-full-time-n95-use-offers-best-respiratory-protection
Read Online
Online location of the resource.
http://www.cidrap.umn.edu/news-perspective/2013/02/study-full-time-n95-use-offers-best-respiratory-protection
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Study: Full-time N95 use offers best respiratory protection
Subject
The topic of the resource
Infection Control
Description
An account of the resource
In a new study, Chinese hospital staffers who wore N95 respirators all the time enjoyed significantly lower rates of clinical respiratory illnesses (CRIs) than workers who wore surgical masks or used N95s only for high-risk procedures.
Creator
An entity primarily responsible for making the resource
CIDRAP
Source
A related resource from which the described resource is derived
Robert Roos
Date
A point or period of time associated with an event in the lifecycle of the resource
2013-02-20
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change to PPE)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-10
Airborne Transmission
Droplet Transmission
Infection Prevention and Control
Mask
Masks
N95
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
MacIntyre, C. Raina, Cauchemez Simon, E. Dwyer Dominic, Seale Holly, Cheung Pamela, Browne Gary, Fasher Michael, Wood James, Gao Zhanhai, Booy Robert, and Ferguson Neil. 2009. "Face Mask Use and Control of Respiratory Virus Transmission in Households." Emerging Infectious Disease journal 15 (2):233.
Abstract
<div class="card">
<div class="card-body bg-tertiary">
<h3>Abstract</h3>
<p>Many countries are stockpiling face masks for use as a nonpharmaceutical intervention to control virus transmission during an influenza pandemic. We conducted a prospective cluster-randomized trial comparing surgical masks, non–fit-tested P2 masks, and no masks in prevention of influenza-like illness (ILI) in households. Mask use adherence was self-reported. During the 2006 and 2007 winter seasons, 286 exposed adults from 143 households who had been exposed to a child with clinical respiratory illness were recruited. We found that adherence to mask use significantly reduced the risk for ILI-associated infection, but <50% of participants wore masks most of the time. We concluded that household use of face masks is associated with low adherence and is ineffective for controlling seasonal respiratory disease. However, during a severe pandemic when use of face masks might be greater, pandemic transmission in households could be reduced.
Many countries are stockpiling face masks for use as nonpharmaceutical interventions to reduce viral transmission during an influenza pandemic. We conducted a prospective cluster-randomized trial comparing surgical masks, non–fit-tested P2 masks, and no masks in prevention of influenza-like illness (ILI) in households. During the 2006 and 2007 winter seasons, 286 exposed adults from 143 households who had been exposed to a child with clinical respiratory illness were recruited. Intent-to-treat analysis showed no significant difference in the relative risk of ILI in the mask use groups compared with the control group; however, <50% of those in the mask use groups reported wearing masks most of the time. Adherence to mask use was associated with a significantly reduced risk of ILI-associated infection. We concluded that household use of masks is associated with low adherence and is ineffective in controlling seasonal ILI. If adherence were greater, mask use might reduce transmission during a severe influenza pandemic.</p>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free Online
URL
https://www.ncbi.nlm.nih.gov/pubmed/19193267
Read Online
Online location of the resource.
https://wwwnc.cdc.gov/eid/article/15/2/08-1167_article
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Face mask use and control of respiratory virus transmission in households
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Many countries are stockpiling face masks for use as a nonpharmaceutical intervention to control virus transmission during an influenza pandemic.
Creator
An entity primarily responsible for making the resource
MacIntyre, C. Raina, Cauchemez Simon, E. Dwyer Dominic, Seale Holly, Cheung Pamela, Browne Gary, Fasher Michael, Wood James, Gao Zhanhai, Booy Robert, and Ferguson Neil.
Date
A point or period of time associated with an event in the lifecycle of the resource
2009-02
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (change to PPE)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-10
Airborne Transmission
Droplet Transmission
Infection Prevention and Control
Mask
Masks
N95
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/78cc3dc94ca5b2e06d0f99e03b3a7efb.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Casanova, Lisa, William A. Rutala, David J. Weber, and Mark D. Sobsey. 2010. "Coronavirus Survival on Healthcare Personal Protective Equipment." Infection Control & Hospital Epidemiology 31 (5):560-1.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Pay online - or through Ovid subscription
URL
https://www.ncbi.nlm.nih.gov/pubmed/20350196
Read Online
Online location of the resource.
https://doi.org/10.1086/652452
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Coronavirus survival on healthcare personal protective equipment
Subject
The topic of the resource
Infection Control
Creator
An entity primarily responsible for making the resource
Casanova, Lisa, William A. Rutala, David J. Weber, and Mark D. Sobsey.
Date
A point or period of time associated with an event in the lifecycle of the resource
2010-05
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by Shawn Gibbs
2022-01-21 by Lisa (reset to active)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
Do not archive, linked in old blog.
Archived
Coronavirus
COVID-19
Flu
Influenza
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
SARS
-
https://repository.netecweb.org/files/original/44a62b8d850f97fff0ac8c738c681360.png
9a26f8336c8e59d894e4de243ffddd11
Dublin Core
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Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Donning and Doffing Facial Protection – Mask alone" src="https://www.youtube.com/embed/OABvzu9e-hw" frameborder="0"></iframe>
URL
https://www.youtube.com/watch?v=OABvzu9e-hw
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Donning and Doffing Facial Protection – Mask alone
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This video demonstrates how to don and doff a mask (masks) in the clinical area.
Creator
An entity primarily responsible for making the resource
Minnesota Department of Health
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-14
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Airborne Transmission
COVID-19
Droplet Transmission
Mask
Masks
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/5d1ec343f3bc2b035a3aef8af33f773d.pdf
e119cca20ed2f545f81c63507ad72563
PDF Text
Text
How to Properly Put on and Take off a
Disposable Respirator
WASH YOUR HANDS THOROUGHLY BEFORE PUTTING ON AND TAKING OFF THE RESPIRATOR.
If you have used a respirator before that fit you, use the same make, model and size.
Inspect the respirator for damage. If your respirator appears damaged, DO NOT USE IT. Replace it with a new one.
Do not allow facial hair, hair, jewelry, glasses, clothing, or anything else to prevent proper placement or come between your face and the respirator.
Follow the instructions that come with your respirator.1
Putting On The Respirator
Position the respirator in your
hands with the nose piece at
your fingertips.
Cup the respirator in your hand
allowing the headbands to
hang below your hand. Hold
the respirator under your chin
with the nosepiece up.
The top strap (on single or
double strap respirators) goes
over and rests at the top back
of your head. The bottom strap
is positioned around the neck
and below the ears. Do not
crisscross straps.
Place your fingertips from both
hands at the top of the metal
nose clip (if present). Slide
fingertips down both sides of
the metal strip to mold the nose
area to the shape of your nose.
Place both hands completely
over the respirator and exhale.
If you feel leakage, there is not
a proper seal.
If air leaks around the nose,
readjust the nosepiece as
described. If air leaks at the
mask edges, re-adjust the straps
along the sides of your head
until a proper seal is achieved.
If you cannot achieve a proper
seal due to air leakage, ask for
help or try a different size
or model.
Checking Your Seal2
Place both hands over the
respirator, take a quick breath
in to check whether the
respirator seals tightly to
the face.
Removing Your Respirator
DO NOT TOUCH the front
of the respirator! It may be
contaminated!
Remove by pulling the bottom
strap over back of head,
followed by the top strap,
without touching the respirator.
Discard in waste container.
WASH YOUR HANDS!
Employers must comply with the OSHA Respiratory Protection Standard, 29 CFR 1910.134 if respirators are used by employees performing work-related duties.
1 Manufacturer instructions for many NIOSH approved disposable respirators can be found
at www.cdc.gov/niosh/npptl/topics/respirators/disp_part/
2 According to the manufacturer’s recommendations
For more information call 1-800-CDC-INFO or go to http://www.cdc.gov/niosh/npptl/topics/respirators/
CS 207843
DHHS (NIOSH) Publication No. 2010-133
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.cdc.gov/niosh/docs/2010-133/pdfs/2010-133.pdf
Objectives
Directions on how to properly put on and take off a disposable respirator (mask/masks).
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
How to Properly Put on and Take off a Disposable Respirator
Subject
The topic of the resource
Infection Control
Description
An account of the resource
WASH YOUR HANDS THOROUGHLY BEFORE PUTTING ON AND TAKING OFF THE RESPIRATOR.<br /><ul><li>If you have used a respirator before that fit you, use the same make, model and size.</li>
<li>Inspect the respirator for damage.</li>
<li>If your respirator appears damaged, DO NOT USE IT. Replace it with a new one.</li>
<li>Do not allow facial hair, hair, jewelry, glasses, clothing, or anything else to prevent proper placement or come between your face and the respirator.</li>
<li>Follow the instructions that come with your respirator.</li>
</ul><p style="background-color:#ffffa8;">NOTE: If you cannot achieve a proper seal due to air leakage, and you need to try a different size or model - you will need to restart the process and go through fit testing again!</p>
<p> </p>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2010
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Airborne Transmission
Coronavirus
Donning
Donning and Doffing
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/27ae3d08823bebbc0d36598e3073516e.docx
c6fe9a937225b52da4aeab50d06f26de
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
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Title
A name given to the resource
Special Pathogen L2 Donning and Doffing Checklist
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Level 2 Donning and Doffing Checklists. The word doc can be downloaded and edited as a template.
Creator
An entity primarily responsible for making the resource
NYC Health + Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-07-28
Relation
A related resource
Y - PPE pos 102 qualtrics 322; PPE pos 103 qualtrics 323; PPE pos 104 qualtrics 324; PPE pos 105 qualtrics 325
Y - D0.1PPE/D0.2PPE Qualtrics # 322
Y - D0.1PPE/D0.2PPE Qualtrics # 323
Y - D0.1PPE/D0.2PPE Qualtrics # 324
Y - D0.1PPE/D0.2PPE Qualtrics # 325
Contributor
An entity responsible for making contributions to the resource
2022-02-08 by PPE group NYCHH (EB)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-02-08
Checklist
Donning and Doffing
Example
Frontline Facilities Tools
Isolate
Level 2 PPE
Patient Care
Personal Protective Equipment (PPE)
R-PPE
Trained Observer
-
https://repository.netecweb.org/files/original/50b56f827f2b42e04c0cafcd50f687b9.png
4dfe4e9715314593bfafc389bb806d3d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134AppB1
Dublin Core
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Title
A name given to the resource
1910.134 App B-1 - User Seal Check Procedures (Mandatory).
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<p>Available in spanish (Español) on the linked page.<br /><b>User Seal Check Procedures (Mandatory)</b></p>
<ul><li><strong>Part Number:</strong> 1910</li>
<li><strong>Part Number Title:</strong> Occupational Safety and Health Standards</li>
<li><strong>Subpart:</strong> 1910 Subpart I</li>
<li><strong>Subpart Title:</strong> Personal Protective Equipment</li>
<li><strong>Standard Number:</strong> <a href="https://www.osha.gov/laws-regs/interlinking/standards/1910.134%20App%20B-1"> 1910.134 App B-1 </a></li>
<li><strong>Title:</strong> User Seal Check Procedures (Mandatory).</li>
<li><strong>GPO Source:</strong> <a href="https://www.ecfr.gov/cgi-bin/text-idx?SID=65b279ee2e7530009034c1f152d451e5&tpl=/ecfrbrowse/Title29/29tab_02.tpl">e-CFR</a></li>
</ul>
Creator
An entity primarily responsible for making the resource
Occupational Safety and Health Administration (OSHA)
Date
A point or period of time associated with an event in the lifecycle of the resource
1998-01-08
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Donning
N95
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
-
https://repository.netecweb.org/files/original/4f8784f9a2c8ebdbf7b836abc4ece7ae.png
994e33673fe16a0faf6091736809816a
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/masks-and-n95-respirators
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Masks and N95 Respirators
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance information about Masks and N95 Respirators
Creator
An entity primarily responsible for making the resource
U.S. Food and Drug Administration (FDA)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-15
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/100dd3e01959ec4b0c5aeeaf759fcc0c.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Online Course
Access portal to an online course.
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Training videos for each step of the donning and doffing process:<br />
<ul>
<li><a href="https://www.cdc.gov/vhf/ebola/hcp/ppe-training/n95respirator_gown/donning_01.html#" target="_blank" rel="noreferrer noopener">N95 and Gown</a>:
<ul>
<li>Donning: 13 steps</li>
<li>Doffing: 24 steps</li>
</ul>
</li>
<li><a href="https://www.cdc.gov/vhf/ebola/hcp/ppe-training/n95Respirator_Coveralls/donning_01.html" target="_blank" rel="noreferrer noopener">N95 and Coverall</a>:
<ul>
<li>Donning: 13 steps</li>
<li>Doffing: 23 steps</li>
</ul>
</li>
<li><a href="https://www.cdc.gov/vhf/ebola/hcp/ppe-training/PAPRRespirator_Gown/donning_01.html" target="_blank" rel="noreferrer noopener">Powered air-purifying respirator (PAPR) and Gown</a>:
<ul>
<li>Donning: 12 steps</li>
<li>Doffing: 18 steps</li>
</ul>
</li>
<li><a href="https://www.cdc.gov/vhf/ebola/hcp/ppe-training/PAPRRespirator_Coveralls/donning_01.html" target="_blank" rel="noreferrer noopener">Powered air-purifying respirator (PAPR) and Coverall</a>:
<ul>
<li>Donning: 12 steps</li>
<li>Doffing: 21 steps</li>
</ul>
</li>
</ul>
Objectives
<div class="card mb-3">
<div class="card-header h4 bg-gray-l3">Guidance on Personal Protective Equipment</div>
<div class="card-body bg-gray-l3">
<p>The following informational materials demonstrate the procedures described in CDC guidance for donning and doffing (i.e., putting on and removing) personal protective equipment (PPE) for all healthcare providers entering the room of a patient hospitalized with known or suspected Ebola virus disease (Ebola). These informational materials are intended to promote patient safety and increase the safety of the healthcare provider.</p>
<p>Prior to working with Ebola patients, all healthcare providers involved in the care of Ebola patients must receive training and demonstrate competency in performing all Ebola-related infection control practices and procedures, specifically in donning and doffing proper PPE.</p>
</div>
</div>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html
Access
Description of access information (e.g. itunes).
Free online
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE Training Videos
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals - Step by Step Videos
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-07-25
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
CDC
Donning and Doffing
Ebola
Example
Gloves
Gown
Infection Prevention and Control
Mask
Masks
N95
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/0b8d0ac6ab822a26d1841c5a492ee478.png
00e4fd00818deccbbbfb9510dc34c7a2
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Doffing PPE: Your PPE Video PAPR and Coverall" src="https://www.youtube.com/embed/FJzIWgQyTrk" frameborder="0"></iframe>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/videos/DOFF_PAPR_COVER-01.MP4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Doffing PPE: Your PPE Video PAPR and Coverall
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-10-30
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Donning and Doffing
Ebola
Example
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/8f54476985640be03a3a32161d8c120c.png
fb751767ccf29c12e611bcf19e499396
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Doffing PPE: Doff Your PPE Video PAPR and Gown" src="https://www.youtube.com/embed/-X4dNMgFGyo" frameborder="0"></iframe>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/videos/DOFF_PAPR_GOWN-01.MP4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Doffing PPE: Doff Your PPE Video PAPR and Gown
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-10-30
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Donning and Doffing
Ebola
Example
Gown
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/c1fbc99a57071adbbe803b4980e1164d.png
874ffc588505ee9d7a940ba6d9435d3e
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Doffing PPE: Doff your PPE Video Respirator and Coverall" src="https://www.youtube.com/embed/Hd4T-0Lf2fw" frameborder="0"></iframe>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/videos/DOFF_N95_COVER-01.MP4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Doffing PPE: Doff your PPE Video Respirator and Coverall
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-10-30
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Donning and Doffing
Ebola
Example
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/e1ce33606b3f6ae4f8de9e81124f9821.png
aebfde3e2a9bf115c12aedaca39abb6d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Doffing PPE: Doff Your PPE Video Respirator and Gown" src="https://www.youtube.com/embed/bZA424c5sWQ" frameborder="0"></iframe>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/videos/DOFF_N95_GOWN-01.MP4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Doffing PPE: Doff Your PPE Video Respirator and Gown
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-10-30
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Donning and Doffing
Ebola
Gown
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/ca6874a3f6a906e6128f5ba5b2e940d6.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Online Course
Access portal to an online course.
Objectives
<p>When you work with a health care provider and doffing assistant you will not physically assist at all. You are there to monitor, protect, and guide health care providers through the protocols of donning and doffing PPE. Remember, an effective Trained Observer:</p>
<ul><li>is vigilant in spotting defects in equipment;</li>
<li>is proactive in identifying upcoming risks;</li>
<li>follows the provided checklist, but focuses on the big picture;</li>
<li>is informative, supportive and well-paced in issuing instructions or advice;</li>
<li>always practices hand hygiene immediately after providing assistance.</li>
</ul>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/trained-observer/observer_01.html
Alternate URL
Other URLs if necessary.
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/index.html
Access
Description of access information (e.g. itunes).
Free online on CDC website.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Trained Observer for All PPE
Subject
The topic of the resource
Infection Control
Description
An account of the resource
This training module discusses the roles and responsibilities of Trained Donning and Doffing Observers (called Trained Observers or TO). in Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-07-25
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Donning and Doffing
Ebola
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
Trained Observer
-
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2ed1b499c6298daf85a38d6aea36f712
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Donning PPE: Introduction Video Respirator and Coverall" src="https://www.youtube.com/embed/8jX0-cKqnVw" frameborder="0"></iframe>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/videos/DON_N95_COVER-00.MP4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Donning PPE: Introduction Video Respirator and Coverall
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-10-30
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Donning and Doffing
Ebola
Example
Mask
Masks
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/fc0692d2bd2d0157e5a16b779c7519f3.png
1c6c6c2e14f66c20c823f8e62ec4b2da
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Donning PPE: Introduction Video PAPR Coverall" src="https://www.youtube.com/embed/d0lLf63iyPM" frameborder="0"></iframe>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/videos/DON_PAPR_COVER-00.MP4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Donning PPE: Introduction Video PAPR Coverall
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-10-30
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Donning and Doffing
Ebola
Example
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/7c0d72e5fc9e1b99213fd30bd10ce2fc.png
9c0fe061c3e852dbde0aea0eec588146
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Donning PPE: Introduction Video PAPR and Gown" src="https://www.youtube.com/embed/shH4AAjxRs8" frameborder="0"></iframe>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/videos/DON_PAPR_GOWN-00.MP4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Donning PPE: Introduction Video PAPR and Gown
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-10-30
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Donning and Doffing
Ebola
Example
Gown
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/fd23bedd1baf8e9dbd81bce84d009a98.png
89cb4fbbdfaa8fedb12b58fa90e7b0e8
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Donning PPE: Introduction Video Respirator and Gown" src="https://www.youtube.com/embed/Ca66dpjPWZc" frameborder="0"></iframe>
URL
https://www.cdc.gov/vhf/ebola/hcp/ppe-training/videos/DON_N95_GOWN-00.MP4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Donning PPE: Introduction Video Respirator and Gown
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Ebola Virus Disease in U.S. Hospitals
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-10-30
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Donning
Ebola
Gown
N95
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/464349b58ac0059a95dcb2d2e33c634a.pdf
db0302a7660d97b059107afbc5757adc
PDF Text
Text
Laboratory:
All states are strongly encouraged to consider identifying Ebola assessment hospitals;
however, in geographic areas where state and local public health authorities have
elected not to identify or designate Ebola assessment hospitals, all hospitals should
plan, in coordination with state and local authorities, for adequate staff training and PPE
supplies if a PUI has to be managed. In this instance, frontline healthcare facilities
should have plans in place to safely collect, package, and transport laboratory
specimens for PUIs, if needed. If frontline healthcare facilities cannot immediately
transfer the patient to another facility, they should also have plans in place to ensure
that routine laboratory tests needed to determine alternative diagnoses are performed
while the patient is evaluated for EVD.
https://www.cdc.gov/vhf/ebola/healthcare-us/preparing/frontline-healthcare-facilities.html
Before a Patient Presents:
Know your Resources and Capabilities for Lab Testing:
•
Get PH Lab (LRN Lab) phone numbers (weekday and weekend/holiday)
•
Know what screening tests are available at your PH LRN lab
•
Define an in-house testing menu
•
Identify certified Category A shipping person(s)
•
Define a specimen transport procedure
Specimen Collection and Packaging:
If your facility will draw lab samples to be sent for testing:
• Who will collect the samples? (special team, nursing, phlebotomy, etc)
o Does staff know the appropriate specimen to draw (serum, whole blood,
NP Swab, etc)? Contact your designated Public Health Lab for the
appropriate specimen based on the test.
o Is there a protocol in place for specimen collection from PUIs? (See
example protocol)
o Do you have the appropriate tubes/swabs on hand? If not, do you know
where to get some quickly? Will PH or other hospitals help provide
appropriate tubes or swabs if needed?
o Have staff practiced drawing labs in PPE?
o How can specimens be cleaned, labelled, packaged and removed safely
from the patient area?
o Do you know the turn-around time for these labs?
•
How will the specimens be transported to the public health or other reference
laboratory for testing?
FUNDED BY ASPR & CDC
�o How do those specimens need to be packaged (Cat A vs. Cat B) for
transport?
o Does your facility have a person that is certified in Cat A shipping?
o Does your facility have the appropriate packaging? If not, do you know
who to contact to obtain it?
o Who is responsible for the transport, and who will arrange transport for
those specimens? Is that person/company trained in Cat A transport?
o Are there any special considerations for specimen transport, such as
transporting on ice? Does your facility have access to ice packs or dry ice
if needed?
o Does your facility utilize a Chain of Custody (COC) document?
o How long is the anticipated turnaround time for results?
o Who will notify your facility of the test results?
o Who is responsible for notifying public health of the test results, according
to your state CONOPS?
Laboratory Testing (in-house):
• What laboratory testing can be done safely to provide appropriate clinical care
while screening testing is pending
o What tests do physicians need in order to care for the patient? (need vs.
want)
o Do you have Point of Care (POC) instruments? Who is trained to run
them?
o Where will testing take place? POC at bedside, main lab or alternate
space?
o Does the testing staff have PPE protocols in place for testing special
pathogens? Have staff practiced running tests in enhanced PPE?
o Do you have a way to track the location of every specimen as well as who
has handled or tested them?
•
Does the laboratory have a plan to manage laboratory waste if testing specimens
from a positive patient?
o Do you have an autoclave on-site?
o Do you have a plan to sequester all waste associated with these
specimens?
o Can laboratory waste go into the patient waste stream?
Patient Transport:
If your facility will engage EMS to transport the PUI:
• Which agency or agencies could perform the transport?
• Where would the handoff occur?
• What is required to secure that area and the transport route to it?
FUNDED BY ASPR & CDC
�•
•
•
•
•
Has this process been tested in an exercise or real-world event?
Which personnel would perform the transport and handoff to EMS?
o What PPE would these personnel wear? Have they received training on
how to safely don and doff this PPE?
o Would the EMS agency expect the patient to wear PPE? What type?
o Would a containment wrap or patient isolation transport device (e.g.
Isopod) be utilized (what, if anything, do the EMS agencies or state
CONOPS recommend?
If containment devices are used:
Who has access to them?
Are personnel trained on how to set them up and ensure they are
safe for patient use?
Does your facility have a plan to manage any body fluid spills that occur along
the transport route?
o Who will manage those spills?
o How will personnel package and process the waste generated during the
clean up of the spill?
Where will designated transport staff doff their PPE after handoff to EMS?
o What equipment will need to be decontaminated (or held pending testing)?
o Where will that occur? Who will do it?
What is your facility’s plan for holding or decontaminating the designated
isolation room pending results or after a confirmation?
o Will the EMS crew transport your facility’s waste with the PUI?
o If so, does our facility have a plan for transporting this waste to the
ambulance?
Decedent Management:
Does your facility have a plan to manage decedent remains of a PUI or patient
confirmed to have Ebola or other special pathogen?
• Do you have an established process for your facility to contact public health in
the event that a PUI or confirmed patient expires while at your facility?
• What is the process that Public Health would like you to use if a person under
investigation dies within your health system/hospital?
• If your facility is expected to package decedent remains, is there a strategy in
place to train staff in the process?
• Does your facility have access to recommended equipment or materials to
package the remains? Who are your resources to obtain them if you are
expected to package the remains?
• If diagnostic tests are pending when the patient expires, what does your public
health authority advise for your facility?
• Is there a designated mortuary or crematorium that will accept the remains?
FUNDED BY ASPR & CDC
�
https://repository.netecweb.org/files/original/43761f094e5d1363affdad530148f0ed.docx
f40c660f985bd0028e22c779338b9a35
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Laboratory
Subject
The topic of the resource
Laboratory
Description
An account of the resource
All states are strongly encouraged to consider identifying Ebola assessment hospitals; however, in geographic areas where state and local public health authorities have elected not to identify or designate Ebola assessment hospitals, all hospitals should plan, in coordination with state and local authorities, for adequate staff training and PPE supplies if a PUI has to be managed. In this instance, frontline healthcare facilities should have plans in place to safely collect, package, and transport laboratory specimens for PUIs, if needed. If frontline healthcare facilities cannot immediately transfer the patient to another facility, they should also have plans in place to ensure that routine laboratory tests needed to determine alternative diagnoses are performed while the patient is evaluated for EVD.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019
Contributor
An entity responsible for making contributions to the resource
2023-12-18 by Lab (Vicki and Kim), 1 yr
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-12-18
Assessment Facility
Frontline Facilities Tools
Frontline Facility
Lab
Laboratory
Laboratory Testing
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
R-Lab
R-PPE
-
https://repository.netecweb.org/files/original/83bdbe1b588410fa388769ef05cb49b6.pdf
fc00691b67b880bde74140b7519024be
PDF Text
Text
Special Pathogen L1 Personal Protective Equipment
Donning and Doffing Checklist
Level 1 DONNING CHECKLIST
Step
#
1.
2.
Task
Gather PPE
in proper
sizes
Prepare to
don PPE
Criteria
•
•
•
•
•
•
•
•
•
3.
Inspect PPE
Surgical gown
N95 respirator mask
Nitrile gloves, extended cuff (2 pr.)
Face shield
Trained observer present with checklist
OUTSIDE of the patient’s room
Remove watches, jewelry, and dangling items
that could interfere with integrity of PPE
Secure eyeglasses with a tie
Hydrate and attend to personal hygiene
•
Inspect PPE for serviceability (e.g., not torn or
ripped) and proper size
Completed
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
4.
Perform hand
hygiene
•
Perform hand hygiene with alcohol-based hand
sanitizer
5.
Don nitrile
gloves (inner)
•
Don nitrile inner gloves
•
❑ Yes
❑ No
6.
Don surgical
gown
•
•
•
Fully covers torso from neck to knees; arms to
end of wrists
Fastens at the back of neck; ties at waist
Do not tie inside ties
Ensures no trip hazard exists
7.
Don N95
respirator
•
Don N95 mask and check for seal
❑ Yes
❑ No
8.
Don nitrile
gloves (outer)
•
Extends to cover the sleeves or cuffs of the
surgical gown
Tuck excess material at sleeve into cuff
❑ Yes
❑ No
Positions shield above eyebrows and midforehead to cover eyes
❑ Yes
❑ No
9.
Don face
shield
•
•
•
10.
Inspection
Extends arms and verifies integrity of PPE with
observer:
• Bends at waist
• Squats and returns to standing position
• Slowly turns in circle for final inspection
• Observer to mark suit with wearer’s name and
time donned
❑ Yes
❑ No
Colored steps indicate location: Red = in patient room | Yellow = In designated decontamination area | Green = In cold/clean zone outside decontamination area
Reference: Healthcare providers in the U.S. evaluating PUIs for Ebola who are clinically stable AND do not have bleeding, vomiting, or diarrhea. Accessed online at
https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html; Accessed on 3/30/2018
V.2.0 021319
Page 1 of 4
�Special Pathogen L1 Personal Protective Equipment
Donning and Doffing Checklist
11.
Reminder
•
Hands are to be kept away from all mucous
membranes / Review hand signals
❑ Yes
❑ No
Colored steps indicate location: Red = in patient room | Yellow = In designated decontamination area | Green = In cold/clean zone outside decontamination area
Reference: Healthcare providers in the U.S. evaluating PUIs for Ebola who are clinically stable AND do not have bleeding, vomiting, or diarrhea. Accessed online at
https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html; Accessed on 3/30/2018
V.2.0 021319
Page 2 of 4
�Special Pathogen L1 Personal Protective Equipment
Donning and Doffing Checklist
Level 1 DOFFING CHECKLIST
Step
#
Task
1.
Trained
Observer
•
2.
Inspect PPE
3.
Perform hand
hygiene
•
•
•
•
1.
2.
4.
Doff outer
gloves
3.
4.
5.
6.
7.
Hand hygiene
Doff face
shield
Hand hygiene
Doff surgical
gown
Perform hand
hygiene
Engage the trained observer outside patient room
with the checklist
Determine contact time requirement for
disinfectant wipe per product label
❑ Yes
❑ No
In patient room;
Inspect PPE for soiling or breaches
If PPE is visibly contaminated, disinfect by using
an EPA-registered disinfectant wipe (allow contact
time per product label)
Perform hand hygiene by using an EPA-registered
disinfectant wipe (allow contact time per product
label) or with alcohol-based hand sanitizer
Using gloved hand, grasp the palm area of the
other gloved hand and peel off first glove
Hold the removed glove in the opposite, gloved
hand
Slide fingers of the ungloved hand under the
remaining glove at the wrist and peel off the
remaining outer glove over the first glove
Discard both outer gloves in the infectious waste
container
Clean hands with alcohol-based hand sanitizer
•
•
Face shield is considered contaminated
Remove by tilting the head slightly forward,
grasping the rear strap and pulling it gently over
the head and allowing the face shield to fall
forward
Discard in the infectious waste container
Clean hands with an EPA-registered disinfectant
wipe (allow contact time per product label) or
alcohol-based hand sanitizer
Front and sleeves are potentially contaminated
Pull the gown away from the body until the ties
break
Remove gown by pulling the gown away from the
neck and shoulders, touching the inside only
As the gown is rolled away from the body it is
turned inside out, folded, or rolled into a bundle
and discarded into an infectious waste container
Perform hand hygiene by using an EPA-registered
disinfectant wipe (allow contact time per product
label) or with alcohol-based hand sanitizer
•
•
•
•
9.
Completed
•
•
•
8.
Criteria
•
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Colored steps indicate location: Red = in patient room | Yellow = In designated decontamination area | Green = In cold/clean zone outside decontamination area
Reference: Healthcare providers in the U.S. evaluating PUIs for Ebola who are clinically stable AND do not have bleeding, vomiting, or diarrhea. Accessed online at
https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html; Accessed on 3/30/2018
V.2.0 021319
Page 3 of 4
�Special Pathogen L1 Personal Protective Equipment
Donning and Doffing Checklist
Level 1 DOFFING CHECKLIST
Step
#
Task
Criteria
Completed
1. Using gloved hand, grasp the palm area of the
other gloved hand and peel off first glove
2. Hold the removed glove in the opposite, gloved
hand
3. Slide fingers of the ungloved hand under the
remaining glove at the wrist and peel off the
remaining outer glove over the first glove
4. Discard both outer gloves in the infectious waste
container
❑ Yes
❑ No
11. Hand hygiene
•
Clean hands with alcohol-based hand sanitizer
❑ Yes
❑ No
Don nitrile
gloves
•
Don a new pair of nitrile gloves
❑ Yes
❑ No
13. Relocate
•
Move to designated doffing area
Remove N95
respirator
Doff final
15.
gloves
•
Remove N95 respirator from the back to front and
discard in the infectious waste container
Remove gloves using same procedure as first two
pairs
Wash or clean hands with an alcohol-based hand
sanitizer; hands completely dry before exiting the
area
Inspect for any contamination of the clothing worn
under the PPE. If there is contamination, shower
immediately.
Perform staff rehab, medical monitoring,
documentation, and behavioral wellness check as
indicated
10.
12.
Doff inner
gloves
14.
16. Hand Hygiene
17. Inspect
18. Follow Up
•
•
•
•
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Colored steps indicate location: Red = in patient room | Yellow = In designated decontamination area | Green = In cold/clean zone outside decontamination area
Reference: Healthcare providers in the U.S. evaluating PUIs for Ebola who are clinically stable AND do not have bleeding, vomiting, or diarrhea. Accessed online at
https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance-clinically-stable-puis.html; Accessed on 3/30/2018
V.2.0 021319
Page 4 of 4
�
https://repository.netecweb.org/files/original/ff9449b2fdb9e0c2c792ab72b91e19b8.docx
dacd06fdb8eac254d849ef771efdd3fe
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Editable version of the Checklist
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Special Pathogen L1 Personal Protective Equipment: Donning and Doffing Checklist
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Donning and Doffing Checklists. The word doc can be downloaded and edited as a template. This is a Level 1 PPE Checklist.
Creator
An entity primarily responsible for making the resource
NYC Health + Hospitals
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-02-13
Relation
A related resource
Y - PPE pos 102 qualtrics 322
Y - D0.1PPE/D0.2PPE Qualtrics # 322
Contributor
An entity responsible for making contributions to the resource
2022-02-08 by PPE group NYCHH (EB)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-02-08
Checklist
Donning and Doffing
Example
Frontline Facilities Tools
Isolate
Level 1 PPE
Patient Care
Personal Protective Equipment (PPE)
R-PPE
Trained Observer
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Andonian, Jennifer, Sadaf Kazi, Jennifer Therkorn, Lauren Benishek, Carrie Billman, Margaret Schiffhauer, Elaine Nowakowski, Patience Osei, Ayse P. Gurses, Yea-Jen Hsu, David Drewry, Ellen R. Forsyth, Arjun Vignesh, Ifeoluwa Oresanwo, Brian T. Garibaldi, Kaitlin Rainwater-Lovett, Polly Trexler, and Lisa L. Maragakis. 2019. "Effect of an Intervention Package and Teamwork Training to Prevent Healthcare Personnel Self-contamination During Personal Protective Equipment Doffing." Clinical Infectious Diseases 69 (Supplement_3):S248-S55.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>More than 28 000 people were infected with Ebola virus during the 2014–2015 West African outbreak, resulting in more than 11 000 deaths. Better methods are needed to reduce the risk of self-contamination while doffing personal protective equipment (PPE) to prevent pathogen transmission.</p>
<div class="title">Methods</div>
<p>A set of interventions based on previously identified failure modes was designed to mitigate the risk of self- contamination during PPE doffing. These interventions were tested in a randomized controlled trial of 48 participants with no prior experience doffing enhanced PPE. Contamination was simulated using a fluorescent tracer slurry and fluorescent polystyrene latex spheres (PLSs). Self-contamination of scrubs and skin was measured using ultraviolet light visualization and swabbing followed by microscopy, respectively. Doffing sessions were videotaped and reviewed to score standardized teamwork behaviors.</p>
<div class="title">Results</div>
<p>Participants in the intervention group contaminated significantly fewer body sites than those in the control group (median [interquartile range], 6 [3–8] vs 11 [6–13], P = .002). The median contamination score was lower for the intervention group than the control group when measured by ultraviolet light visualization (23.15 vs 64.45, P = .004) and PLS swabbing (72.4 vs 144.8, P = .001). The mean teamwork score was greater in the intervention group (42.2 vs 27.5, P < .001).</p>
<div class="title">Conclusions</div>
<p>An intervention package addressing the PPE doffing task, tools, environment, and teamwork skills significantly reduced the amount of self-contamination by study participants. These elements can be incorporated into PPE guidance and training to reduce the risk of pathogen transmission.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: personal protective equipment doffing</a>, <a class="kwd-part kwd-main">self-contamination</a>, <a class="kwd-part kwd-main">inhalational exposure</a>, <a class="kwd-part kwd-main">viral hemorrhagic fever</a>, <a class="kwd-part kwd-main">biocontainment</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>disease transmission, </span></a><a><span>health personnel, </span></a><a><span>personal protective equipment, </span></a><a><span>work teams</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517976
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S248/5568514
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Effect of an Intervention Package and Teamwork Training to Prevent Healthcare Personnel Self-contamination During Personal Protective Equipment Doffing
Subject
The topic of the resource
Infection Control
Description
An account of the resource
More than 28 000 people were infected with Ebola virus during the 2014–2015 West African outbreak, resulting in more than 11 000 deaths. Better methods are needed to reduce the risk of self-contamination while doffing personal protective equipment (PPE) to prevent pathogen transmission.
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program (CDC)
Source
A related resource from which the described resource is derived
Andonian, Jennifer, Sadaf Kazi, Jennifer Therkorn, Lauren Benishek, Carrie Billman, Margaret Schiffhauer, Elaine Nowakowski, Patience Osei, Ayse P. Gurses, Yea-Jen Hsu, David Drewry, Ellen R. Forsyth, Arjun Vignesh, Ifeoluwa Oresanwo, Brian T. Garibaldi, Kaitlin Rainwater-Lovett, Polly Trexler, and Lisa L. Maragakis.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Airborne Transmission
Donning and Doffing
Ebola
Isolation/Biocontainment
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
Staff Support
Staffing
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Therkorn, Jennifer, David Drewry, Jennifer Andonian, Lauren Benishek, Carrie Billman, Ellen R. Forsyth, Brian T. Garibaldi, Elaine Nowakowski, Kaitlin Rainwater-Lovett, Lauren Sauer, Maggie Schiffhauer, and Lisa L. Maragakis. 2019. "Development and Comparison of Complementary Methods to Study Potential Skin and Inhalational Exposure to Pathogens During Personal Protective Equipment Doffing." Clinical Infectious Diseases 69 (Supplement_3):S231-S40.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>Fluorescent tracers are often used with ultraviolet lights to visibly identify healthcare worker self-contamination after doffing of personal protective equipment (PPE). This method has drawbacks, as it cannot detect pathogen-sized contaminants nor airborne contamination in subjects’ breathing zones.</p>
<div class="title">Methods</div>
<p>A contamination detection/quantification method was developed using 2-µm polystyrene latex spheres (PSLs) to investigate skin contamination (via swabbing) and potential inhalational exposure (via breathing zone air sampler). Porcine skin coupons were used to estimate the PSL swabbing recovery efficiency and limit of detection (LOD). A pilot study with 5 participants compared skin contamination levels detected via the PSL vs fluorescent tracer methods, while the air sampler quantified potential inhalational exposure to PSLs during doffing.</p>
<div class="title">Results</div>
<p>Average PSL skin swab recovery efficiency was 40% ± 29% (LOD = 1 PSL/4 cm<sup>2</sup> of skin). In the pilot study, all subjects had PSL and fluorescent tracer skin contamination. Two subjects had simultaneously located contamination of both types on a wrist and hand. However, for all other subjects, the PSL method enabled detection of skin contamination that was not detectable by the fluorescent tracer method. Hands/wrists were more commonly contaminated than areas of the head/face (57% vs 23% of swabs with PSL detection, respectively). One subject had PSLs detected by the breathing zone air sampler.</p>
<div class="title">Conclusions</div>
<p>This study provides a well-characterized method that can be used to quantitate levels of skin and inhalational contact with simulant pathogen particles. The PSL method serves as a complement to the fluorescent tracer method to study PPE doffing self-contamination.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: personal protective equipment doffing</a>, <a class="kwd-part kwd-main">exposure assessment</a>, <a class="kwd-part kwd-main">doffing self-contamination</a>, <a class="kwd-part kwd-main">inhalational exposure</a>, <a class="kwd-part kwd-main">methods development</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>inspiration, </span></a><a><span>latex, </span></a><a><span>polystyrenes, </span></a><a><span>skin, </span></a><a><span>pathogenic organism, </span></a><a><span>personal protective equipment</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517983
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S231/5568521
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Development and Comparison of Complementary Methods to Study Potential Skin and Inhalational Exposure to Pathogens During Personal Protective Equipment Doffing
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Fluorescent tracers are often used with ultraviolet lights to visibly identify healthcare worker self-contamination after doffing of personal protective equipment (PPE).
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program (CDC)
Source
A related resource from which the described resource is derived
Therkorn, Jennifer, David Drewry, Jennifer Andonian, Lauren Benishek, Carrie Billman, Ellen R. Forsyth, Brian T. Garibaldi, Elaine Nowakowski, Kaitlin Rainwater-Lovett, Lauren Sauer, Maggie Schiffhauer, and Lisa L. Maragakis.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Airborne Transmission
Donning and Doffing
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Robinson, Gwen L., Stephanie Hitchcock, Zegbeh Kpadeh-Rogers, Nicole Karikari, J. Kristie Johnson, Natalia Blanco, Daniel J. Morgan, Anthony D. Harris, and Surbhi Leekha. 2019. "Preventing Viral Contamination: Effects of Wipe and Spray-based Decontamination of Gloves and Gowns." Clinical Infectious Diseases 69 (Supplement_3):S228-S30.
Abstract
<h2 class="abstract-title">Abstract</h2>
<p>We conducted a laboratory simulation to evaluate the contamination of environmental surfaces when using wipe vs spray methods of personal protective equipment (PPE) decontamination. We did not observe any environmental contamination with the bacteriophage MS-2 when bleach solution spray or wipes were used for PPE disinfection.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: personal protective equipment</a>, <a class="kwd-part kwd-main">contamination</a>, <a class="kwd-part kwd-main">decontamination</a>, <a class="kwd-part kwd-main">aerosol</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>aerosols, </span></a><a><span>bacteriophages, </span></a><a><span>decontamination, </span></a><a><span>disinfection, </span></a><a><span>environmental pollution, </span></a><a><span>gloves, protective, </span></a><a><span>personal protective equipment, </span></a><a><span>bleach</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517980
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S228/5568518
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Preventing Viral Contamination: Effects of Wipe and Spray-based Decontamination of Gloves and Gowns
Subject
The topic of the resource
Infection Control
Description
An account of the resource
We conducted a laboratory simulation to evaluate the contamination of environmental surfaces when using wipe vs spray methods of personal protective equipment (PPE) decontamination.
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program (CDC)
Source
A related resource from which the described resource is derived
Robinson, Gwen L., Stephanie Hitchcock, Zegbeh Kpadeh-Rogers, Nicole Karikari, J. Kristie Johnson, Natalia Blanco, Daniel J. Morgan, Anthony D. Harris, and Surbhi Leekha.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Gloves
Gown
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Kpadeh-Rogers, Zegbeh, Gwen L. Robinson, Haleema Alserehi, Daniel J. Morgan, Anthony D. Harris, Natalia Blanco Herrera, Laura J. Rose, Judith Noble-Wang, J. Kristie Johnson, and Surbhi Leekha. 2019. "Effect of Glove Decontamination on Bacterial Contamination of Healthcare Personnel Hands." Clinical Infectious Diseases 69 (Supplement_3):S224-S7.
Abstract
<h2 class="abstract-title">Abstract</h2>
<p>We examined the effect of glove decontamination prior to removal on bacterial contamination of healthcare personnel hands in a laboratory simulation study. Glove decontamination reduced bacterial contamination of hands following removal. However, hand contamination still occurred with all decontamination methods, reinforcing the need for hand hygiene following glove removal.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main"> Keywords: personal protective equipment</a>, <a class="kwd-part kwd-main">transmission</a>, <a class="kwd-part kwd-main">hand hygiene and gloves</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>decontamination, </span></a><a><span>gloves, protective, </span></a><a><span>health personnel, </span></a><a><span>hand, </span></a><a><span>washing hands, </span></a><a><span>glove removal</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517972
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S224/5568510
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Effect of Glove Decontamination on Bacterial Contamination of Healthcare Personnel Hands
Subject
The topic of the resource
Infection Control
Description
An account of the resource
We examined the effect of glove decontamination prior to removal on bacterial contamination of healthcare personnel hands in a laboratory simulation study.
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program (CDC)
Source
A related resource from which the described resource is derived
Kpadeh-Rogers, Zegbeh, Gwen L. Robinson, Haleema Alserehi, Daniel J. Morgan, Anthony D. Harris, Natalia Blanco Herrera, Laura J. Rose, Judith Noble-Wang, J. Kristie Johnson, and Surbhi Leekha.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Contact Transmission
Gloves
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Mumma, Joel M., Francis T. Durso, Lisa M. Casanova, Kimberly Erukunuakpor, Colleen S. Kraft, Susan M. Ray, Andi L. Shane, Victoria L. Walsh, Puja Y. Shah, Craig Zimring, Jennifer DuBose, and Jesse T. Jacob. 2019. "Variability in the Duration and Thoroughness of Hand Hygiene." Clinical Infectious Diseases 69 (Supplement_3):S221-S3.
Abstract
<h2 class="abstract-title">Abstract</h2>
<p>We observed 354 hand hygiene instances across 41 healthcare workers doffing personal protective equipment at 4 hospital-based biocontainment units. We measured the duration and thoroughness of each hand hygiene instance. Both parameters varied substantially, with systematic differences between hospitals and differences between healthcare workers accounting for much of the variance.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main"> Keywords: hand hygiene</a>, <a class="kwd-part kwd-main">human factors engineering</a>, <a class="kwd-part kwd-main">personal protective equipment</a>, <a class="kwd-part kwd-main">serious communicable disease</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>health personnel, </span></a><a><span>washing hands, </span></a><a><span>personal protective equipment</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517981
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S221/5568519
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Variability in the Duration and Thoroughness of Hand Hygiene
Subject
The topic of the resource
Infection Control
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program (CDC)
Source
A related resource from which the described resource is derived
Mumma, Joel M., Francis T. Durso, Lisa M. Casanova, Kimberly Erukunuakpor, Colleen S. Kraft, Susan M. Ray, Andi L. Shane, Victoria L. Walsh, Puja Y. Shah, Craig Zimring, Jennifer DuBose, and Jesse T. Jacob.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Description
An account of the resource
We observed 354 hand hygiene instances across 41 healthcare workers doffing personal protective equipment at 4 hospital-based biocontainment units.
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Mumma, Joel M., Francis T. Durso, Lisa M. Casanova, Kimberly Erukunuakpor, Colleen S. Kraft, Susan M. Ray, Andi L. Shane, Victoria L. Walsh, Puja Y. Shah, Craig Zimring, Jennifer DuBose, and Jesse T. Jacob. 2019. "Common Behaviors and Faults When Doffing Personal Protective Equipment for Patients With Serious Communicable Diseases." Clinical Infectious Diseases 69 (Supplement_3):S214-S20.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>The safe removal of personal protective equipment (PPE) can limit transmission of serious communicable diseases, but this process poses challenges to healthcare workers (HCWs).</p>
<div class="title">Methods</div>
<p>We observed 41 HCWs across 4 Ebola treatment centers in Georgia doffing PPE for simulated patients with serious communicable diseases. Using human factors methodologies, we obtained the details, sequences, and durations of doffing steps; identified the ways each step can fail (failure modes [FMs]); quantified the riskiness of FMs; and characterized the workload of doffing steps.</p>
<div class="title">Results</div>
<p>Eight doffing steps were common to all hospitals—removal of boot covers, gloves (outer and inner pairs), the outermost garment, the powered air purifying respirator (PAPR) hood, and the PAPR helmet assembly; repeated hand hygiene (eg, with hand sanitizer); and a final handwashing with soap and water. Across hospitals, we identified 256 FMs during the common doffing steps, 61 of which comprised 19 common FMs. Most of these common FMs were above average in their riskiness at each hospital. At all hospitals, hand hygiene, removal of the outermost garment, and removal of boot covers were above average in their overall riskiness. Measurements of workload revealed that doffing steps were often mentally demanding, and this facet of workload correlated most strongly with the effortfulness of a doffing step.</p>
<div class="title">Conclusions</div>
<p>We systematically identified common points of concern in protocols for doffing high-level PPE. Addressing FMs related to hand hygiene and the removal of the outermost garment, boot covers, and PAPR hood could improve HCW safety when doffing high-level PPE.</p>
<p>We identified ways that doffing protocols for high-level personal protective equipment may fail to protect healthcare workers. Hand hygiene, removing the outermost garment, boot covers, and respirator hood harbored the greatest risk and failed in similar ways across different hospitals.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main"> Keywords: serious communicable disease</a>, <a class="kwd-part kwd-main">personal protective equipment</a>, <a class="kwd-part kwd-main">occupational health</a>, <a class="kwd-part kwd-main">human factors</a>, <a class="kwd-part kwd-main">risk analysis</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>clothing, </span></a><a><span>communicable diseases, </span></a><a><span>gloves, protective, </span></a><a><span>health personnel, </span></a><a><span>ebola virus disease, </span></a><a><span>patient simulation, </span></a><a><span>soap, </span></a><a><span>ventilators, mechanical, </span></a><a><span>workload, </span></a><a><span>washing hands, </span></a><a><span>protective helmet, </span></a><a><span>personal protective equipment, </span></a><a><span>human factors engineering</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517977
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S214/5568515
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Common Behaviors and Faults When Doffing Personal Protective Equipment for Patients With Serious Communicable Diseases
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The safe removal of personal protective equipment (PPE) can limit transmission of serious communicable diseases, but this process poses challenges to healthcare workers (HCWs).
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program (CDC)
Source
A related resource from which the described resource is derived
Mumma, Joel M., Francis T. Durso, Lisa M. Casanova, Kimberly Erukunuakpor, Colleen S. Kraft, Susan M. Ray, Andi L. Shane, Victoria L. Walsh, Puja Y. Shah, Craig Zimring, Jennifer DuBose, and Jesse T. Jacob.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Donning and Doffing
Gloves
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
Special Pathogens
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Toth, Damon J. A., Karim Khader, Alexander Beams, and Matthew H. Samore. 2019. "Model-based Assessment of the Effect of Contact Precautions Applied to Surveillance-detected Carriers of Carbapenemase-producing Enterobacteriaceae in Long-term Acute Care Hospitals." Clinical Infectious Diseases 69 (Supplement_3):S206-S13.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>An intervention that successfully reduced colonization and infection with carbapenemase-producing Enterobacteriaceae (CPE) in Chicago-area long-term acute-care hospitals included active surveillance and contact precautions. However, the specific effects of contact precautions applied to surveillance-detected carriers on patient-to-patient transmission are unknown, as other, concurrent intervention components or changes in facility patient dynamics also could have affected the observed outcomes.</p>
<div class="title">Methods</div>
<p>Using previously published data from before and after the CPE intervention, we designed a mathematical model with an explicit representation of postintervention surveillance. We estimated preintervention to postintervention changes of 3 parameters: <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-1-Frame"><span class="math" id="MathJax-Span-1" style="width:0.672em;"><span style="width:0.502em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-2"><span class="mstyle" id="MathJax-Span-3"><span class="mrow" id="MathJax-Span-4"><span class="mi" id="MathJax-Span-5" style="font-family:STIXGeneral;font-style:italic;">β<span style="height:1px;width:0.008em;"></span></span></span></span></span><span style="width:0px;height:2.567em;"></span></span></span><span style="vertical-align:-0.334em;border-left:0px solid;width:0px;height:1.273em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>, the baseline transmission rate excluding contact precaution effects; <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-2-Frame"><span class="math" id="MathJax-Span-6" style="width:1.175em;"><span style="width:0.893em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-7"><span class="mstyle" id="MathJax-Span-8"><span class="mrow" id="MathJax-Span-9"><span class="mrow" id="MathJax-Span-10"><span class="msub" id="MathJax-Span-11"><span style="width:0.889em;height:0px;"><span><span class="mrow" id="MathJax-Span-12"><span class="mi" id="MathJax-Span-13" style="font-family:STIXGeneral;font-style:italic;">δ</span></span><span style="width:0px;height:4.018em;"></span></span><span><span class="mrow" id="MathJax-Span-14"><span class="mrow" id="MathJax-Span-15"><span class="mi" id="MathJax-Span-16" style="font-size:70.7%;font-family:STIXGeneral;">b</span></span></span><span style="width:0px;height:4.018em;"></span></span></span></span></span></span></span></span><span style="width:0px;height:2.288em;"></span></span></span><span style="vertical-align:-0.272em;border-left:0px solid;width:0px;height:1.199em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>, the rate of a CPE carrier progressing to bacteremia; and <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-3-Frame"><span class="math" id="MathJax-Span-17" style="width:1.119em;"><span style="width:0.837em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-18"><span class="mstyle" id="MathJax-Span-19"><span class="mrow" id="MathJax-Span-20"><span class="mrow" id="MathJax-Span-21"><span class="msub" id="MathJax-Span-22"><span style="width:0.849em;height:0px;"><span><span class="mrow" id="MathJax-Span-23"><span class="mi" id="MathJax-Span-24" style="font-family:STIXGeneral;font-style:italic;">δ</span></span><span style="width:0px;height:4.018em;"></span></span><span><span class="mrow" id="MathJax-Span-25"><span class="mrow" id="MathJax-Span-26"><span class="mi" id="MathJax-Span-27" style="font-size:70.7%;font-family:STIXGeneral;">c</span></span></span><span style="width:0px;height:4.018em;"></span></span></span></span></span></span></span></span><span style="width:0px;height:2.288em;"></span></span></span><span style="vertical-align:-0.272em;border-left:0px solid;width:0px;height:1.199em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>, the progression rate to nonbacteremia clinical detection.</p>
<div class="title">Results</div>
<p>Assuming that CPE carriers under contact precautions transmit carriage to other patients at half the rate of undetected carriers, the model produced no convincing evidence for a postintervention change in the baseline transmission rate <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-4-Frame"><span class="math" id="MathJax-Span-28" style="width:0.672em;"><span style="width:0.502em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-29"><span class="mstyle" id="MathJax-Span-30"><span class="mrow" id="MathJax-Span-31"><span class="mi" id="MathJax-Span-32" style="font-family:STIXGeneral;font-style:italic;">β <span style="height:1px;width:0.008em;"></span></span></span></span></span><span style="width:0px;height:2.567em;"></span></span></span><span style="vertical-align:-0.334em;border-left:0px solid;width:0px;height:1.273em;"></span></span></span></span>(+2.1% [95% confidence interval {CI}, −18% to +28%]). The model did find evidence of a postintervention decrease for <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-5-Frame"><span class="math" id="MathJax-Span-33" style="width:1.175em;"><span style="width:0.893em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-34"><span class="mstyle" id="MathJax-Span-35"><span class="mrow" id="MathJax-Span-36"><span class="mrow" id="MathJax-Span-37"><span class="msub" id="MathJax-Span-38"><span style="width:0.889em;height:0px;"><span><span class="mrow" id="MathJax-Span-39"><span class="mi" id="MathJax-Span-40" style="font-family:STIXGeneral;font-style:italic;">δ</span></span><span style="width:0px;height:4.018em;"></span></span><span><span class="mrow" id="MathJax-Span-41"><span class="mrow" id="MathJax-Span-42"><span class="mi" id="MathJax-Span-43" style="font-size:70.7%;font-family:STIXGeneral;">b</span></span></span><span style="width:0px;height:4.018em;"></span></span></span></span></span></span></span></span><span style="width:0px;height:2.288em;"></span></span></span><span style="vertical-align:-0.272em;border-left:0px solid;width:0px;height:1.199em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>(−41% [95% CI, −60% to −18%]), but not for <span class="inline-formula no-formula-id"><span class="MathJax" id="MathJax-Element-6-Frame"><span class="math" id="MathJax-Span-44" style="width:1.119em;"><span style="width:0.837em;height:0px;font-size:128%;"><span><span class="mrow" id="MathJax-Span-45"><span class="mstyle" id="MathJax-Span-46"><span class="mrow" id="MathJax-Span-47"><span class="mrow" id="MathJax-Span-48"><span class="msub" id="MathJax-Span-49"><span style="width:0.849em;height:0px;"><span><span class="mrow" id="MathJax-Span-50"><span class="mi" id="MathJax-Span-51" style="font-family:STIXGeneral;font-style:italic;">δ</span></span><span style="width:0px;height:4.018em;"></span></span><span><span class="mrow" id="MathJax-Span-52"><span class="mrow" id="MathJax-Span-53"><span class="mi" id="MathJax-Span-54" style="font-size:70.7%;font-family:STIXGeneral;">c</span></span></span><span style="width:0px;height:4.018em;"></span></span></span></span></span></span></span></span><span style="width:0px;height:2.288em;"></span></span></span><span style="vertical-align:-0.272em;border-left:0px solid;width:0px;height:1.199em;"></span></span></span></span><span class="inline-formula no-formula-id"></span>(−7% [95% CI, −28% to +19%]).</p>
<div class="title">Conclusions</div>
<p>Our results suggest that contact precautions for surveillance-detected CPE carriers could potentially explain the observed decrease in colonization by itself, even under conservative assumptions for the effectiveness of those precautions for reducing cross-transmission. Other intervention components such as daily chlorhexidine gluconate bathing of all patients and hand-hygiene education and adherence monitoring may have contributed primarily to reducing rates of colonized patients progressing to bacteremia.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: contact precautions</a>, <a class="kwd-part kwd-main">carbapenem-resistant Enterobacteriaceae</a>, <a class="kwd-part kwd-main">transmission</a>, <a class="kwd-part kwd-main">active surveillance</a>, <a class="kwd-part kwd-main">mathematical model</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>bacteremia, </span></a><a><span>disease transmission, </span></a><a><span>watchful waiting, </span></a><a><span>acute care, </span></a><a><span>contact precautions, </span></a><a><span>surveillance, medical, </span></a><a><span>microbial colonization, </span></a><a><span>mathematical model, </span></a><a><span>carbapenem-resistant enterobacteriaceae</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517974
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S206/5568512
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Model-based Assessment of the Effect of Contact Precautions Applied to Surveillance-detected Carriers of Carbapenemase-producing Enterobacteriaceae in Long-term Acute Care Hospitals
Subject
The topic of the resource
Infection Control
Description
An account of the resource
An intervention that successfully reduced colonization and infection with carbapenemase-producing Enterobacteriaceae (CPE) in Chicago-area long-term acute-care hospitals included active surveillance and contact precautions.
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program and C. D. C. Modeling Infectious Diseases in Healthcare Program (CDC)
Source
A related resource from which the described resource is derived
Toth, Damon J. A., Karim Khader, Alexander Beams, and Matthew H. Samore.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Contact Transmission
Long-term Care
Personal Protective Equipment (PPE)
R-LTC
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Drews, Frank A., Diane Mulvey, Kristina Stratford, Matthew H. Samore, and Jeanmarie Mayer. 2019. "Evaluation of a Redesigned Personal Protective Equipment Gown." Clinical Infectious Diseases 69 (Supplement_3):S199-S205.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>In healthcare, the goal of personal protective equipment (PPE) is to protect healthcare personnel (HCP) and patients from body fluids and infectious organisms via contact, droplet, or airborne transmission. The critical importance of using PPE properly is highlighted by 2 potentially fatal viral infections, severe acute respiratory syndrome–associated coronavirus and Ebola virus, where HCP became infected while caring for patients due to errors in the use of PPE. However, PPE in dealing with less dangerous, but highly infectious organisms is important as well. This work proposes a framework to test and evaluate PPE with a focus on gown design.</p>
<div class="title">Methods</div>
<p>An observational study identified issues with potential for contamination related to gown use. After redesigning the existing gown, a high-fidelity patient simulator study with 40 HCP as participants evaluated the gown redesign using 2 commonly performed tasks. Variables of interest were nonadherence to procedural standards, use problems with the gown during task performance, and usability and cognitive task load ratings of the standard and redesigned gowns.</p>
<div class="title">Results</div>
<p>While no differences were found in terms of nonadherence and use problems between the current and the redesigned gown, differences in usability and task load ratings suggested that the redesigned gown is perceived more favorably by HCP.</p>
<div class="title">Conclusions</div>
<p>This work proposes a framework to guide the evaluation of PPE. The results suggest that the current design of the PPE gown can be improved in usability and user satisfaction. Although our data did not find an increase in adherence to protocol when using the redesigned gown, it is likely that higher usability and lower task load could result in higher adherence over longer periods of use.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: PPE</a>, <a class="kwd-part kwd-main">evaluation</a>, <a class="kwd-part kwd-main">gown</a>, <a class="kwd-part kwd-main">usability</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>body fluid, </span></a><a><span>coronavirus, </span></a><a><span>ebola virus, </span></a><a><span>health personnel, </span></a><a><span>task performance and analysis, </span></a><a><span>virus diseases, </span></a><a><span>severe acute respiratory syndrome, </span></a><a><span>personal protective equipment, </span></a><a><span>simulators, </span></a><a><span>airborne transmission</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title"><a>Issue Section: </a><a>supplement articles</a></div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517973
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S199/5568511
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Evaluation of a Redesigned Personal Protective Equipment Gown
Subject
The topic of the resource
Infection Control
Description
An account of the resource
In healthcare, the goal of personal protective equipment (PPE) is to protect healthcare personnel (HCP) and patients from body fluids and infectious organisms via contact, droplet, or airborne transmission.
Creator
An entity primarily responsible for making the resource
Drews, Frank A., Diane Mulvey, Kristina Stratford, Matthew H. Samore, and Jeanmarie Mayer.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Airborne Transmission
Contact Transmission
Coronavirus
Droplet Transmission
Ebola
Gown
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
SARS
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Baloh, Jure, Heather Schacht Reisinger, Kimberly Dukes, Jaqueline Pereira da Silva, Hugh P. Salehi, Melissa Ward, Emily E. Chasco, Priyadarshini R. Pennathur, and Loreen Herwaldt. 2019. "Healthcare Workers’ Strategies for Doffing Personal Protective Equipment." Clinical Infectious Diseases 69 (Supplement_3):S192-S8.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from pathogens and prevents cross-contamination. PPE effectiveness is often undermined by inappropriate doffing methods. Our knowledge of how HCWs approach doffing PPE in practice is limited. In this qualitative study, we examine HCWs’ perspectives about doffing PPE.</p>
<div class="title">Methods</div>
<p>Thirty participants at a Midwestern academic hospital were recruited and assigned to 1 of 3 doffing simulation scenarios: 3 mask designs (n = 10), 2 gown designs (n = 10), or 2 glove designs (n = 10). Participants were instructed to doff PPE as they would in routine practice. Their performances were video-recorded and reviewed with participants. Semistructured interviews about their doffing approaches were conducted and audio-recorded, then transcribed and thematically analyzed.</p>
<div class="title">Results</div>
<p>Three overarching themes were identified in interviews: doffing strategies, cognitive processes, and barriers and facilitators. Doffing strategies included doffing safely (minimizing self-contamination) and doffing expediently (eg, ripping PPE off). Cognitive processes during doffing largely pertained to tracking contaminated PPE surfaces, examining PPE design cues (eg, straps), or improvising based on prior experience from training or similar PPE designs. Doffing barriers and facilitators typically related to PPE design, such as PPE fit (or lack of it) and fastener type. Some participants also described personal barriers (eg, glasses, long hair); however, some PPE designs helped mitigate these barriers.</p>
<div class="title">Conclusions</div>
<p>Efforts to improve HCWs’ doffing performance need to address HCWs’ preferences for both safety and expediency when using PPE, which has implications for PPE design, training approaches, and hospital policies and procedures.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main"> Keywords: healthcare workers</a>, <a class="kwd-part kwd-main">personal protective equipment</a>, <a class="kwd-part kwd-main">doffing</a>, <a class="kwd-part kwd-main">strategies</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>cues, </span></a><a><span>gloves, protective, </span></a><a><span>health personnel, </span></a><a><span>masks, </span></a><a><span>mental processes, </span></a><a><span>safety, </span></a><a><span>personal protective equipment</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title">Issue Section: supplement articles</div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online through journal subscription (Oxford Academic).
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517970
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S192/5568508
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Healthcare Workers’ Strategies for Doffing Personal Protective Equipment
Subject
The topic of the resource
Infection Control
Creator
An entity primarily responsible for making the resource
Baloh, Jure, Heather Schacht Reisinger, Kimberly Dukes, Jaqueline Pereira da Silva, Hugh P. Salehi, Melissa Ward, Emily E. Chasco, Priyadarshini R. Pennathur, and Loreen Herwaldt.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Description
An account of the resource
Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from pathogens and prevents cross-contamination.
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Donning and Doffing
Gloves
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Harrod, Molly, Laura Petersen, Lauren E. Weston, Lynn Gregory, Jeanmarie Mayer, Matthew H. Samore, Frank A. Drews, and Sarah L. Krein. 2019. "Understanding Workflow and Personal Protective Equipment Challenges Across Different Healthcare Personnel Roles." Clinical Infectious Diseases 69 (Supplement_3):S185-S91.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>Hospitals use standard and transmission-based precautions, including personal protective equipment (PPE), to prevent the spread of infectious organisms. However, little attention has been paid to the potentially unique challenges of various healthcare personnel (HCP) in following precaution practices.</p>
<div class="title">Methods</div>
<p>From September through December 2016, 5 physicians, 5 nurses, and 4 physical therapists were shadowed for 1 hour 30 minutes to 3 hours 15 minutes at an academic medical center. Observers documented activities using unstructured field notes. Focus groups were conducted to better understand HCP perspectives about precautions and PPE-related challenges. Data were analyzed by comparing workflow and challenges (observed and stated) in precaution practices across HCP roles.</p>
<div class="title">Results</div>
<p>Precaution patients were interspersed throughout physician rounds, which covered a broad geographic range throughout the hospital. Patient encounters were generally brief, and appropriate use of gowns and cleaning of personal stethoscopes varied among observed physicians. Nurses were unit based and frequently entered/exited rooms. Frustration with donning/doffing was especially apparent when needing supplies while in a precaution room, which nurses acknowledged was a time when practice lapses could occur. The observed physical therapists worked in one geographic location, spent extended periods of time with patients, and noted that given their close physical contact with patients, gowns do not fully protect them.</p>
<div class="title">Conclusions</div>
<p>Movement patterns, time with patients, care activities, and equipment use varied across HCP, leading to a diverse set of challenges in following precaution practices and PPE use. Attention to these differences among HCP is important for understanding and developing effective strategies to prevent the potential spread of infectious organisms.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: healthcare personnel roles</a>, <a class="kwd-part kwd-main">personal protective equipment</a>, <a class="kwd-part kwd-main">qualitative research</a>, <a class="kwd-part kwd-main">workflow</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>health personnel, </span></a><a><span>nurses, </span></a><a><span>stethoscopes, </span></a><a><span>personal protective equipment, </span></a><a><span>physical therapists, </span></a><a><span>participation in ward rounds, </span></a><a><span>workflow</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title">Issue Section: supplement articles</div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online.
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517971
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S185/5568509
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Understanding Workflow and Personal Protective Equipment Challenges Across Different Healthcare Personnel Roles
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Hospitals use standard and transmission-based precautions, including personal protective equipment (PPE), to prevent the spread of infectious organisms.
Creator
An entity primarily responsible for making the resource
Harrod, Molly, Laura Petersen, Lauren E. Weston, Lynn Gregory, Jeanmarie Mayer, Matthew H. Samore, Frank A. Drews, and Sarah L. Krein.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
Staff Rotations
Staffing
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Phan, Linh T., Dayana Maita, Donna C. Mortiz, Susan C. Bleasdale, and Rachael M. Jones. 2019. "Environmental Contact and Self-contact Patterns of Healthcare Workers: Implications for Infection Prevention and Control." Clinical Infectious Diseases 69 (Supplement_3):S178-S84.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>Respiratory viruses on fomites can be transferred to sites susceptible to infection via contact by hands or other fomites.</p>
<div class="title">Methods</div>
<p>Care for hospitalized patients with viral respiratory infections was observed in the patient room for 3-hour periods at an acute care academic medical center for over a 2 year period. One trained observer recorded the healthcare activities performed, contacts with fomites, and self-contacts made by healthcare workers (HCWs), while another observer recorded fomite contacts of patients during the encounter using predefined checklists.</p>
<div class="title">Results</div>
<p>The surface contacted by HCWs during the majority of visits was the patient (90%). Environmental surfaces contacted by HCWs frequently during healthcare activities included the tray table (48%), bed surface (41%), bed rail (41%), computer station (37%), and intravenous pole (32%). HCWs touched their own torso and mask in 32% and 29% of the visits, respectively. HCWs’ self-contacts differed significantly among HCW job roles, with providers and respiratory therapists contacting themselves significantly more times than nurses and nurse technicians (<em>P</em> < .05). When HCWs performed only 1 care activity, there were significant differences in the number of patient contacts and self-contacts that HCWs made during performance of multiple care activities (<em>P</em> < .05).</p>
<div class="title">Conclusions</div>
<p>HCWs regularly contact environmental surfaces, patients, and themselves while providing care to patients with infectious diseases, varying among care activities and HCW job roles. These contacts may facilitate the transmission of infection to HCWs and susceptible patients.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: contact transmission</a>, <a class="kwd-part kwd-main">fomites</a>, <a class="kwd-part kwd-main">self-contact</a>, <a class="kwd-part kwd-main">infection control</a>, <a class="kwd-part kwd-main">respiratory infections</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>academic medical centers, </span></a><a><span>communicable diseases, </span></a><a><span>computers, </span></a><a><span>disease transmission, </span></a><a><span>health personnel, </span></a><a><span>infectious disease prevention / control, </span></a><a><span>inpatients, </span></a><a><span>masks, </span></a><a><span>nurses, </span></a><a><span>patients' rooms, </span></a><a><span>infection, </span></a><a><span>hand, </span></a><a><span>viruses, </span></a><a><span>pathogenic organism, </span></a><a><span>viral respiratory infections, </span></a><a><span>infection prophylaxis, </span></a><a><span>acute care, </span></a><a><span>respiratory therapist, </span></a><a><span>trunk structure, </span></a><a><span>intravenous poles</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title">Issue Section: supplement articles</div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online with journal subscription (Oxford Academic)
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517975
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S178/5568513
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Environmental Contact and Self-contact Patterns of Healthcare Workers: Implications for Infection Prevention and Control
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Respiratory viruses on fomites can be transferred to sites susceptible to infection via contact by hands or other fomites.
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program (CDC)
Source
A related resource from which the described resource is derived
Phan, Linh T., Dayana Maita, Donna C. Mortiz, Susan C. Bleasdale, and Rachael M. Jones.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Contact Transmission
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Respiratory Pathogen
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
O’Hara, Lyndsay M., David P. Calfee, Loren G. Miller, Lisa Pineles, Laurence S. Magder, J. Kristie Johnson, Daniel J. Morgan, and Anthony D. Harris. 2019. "Optimizing Contact Precautions to Curb the Spread of Antibiotic-resistant Bacteria in Hospitals: A Multicenter Cohort Study to Identify Patient Characteristics and Healthcare Personnel Interactions Associated With Transmission of Methicillin-resistant Staphylococcus aureus." Clinical Infectious Diseases 69 (Supplement_3):S171-S7.
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title">Background</div>
<p>Healthcare personnel (HCP) acquire antibiotic-resistant bacteria on their gloves and gowns when caring for intensive care unit (ICU) patients. Yet, contact precautions for patients with methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) remains controversial despite existing guidelines. We sought to understand which patients are more likely to transfer MRSA to HCP and to identify which HCP interactions are more likely to lead to glove or gown contamination.</p>
<div class="title">Methods</div>
<p>This was a prospective, multicenter cohort study of cultured HCP gloves and gowns for MRSA. Samples were obtained from patients’ anterior nares, perianal area, and skin of the chest and arm to assess bacterial burden.</p>
<div class="title">Results</div>
<p>Among 402 MRSA-colonized patients with 3982 interactions, we found that HCP gloves and gowns were contaminated with MRSA 14.3% and 5.9% of the time, respectively. Contamination of either gloves or gowns occurred in 16.2% of interactions. Contamination was highest among occupational/physical therapists (odds ratio [OR], 6.96; 95% confidence interval [CI], 3.51, 13.79), respiratory therapists (OR, 5.34; 95% CI, 3.04, 9.39), and when any HCP touched the patient (OR, 2.59; 95% CI, 1.04, 6.51). Touching the endotracheal tube (OR, 1.75; 95% CI, 1.38, 2.19), bedding (OR, 1.43; 95% CI, 1.20, 1.70), and bathing (OR, 1.32; 95% CI, 1.01, 1.75) increased the odds of contamination. We found an association between increasing bacterial burden on the patient and HCP glove or gown contamination.</p>
<div class="title">Conclusions</div>
<p>Gloves and gowns are frequently contaminated with MRSA in the ICU. Hospitals may consider using fewer precautions for low-risk interactions and more for high-risk interactions and personnel.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: antibiotic-resistant bacteria</a>, <a class="kwd-part kwd-main">MRSA</a>, <a class="kwd-part kwd-main">infection prevention</a>, <a class="kwd-part kwd-main">contact precautions</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>antibiotic resistance, bacterial, </span></a><a><span>gloves, protective, </span></a><a><span>health personnel, </span></a><a><span>intensive care unit, </span></a><a><span>bacteria, </span></a><a><span>contact precautions, </span></a><a><span>methicillin-resistant staphylococcus aureus, </span></a><a><span>surgical gowns, </span></a><a><span>respiratory therapist, </span></a><a><span>touch sensation</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title">Issue Section: supplement articles</div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
On-line through journal site subscription (Oxford academic)
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517979
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S171/5568517
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Optimizing Contact Precautions to Curb the Spread of Antibiotic-resistant Bacteria in Hospitals: A Multicenter Cohort Study to Identify Patient Characteristics and Healthcare Personnel Interactions Associated With Transmission of Methicillin-resistant Staphylococcus aureus.
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Healthcare personnel (HCP) acquire antibiotic-resistant bacteria on their gloves and gowns when caring for intensive care unit (ICU) patients.
Creator
An entity primarily responsible for making the resource
C. D. C. Prevention Epicenters Program (CDC)
Source
A related resource from which the described resource is derived
O’Hara, Lyndsay M., David P. Calfee, Loren G. Miller, Lisa Pineles, Laurence S. Magder, J. Kristie Johnson, Daniel J. Morgan, and Anthony D. Harris.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Contact Transmission
Gloves
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Reddy, Sujan C., Amy L. Valderrama, and David T. Kuhar. 2019. "Improving the Use of Personal Protective Equipment: Applying Lessons Learned." Clinical Infectious Diseases 69 (Supplement_3):S165-S70.
Abstract
<h2 class="abstract-title">Abstract</h2>
<p>Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.</p>
<div class="article-metadata-panel clearfix">
<div class="kwd-group"><a class="kwd-part kwd-main">Keywords: contact precautions</a>, <a class="kwd-part kwd-main">healthcare personnel</a>, <a class="kwd-part kwd-main">personal protective equipment</a></div>
<div class="related-topic-tags">
<div class="related-topic-tag-label">Topic: <a><span>ebola virus, </span></a><a><span>delivery of health care, </span></a><a><span>health personnel, </span></a><a><span>ebola virus disease, </span></a><a><span>infection, </span></a><a><span>pathogenic organism, </span></a><a><span>personal protective equipment, </span></a><a><span>contact precautions, </span></a><a><span>microbial colonization, </span></a><a><span>prevention, </span></a><a><span>best practice</span></a></div>
</div>
<div class="article-metadata-tocSections">
<div class="article-metadata-tocSections-title">Issue Section: supplement articles</div>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free on-line.
URL
https://www.ncbi.nlm.nih.gov/pubmed/31517978
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/69/Supplement_3/S165/5568516
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Improving the Use of Personal Protective Equipment: Applying Lessons Learned.
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients.
Creator
An entity primarily responsible for making the resource
Reddy, Sujan C., Amy L. Valderrama, and David T. Kuhar.
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-10-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Contact Transmission
Infection Prevention and Control
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Casanova, L. M., K. Erukunuakpor, C. S. Kraft, J. M. Mumma, F. T. Durso, A. N. Ferguson, C. L. Gipson, V. L. Walsh, C. Zimring, J. DuBose, J. T. Jacob, Control Centers for Disease, and Division of Healthcare Quality Promotion Prevention Epicenters Program. 2018. "Assessing Viral Transfer During Doffing of Ebola-Level Personal Protective Equipment in a Biocontainment Unit." Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 66 (6):945-9.
Abstract
<div class="abstr">
<h3>Abstract</h3>
<div>
<h4>Background:</h4>
<p>Personal protective equipment (PPE) protects healthcare workers (HCWs) caring for patients with Ebola virus disease (EVD), and PPE doffing is a critical point for preventing viral self-contamination. We assessed contamination of skin, gloves, and scrubs after doffing Ebola-level PPE contaminated with surrogate viruses: bacteriophages MS2 and Φ6.</p>
<h4>Methods:</h4>
<p>In a medical biocontainment unit, HCWs (n = 10) experienced in EVD care donned and doffed PPE following unit protocols that incorporate trained observer guidance and alcohol-based hand rub (ABHR). A mixture of Φ6 (enveloped), MS2 (nonenveloped), and fluorescent marker was applied to 4 PPE sites, approximating body fluid viral load (Φ6, 105; MS2, 106). They performed a patient care task, then doffed. Inner gloves, face, hands, and scrubs were sampled for virus, as were environmental sites with visible fluorescent marker.</p>
<h4>Results:</h4>
<p>Among 10 HCWs there was no Φ6 transfer to inner gloves, hands, or face; 1 participant had Φ6 on scrubs at low levels (1.4 × 102). MS2 transfer (range, 101-106) was observed to scrubs (n = 2), hands (n = 1), and inner gloves (n = 7), where it was highest. Most (n = 8) had only 1 positive site. Environmental samples with visible fluorescent marker (n = 21) were negative.</p>
<h4>Conclusions:</h4>
<p>Among experienced HCWs, structured, observed doffing using ABHR protected against hand contamination with enveloped virus. Nonenveloped virus was infrequent on hands and scrubs but common on inner gloves, suggesting that inner gloves, but not necessarily ABHR, protect against hand contamination. Optimizing doffing protocols to protect against all types of viruses may require reinforcing careful handling of scrubs and good glove/hand hygiene with effective agents.</p>
</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Available online with Oxford Academic subscription
URL
https://www.ncbi.nlm.nih.gov/pubmed/29471475
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/66/6/945/4869968
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Assessing Viral Transfer During Doffing of Ebola-Level Personal Protective Equipment in a Biocontainment Unit
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The 2014–2015 outbreak of Ebola virus disease (EVD) placed healthcare workers (HCWs) at high risk for acquiring EVD during patient care.
Creator
An entity primarily responsible for making the resource
Casanova, L. M., K. Erukunuakpor, C. S. Kraft, J. M. Mumma, F. T. Durso, A. N. Ferguson, C. L. Gipson, V. L. Walsh, C. Zimring, J. DuBose, J. T. Jacob, Control Centers for Disease, and Division of Healthcare Quality Promotion Prevention Epicenters Program
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-05
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Ebola
Gloves
Internal Transport
Occupational Exposure
Occupational Health
Personal Protective Equipment (PPE)
R-IIT
R-PM
R-PPE
R-Res&Pub
Trained Observer
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
URL
https://wwwnc.cdc.gov/travel/page/recs-organizations-sending-workers-ebola
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola Recommendations for Organizations
Subject
The topic of the resource
Personnel Management
Description
An account of the resource
Recommendations for organizations sending US-based health care or emergency response workers to areas with Ebola outbreaks and predeparture assessment of any workers traveling from Ebola outbreak areas to the United States.
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-04-16
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Relation
A related resource
Y - D0.1PM/D0.2PM Qualtrics # 911, original # 7a
Y - D0.1PM/D0.2PM Qualtrics # 912, original # 8
Clinical Trial
Ebola
Outbreaks
Personal Protective Equipment (PPE)
R-PM
R-PPE
Travel Screening
Vaccine Study
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Objectives
<h2>Purpose of toolbox</h2>
<ul>
<li>Provides ready-to-use tools for frontline facilities to prepare and respond to patients who may have a high consequence infectious disease (HCID).</li>
<li>Helps facilities meet CMS emergency preparedness regulatory requirements for training and testing programs.</li>
<li>Helps facilities develop a multi-year plan for HCID education and exercises.</li>
<li>Incorporates standard infection prevention concepts into training and exercises.</li>
</ul>
URL
https://www.health.state.mn.us/diseases/hcid/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities
Subject
The topic of the resource
Infection Control
Description
An account of the resource
<h2>This toolbox contains</h2>
<ul>
<li>Planning Tools</li>
<li>Training Tools</li>
<li>Exercise Templates</li>
<li>Readiness binder</li>
<li>References</li>
</ul>
<h2>How to use the toolbox</h2>
<ul>
<li>Use sample multi-year planning, training and exercise plan templates to lay out preparedness activities over multiple years.</li>
<li>Incorporate readymade slides and personal protective equipment (PPE) videos into facility infection prevention and emergency preparedness training.</li>
<li>Use or modify sample exercises (seminar, workshop, table top, mini-exercise, game) and templates (Planning Tool, After Action Report).</li>
<li>Use components to make a binder for staff to use at point of care.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Minnesota Department of Health
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-06-11
Contributor
An entity responsible for making contributions to the resource
2023-12-04 by Jill Morgan/PPE Group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-12-04
Donning and Doffing
Example
Frontline Facility
High Consequence Infectious Disease (HCID)
Infection Prevention and Control
R-PPE
Special Pathogens
-
https://repository.netecweb.org/files/original/f5fd708413132f91d8f2cc87fb69a9db.png
f7b9de206383db0bcaa1765be578479c
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
00:21:14
Objectives
This instructional series was created by the University of Maryland Baltimore County (UMBC), Department of Emergency Health Services, with assistance from the Maryland Department of Health, and funding from the U.S. Centers for Disease Control and Prevention.
This program is designed to meet the needs of first responders who are expected to deal with the health needs of people who find themselves in health emergencies they cannot manage on their own. These first responders are typically emergency medical services personnel, such as EMTs and paramedics, but can also be first-aid trained fire fighters, law enforcement personnel, and volunteers such as Red Cross disaster workers. Health officers in summer camps, youth clubs, and other organizations that work with groups of people who may have some vulnerability may also benefit from this program.
Event Type
Instructional series
URL
https://eid4emt.umbc.edu/courses/index.php?courseNum=6
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Module 5: Part 2: Donning and Doffing PPE for Wet Ebola Precautions" src="https://www.youtube.com/embed/1mGZrMZNa8s" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Module 5: Part 2: Donning and Doffing PPE for Wet Ebola Precautions
Subject
The topic of the resource
Infection Control
Description
An account of the resource
EID 4 EMT Free Video Training Series -
Emerging Infectious Diseases Videos for Prehospital Providers -
Donning and Doffing PPE for Wet Ebola Precautions
Creator
An entity primarily responsible for making the resource
University of Maryland, Baltimore County (UMBC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-15
Contributor
An entity responsible for making contributions to the resource
2024-03-27 EMS/Pre-Hospital never reviewed – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
Donning and Doffing
Droplet Transmission
Ebola
Personal Protective Equipment (PPE)
Pre-Hospital
R-EMS
R-PPE
R-PreH
-
https://repository.netecweb.org/files/original/def1fa03779e86fb9ab8bc2686f73c86.png
9f49bd0fb80668915256dc23c17124cd
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
00:23:04
Objectives
This instructional series was created by the University of Maryland Baltimore County (UMBC), Department of Emergency Health Services, with assistance from the Maryland Department of Health, and funding from the U.S. Centers for Disease Control and Prevention.
This program is designed to meet the needs of first responders who are expected to deal with the health needs of people who find themselves in health emergencies they cannot manage on their own. These first responders are typically emergency medical services personnel, such as EMTs and paramedics, but can also be first-aid trained fire fighters, law enforcement personnel, and volunteers such as Red Cross disaster workers. Health officers in summer camps, youth clubs, and other organizations that work with groups of people who may have some vulnerability may also benefit from this program.
Event Type
Instructional series
URL
https://eid4emt.umbc.edu/courses/index.php?courseNum=5
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Module 5: Part 1: Donning and Doffing PPE for Special Respiratory Precautions" src="https://www.youtube.com/embed/31r8NHPSjAE" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Module 5: Part 1: Donning and Doffing PPE for Special Respiratory Precautions, Dry EVD, and Other Highly Infectious Diseases
Subject
The topic of the resource
Infection Control
Description
An account of the resource
EID 4 EMT Free Video Training Series -
Emerging Infectious Diseases Videos for Prehospital Providers -
Donning and Doffing PPE for Special Respiratory Precautions, Dry EVD, and Other Highly Infectious Diseases
Creator
An entity primarily responsible for making the resource
University of Maryland, Baltimore County (UMBC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-04-03
Contributor
An entity responsible for making contributions to the resource
2024-03-27 EMS/Pre-Hospital never reviewed – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
Donning and Doffing
Ebola
Personal Protective Equipment (PPE)
Pre-Hospital
R-EMS
R-PPE
R-PreH
Respiratory Pathogen
Special Pathogens
-
https://repository.netecweb.org/files/original/0f8ce2531e96282078b37df2ffdaa82f.png
ac569bcfc059d605e3ecd3b6c2e825fc
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
00:34:57
Objectives
This instructional series was created by the University of Maryland Baltimore County (UMBC), Department of Emergency Health Services, with assistance from the Maryland Department of Health, and funding from the U.S. Centers for Disease Control and Prevention.
This program is designed to meet the needs of first responders who are expected to deal with the health needs of people who find themselves in health emergencies they cannot manage on their own. These first responders are typically emergency medical services personnel, such as EMTs and paramedics, but can also be first-aid trained fire fighters, law enforcement personnel, and volunteers such as Red Cross disaster workers. Health officers in summer camps, youth clubs, and other organizations that work with groups of people who may have some vulnerability may also benefit from this program.
Event Type
Instructional series
URL
https://eid4emt.umbc.edu/courses/index.php?courseNum=4
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Module 4: Donning & Doffing PPE for Contact, Droplet, and Airborne Precautions" src="https://www.youtube.com/embed/j4xcJyQBIOI" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Module 4: Donning & Doffing PPE for Contact, Droplet, and Airborne Precautions
Subject
The topic of the resource
Infection Control
Description
An account of the resource
EID 4 EMT Free Video Training Series -
Emerging Infectious Diseases Videos for Prehospital Providers -
Donning & Doffing PPE for Contact, Droplet, and Airborne Precautions
Creator
An entity primarily responsible for making the resource
University of Maryland, Baltimore County (UMBC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-15
Contributor
An entity responsible for making contributions to the resource
2024-03-27 EMS/Pre-Hospital never reviewed – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
Airborne Transmission
Contact Transmission
Donning and Doffing
Droplet Transmission
Personal Protective Equipment (PPE)
Pre-Hospital
R-EMS
R-PPE
R-PreH
-
https://repository.netecweb.org/files/original/73aad92d1657764b32dec7a8013a0345.png
dcf194a53ec2572a060248eef64ce78c
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
00:22:33
Objectives
This instructional series was created by the University of Maryland Baltimore County (UMBC), Department of Emergency Health Services, with assistance from the Maryland Department of Health, and funding from the U.S. Centers for Disease Control and Prevention.
This program is designed to meet the needs of first responders who are expected to deal with the health needs of people who find themselves in health emergencies they cannot manage on their own. These first responders are typically emergency medical services personnel, such as EMTs and paramedics, but can also be first-aid trained fire fighters, law enforcement personnel, and volunteers such as Red Cross disaster workers. Health officers in summer camps, youth clubs, and other organizations that work with groups of people who may have some vulnerability may also benefit from this program.
Event Type
Instructional series
URL
https://eid4emt.umbc.edu/courses/index.php?courseNum=3
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Module 3: PPE Considerations for Prehospital Providers: Using the Multi-Pathogen Approach" src="https://www.youtube.com/embed/LbmDGVnbC84" frameborder="0"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Module 3: PPE Considerations for Prehospital Providers: Using the Multi-Pathogen Approach
Subject
The topic of the resource
Infection Control
Description
An account of the resource
EID 4 EMT Free Video Training Series -
Emerging Infectious Diseases Videos for Prehospital Providers -
PPE Considerations for Prehospital Providers: Using the Multi-Pathogen Approach
Creator
An entity primarily responsible for making the resource
University of Maryland, Baltimore County (UMBC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-15
Contributor
An entity responsible for making contributions to the resource
2024-03-27 EMS/Pre-Hospital never reviewed – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
Personal Protective Equipment (PPE)
Pre-Hospital
R-EMS
R-PPE
R-PreH
Special Pathogens
-
https://repository.netecweb.org/files/original/ebaa03225d26634d1a7efdf0900610fb.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Joel M Mumma, Francis T Durso, Ashley N Ferguson, Christina L Gipson, Lisa Casanova, Kimberly Erukunuakpor, Colleen S Kraft, Victoria L Walsh, Craig Zimring, Jennifer DuBose, Jesse T Jacob, Centers for Disease Control and Prevention Epicenters Program, Division of Healthcare Quality Promotion; Human Factors Risk Analyses of a Doffing Protocol for Ebola-Level Personal Protective Equipment: Mapping Errors to Contamination, <em>Clinical Infectious Diseases</em>, Volume 66, Issue 6, 5 March 2018, Pages 950–958, <a href="https://doi.org/10.1093/cid/cix957">https://doi.org/10.1093/cid/cix957</a>
Abstract
<h2 class="abstract-title">Abstract</h2>
<div class="title -title">Background</div>
<p>Doffing protocols for personal protective equipment (PPE) are critical for keeping healthcare workers (HCWs) safe during care of patients with Ebola virus disease. We assessed the relationship between errors and self-contamination during doffing.</p>
<div class="title -title">Methods</div>
<p>Eleven HCWs experienced with doffing Ebola-level PPE participated in simulations in which HCWs donned PPE marked with surrogate viruses (ɸ6 and MS2), completed a clinical task, and were assessed for contamination after doffing. Simulations were video recorded, and a failure modes and effects analysis and fault tree analyses were performed to identify errors during doffing, quantify their risk (risk index), and predict contamination data.</p>
<div class="title -title">Results</div>
<p>Fifty-one types of errors were identified, many having the potential to spread contamination. Hand hygiene and removing the powered air purifying respirator (PAPR) hood had the highest total risk indexes (111 and 70, respectively) and number of types of errors (9 and 13, respectively). ɸ6 was detected on 10% of scrubs and the fault tree predicted a 10.4% contamination rate, likely occurring when the PAPR hood inadvertently contacted scrubs during removal. MS2 was detected on 10% of hands, 20% of scrubs, and 70% of inner gloves and the predicted rates were 7.3%, 19.4%, 73.4%, respectively. Fault trees for MS2 and ɸ6 contamination suggested similar pathways.</p>
<div class="title -title">Conclusions</div>
<p>Ebola-level PPE can both protect and put HCWs at risk for self-contamination throughout the doffing process, even among experienced HCWs doffing with a trained observer. Human factors methodologies can identify error-prone steps, delineate the relationship between errors and self-contamination, and suggest remediation strategies.</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Read with OUP subscription.
URL
https://www.ncbi.nlm.nih.gov/pubmed/29471368/
Read Online
Online location of the resource.
https://academic.oup.com/cid/article/66/6/950/4869969
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Human Factors Risk Analyses of a Doffing Protocol for Ebola-Level Personal Protective Equipment: Mapping Errors to Contamination
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Doffing protocols for personal protective equipment (PPE) are critical for keeping healthcare workers (HCWs) safe during care of patients with Ebola virus disease.
Creator
An entity primarily responsible for making the resource
Centers for Disease Control and Prevention Epicenters Program, Division of Healthcare Quality Promotion
Source
A related resource from which the described resource is derived
Joel M Mumma, Francis T Durso, Ashley N Ferguson, Christina L Gipson, Lisa Casanova, Kimberly Erukunuakpor, Colleen S Kraft, Victoria L Walsh, Craig Zimring, Jennifer DuBose, Jesse T Jacob.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-02-17
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Ebola
Gloves
Occupational Exposure
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/4bc8d1ce26c9cc048b5a4707e6b19e9f.pdf
0345dded904927a4473f70d1626b7a9e
PDF Text
Text
Virus Transfer
from Personal
Protective
Equipment to
Healthcare
Employees’ Skin
and Clothing
Lisa Casanova,* Edie Alfano-Sobsey,†
William A. Rutala,* David J. Weber,*
and Mark Sobsey*
We evaluated a personal protective equipment removal protocol designed to minimize wearer contamination
with pathogens. Following this protocol often resulted in virus transfer to hands and clothing. An altered protocol or
other measures are needed to prevent healthcare worker
contamination.
C
aring for patients with communicable diseases places
healthcare workers (HCWs) at risk. Infected HCWs
may not only incur serious illness or death themselves but
may spread infection to others. Methods to prevent HCW
infections include vaccination (1), hand hygiene (2), and
isolation of patients with communicable diseases (3).
A key aspect of patient isolation is proper use of personal protective equipment (PPE) to protect HCWs from
pathogen exposure during patient care. PPE includes use of
barriers (gowns, gloves, eye shields) and respiratory protection (masks, respirators) to protect mucous membranes,
airways, skin, and clothing from contact with infectious
agents (3). The importance of PPE was underscored in
the recent outbreak of severe acute respiratory syndrome
(SARS). HCWs accounted for ≈20% of cases (4); failure to
properly use PPE was a risk factor for HCW infection (5).
This outbreak raised concern that HCWs could contaminate their skin or clothes with pathogens during PPE
removal, resulting in accidental self-inoculation and virus
spread to patients, other HCWs, or fomites. The Centers
for Disease Control and Prevention (CDC) addressed this
concern by designing a protocol to minimize contamination to the wearer during PPE removal (Figure 1) (6).
However, the effectiveness of this protocol in preventing
*University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA; and †Wake County Human Services, Raleigh, North
Carolina, USA
DOI: 10.3201/eid1408.080085
self-contamination has not been validated. To determine if
removing PPE according to the CDC protocol prevents viral contamination of the wearer, a human challenge study
was undertaken using a nonpathogenic virus.
The Study
PPE (gowns, gloves, respirators, and goggles) donned
by volunteers was contaminated with bacteriophage MS2,
a nonenveloped, nonpathogenic RNA virus suspended
in 0.01 mol/L phosphate-buffered saline and GloGerm
(GloGerm, Moab, UT, USA), synthetic beads that fluoresce under UV light (for visual tracking of virus). Sites
of contamination were as follows: front shoulder of gown,
back shoulder of gown, right side of N95 respirator, upper
right front of goggles, and palm of dominant hand. Each
site was contaminated with a total of 104 PFU of MS2 in
5 drops of 5 μL each. Participants performed a healthcare
task (measuring blood pressure on a mannequin) and then
removed PPE according to CDC protocol. Hands, items
of PPE, and scrubs worn underneath were sampled for virus. Hands were sampled by using the glove juice method
(7). Each hand was placed inside a bag containing 75 mL
stripping solution (0.4 g KH2PO4, 10.1 g Na2HPO4, 1.0
mL Triton-X/L) and massaged for 60 seconds to cover all
hand surfaces with solution. PPE items were immersed in
1.5% beef extract, pH 7.5, and agitated on a shaker for 20
minutes. Eluent from hands and PPE was assayed by the
most probable number (MPN) enrichment infectivity assay
(8). To prevent cross-contamination, samples from only 1
volunteer were processed at a time, and individual eluent
samples were processed separately in a biological safety
cabinet, with decontamination in between.
Figure 1. Centers for Disease Control and Prevention protocol for
removing healthcare worker PPE.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 8, August 2008
1291
�DISPATCHES
When an a priori value of 25% was used for the 95%
upper confidence limit when p (transfer) = 0, the sample
size was N = 10. Protocols were approved by the University
of North Carolina (UNC) Biomedical Institutional Review
Board, and written informed consent was obtained. Enrolled participants met the following inclusion criteria: >18
years of age, nonpregnant, nonallergic to latex, no active
skin disorders, and medical evaluation approval for N95
respirator fit testing and use (9). Experiments took place in
a patient care room in the UNC Hospitals’ General Clinical
Research Center. The experimental protocol is shown in
Figure 2. Participants were shown the poster distributed by
CDC (Figure 1) and given an opportunity to read it and ask
questions. The poster was placed in front of the participants
for reference while they donned and removed PPE.
Ten study participants were enrolled in this study: 9
women and 1 man. Nine participants were right-handed,
and 1 was left-handed. Transfer of virus to both hands, the
initially uncontaminated glove on the nondominant hand,
and the scrub shirt and pants worn underneath the PPE was
observed in most volunteers (Table). Because of the difficulty of sampling large facial areas, visible fluorescent
tracer was used as the criterion to determine whether the
face would be sampled. No tracer was observed on the facial areas of any volunteer. The fluorescent tracer was not
a consistent indicator of virus contamination; virus was recovered both from sites where tracer was visible and where
it was not detected.
The amount of virus recovered was 1–3 log10 MPN for
hands and 1–4 log10 MPN for scrubs. The mean amount of
virus recovered from the right hand (the dominant hand of
90% of volunteers) was greater than that recovered from
the left hand. While removal of gloves and gowns required
2 hands, mask and goggle removal was one-handed, which
could have resulted in larger quantities of virus being transferred to the dominant hand during removal. In the single
left-handed study participant, recovery of virus was greater
from the left hand than the right (1.82 log10 vs. 0.98 log10
MPN). The mean amount of virus recovered from scrub
shirts was significantly greater than that recovered from
pants (p = 0.01), possibly because of contact with hands
when the gown is pulled away from the shoulder during
removal.
PPE use
Sampling
Put on scrub shirt and pants
Participant’s face and hands examined
under UV light for the presence of tracer
Undergo fit testing and instruction in how
to put on and fit check N95 respirator
Don PPE (contact isolation gown, N95
respirator, goggles, gloves)
Participant’s hands sampled using glove
juice method
Participant’s hands cleaned with
antimicrobial soap and 70% ethanol
Place virus/tracer on PPE
Participant removes scrubs and is
showered to remove any virus/tracer
Perform simulated healthcare task
(use blood pressure cuff to take the blood
pressure of a mannequin on an
examination bed in the room; count the
pulse at the wrist)
Remove PPE (with CDC poster visible for
reference at all times)
Scrubs and PPE collected and
examined under UV light for presence of
tracer
Scrubs and PPE placed in sterile eluent
and transported to laboratory for
analysis
Figure 2. Protocol for human challenge experiments. PPE, personal
protective equipment; CDC, Centers for Disease Control and
Prevention.
Conclusions
PPE is vital for protecting HCWs from occupationally
acquired infection during patient care, particularly from
droplet- or airborne-transmitted diseases. However, removing PPE after patient care without contaminating skin or
clothes is important. Although PPE is usually worn only
for short periods, viruses such as influenza (10) and SARS
coronavirus (11) can survive for hours on surfaces, and
viral infection can be spread by surface-to-hand (12) and
hand-to-hand contact (13).
Developing and validating an algorithm for removing
PPE that prevents contamination of the skin and clothes
of HCWs are key to interrupting nosocomial transmission
of infectious agents. These experiments demonstrate that
the current CDC algorithm is insufficient to protect HCWs
from contamination during PPE removal. However, options
that might prevent such contamination do exist, including
double gloving, use of surgical protocols for PPE removal,
and PPE impregnated with an antimicrobial agent.
A double-glove removal sequence would begin with
removal of the outer glove, followed by removal of goggles or face shield, gown, and respirator/mask, and finishing with removal of the inner glove followed by hand
Table. Frequency and levels of viral contamination of selected sites, virus transfer study, 2007*
% Volunteers who transferred Mean viral titer recovered from site
virus to site (N = 10)
(log10 MPN)
Site
Nondominant glove
80
2.2
Right hand (skin)
90
2.4
Left hand (skin)
70
1.8
Scrub shirt
100
3.2
Scrub pants
75†
2.1
Face
0
–
*MPN, most probable number; –, not measured.
†N = 8.
1292
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 8, August 2008
% Contaminated sites with
visible tracer (N = 10)
10
20
0
10
0
–
�Virus Transfer from PPE
hygiene; handling of PPE with ungloved hands is avoided.
Borrowing PPE protocols from surgery, in which the ends
of gown sleeves are tucked underneath gloves during wear,
might also reduce contamination. When the HCW is finished, goggles and respirator are removed first, and gown
and gloves are then removed together by peeling off both at
the same time, again avoiding handling PPE with ungloved
hands. Finally, the use of PPE impregnated with antimicrobial agents might also reduce or eliminate contamination of
skin and clothes.
This study also indicates the need for continued emphasis on hand hygiene. A barrier to improving hand hygiene compliance rates is the belief that gloves make hand
hygiene unnecessary (14). This is contradicted by our study
and others showing that organisms can spread from gloves
to hands after glove removal (15). Even if double gloving is
incorporated into protocols for PPE use, it is not a substitute
for proper hand hygiene. Before these or other candidate
methods are introduced into clinical practice, their impact
on the safety of HCWs should be validated by testing with
methods such as we have described.
Acknowledgment
We thank Maria Gergen for technical assistance.
This research was supported by the Centers for Disease Control and Prevention and by a grant (RR00046) from the General
Clinical Research Centers program of the Division of Research
Resources, National Institutes of Health.
Ms Casanova is a doctoral student in environmental health
sciences at the University of North Carolina, Chapel Hill. Her research interests include the detection and fate of viruses in natural
and human-built environments, and low-cost drinking water treatment technologies for developing countries.
References
1.
Centers for Disease Control and Prevention. Immunization of
health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection
Control Practices Advisory Committee (HICPAC). MMWR Morb
Mortal Wkly Rep. 1997;46(RR-18):1–42.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Boyce JM, Pittet D. Guideline for hand hygiene in health-care
settings: recommendations of the Healthcare Infection Control
Practices Advisory Committee and the HICPAC/SHEA/APIC/
IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol.
2002;23(Suppl):S3–40. DOI: 10.1086/503164
Siegel J, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection
Control Practices Advisory Committee. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare
settings 2007 [cited 2007 Dec 31]. Available from http://www.cdc.
gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf
Chan-Yeung M. Severe acute respiratory syndrome (SARS) and
healthcare workers. Int J Occup Environ Health. 2004;10:421–7.
Lau JTF, Fung KS, Wong TW, Kim JH, Wong E, Chung S, et al.
SARS transmission among hospital workers in Hong Kong. Emerg
Infect Dis [serial online] 2003 Feb [cited 2007 Dec]. Available from
http://www.cdc.gov/ncidod/EID/vol10no2/03-0534.htm
Centers for Disease Control and Prevention. Sequence for donning
and removing personal protective equipment (ppe). 2004 [cited 2007
Jan 21]. Available from http://www.cdc.gov/ncidod/sars/ic.htm
American Society for Testing and Materials. Standard test method
for evaluation of health care professional handwash formulation
(method e 1174–94). West Conshohocken (PA): The Society; 1994.
Environmental Protection Agency. Method 1601: male-specific
(F+) and somatic coliphage in water by two-step enrichment procedure. 2001 [cited 2008 Jan 17]. Available from http://www.epa.gov/
nerlcwww/1601ap01.pdf
Respiratory Protection. 29 C.ER § 1910.134 (1998) [cited 2008
Jan 6]. Available from http://www.osha.gov/pls/oshaweb/owadisp.
show_document?p_table=STANDARDS&p_id=12716
Bean B, Moore BM, Sterner B, Peterson LR, Gerding DN, Balfour
HH Jr. Survival of influenza viruses on environmental surfaces. J
Infect Dis. 1982;146:47–51.
Rabenau HF, Cinatl J, Morgenstern B, Bauer G, Preiser W, Doerr
HW. Stability and inactivation of SARS coronavirus. Med Microbiol
Immunol. 2005;194:1–6. DOI: 10.1007/s00430-004-0219-0
Gwaltney JM Jr, Hendley JO. Transmission of experimental rhinovirus infection by contaminated surfaces. Am J Epidemiol.
1982;116:828–33.
Gwaltney JM, Moskalski PB, Hendley JO. Hand-to-hand transmission of rhinovirus colds. Ann Intern Med. 1978;88:463–7.
Pittet D. Improving adherence to hand hygiene practice: a multidisciplinary approach. Emerg Infect Dis. 2001;7:234–40.
Doebbeling BN, Pfaller MA, Houston AK, Wenzel RP. Removal of
nosocomial pathogens from the contaminated glove. Implications for
glove reuse and handwashing. Ann Intern Med. 1988;109:394–8.
Address for correspondence: Mark Sobsey, Environmental Sciences
and Engineering; CB# 7431 McGavran-Greenberg, University of North
Carolina, Chapel Hill, NC 27599, USA; email: sobsey@email.unc.edu
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 8, August 2008
1293
�
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PDF of the article: Virus Transfer from Personal Protective Equipment to Healthcare Employees’ Skin and Clothing
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
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<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
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<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
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</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
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Publication
A peer reviewed publication.
Citation
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Casanova, L., Alfano-Sobsey, E., Rutala, W. A., Weber, D. J., & Sobsey, M. 2008. Virus transfer from personal protective equipment to healthcare employees' skin and clothing. <em>Emerging infectious diseases</em>, 14(8), 1291-3.
Abstract
We evaluated a personal protective equipment removal protocol designed to minimize wearer contamination with pathogens. Following this protocol often resulted in virus transfer to hands and clothing. An altered protocol or other measures are needed to prevent healthcare worker contamination.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online
URL
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600382/
Read Online
Online location of the resource.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600382/
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Title
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Virus Transfer from Personal Protective Equipment to Healthcare Employees’ Skin and Clothing
Subject
The topic of the resource
Infection Control
Description
An account of the resource
We evaluated a personal protective equipment removal protocol designed to minimize wearer contamination with pathogens.
Creator
An entity primarily responsible for making the resource
Lisa Casanova, Edie Alfano-Sobsey, William A. Rutala, David J. Weber, and Mark Sobsey.
Date
A point or period of time associated with an event in the lifecycle of the resource
2008-08
Type
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Publication
Contributor
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2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Occupational Exposure
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
-
https://repository.netecweb.org/files/original/4c3efe7a866f4b425ee894305ff8e516.pdf
fcbe00dddb50c1f35b1bdbd718f240da
PDF Text
Text
Comment retirer des gants
Afin de vous protéger, suivez ces étapes pour retirer des gants
1
2
Saisissez l’extérieur du gant au niveau du poignet.
Ne touchez pas votre peau nue.
3
Tirez sur le gant pour l’enlever,
de façon à le tourner à l’envers.
4
Tenez le gant que vous venez de retirer dans
votre main gantée.
5
Retirez le deuxième gant en glissant vos doigts à
l’intérieur du gant, en haut de votre poignet.
6
Retournez le deuxième gant à l’envers en le tirant
pour l’enlever de votre main, tout en laissant le
premier gant à l’intérieur du deuxième.
Jetez les gants de manière sécurisée.
Ne réutilisez pas les gants.
7
Lavez-vous les mains immédiatement
après avoir retiré les gants.
Adapté de la Commission de l’indemnisation des travailleurs (Worker’s Compensation Board) de Colombie-Britannique, Canada.
CS 295668-A French
�
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Comment retirer des gants
Guide
Document providing operation or response information, general guidance documents.
URL
https://www.cdc.gov/vhf/ebola/resources/posters.html
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Comment retirer des gants
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Contenu Français
Description
An account of the resource
CDC poster in French: Comment retirer des gants, Afin de vous protéger, suivez ces étapes pour retirer des gants.
Creator
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CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-08-27
Contributor
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2022-01-19 by Beth Beam
Coverage
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2025-01-19
Doffing
Donning and Doffing
Français
French
Gloves
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/851535e52c508d4104cebdc6c95bd715.pdf
e1a89d08b6774981fbcfe3f970d0b03b
PDF Text
Text
How to Remove Gloves
To protect yourself, use the following steps to take off gloves
1
2
Grasp the outside of one glove at the wrist.
Do not touch your bare skin.
3
Peel the glove away from your body,
pulling it inside out.
4
Hold the glove you just removed in
your gloved hand.
5
Peel off the second glove by putting your fingers
inside the glove at the top of your wrist.
6
Turn the second glove inside out while pulling
it away from your body, leaving the first glove
inside the second.
Dispose of the gloves safely. Do not reuse the gloves.
7
Clean your hands immediately after removing gloves.
Adapted from Workers’ Compensation Board of B.C.
CS 254759-A
�
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How to Remove Gloves Safely
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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How to Remove Gloves Safely
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Infection Control
Description
An account of the resource
CDC Communication Resources, Poster on how to remove gloves safely: To protect yourself, use the following steps to take off gloves.
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CDC
Date
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2018-08-27
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2022-01-19 by Beth Beam
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2025-01-19
Doffing
Gloves
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-PPE
-
Online Course
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Duration
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Self-paced
Objectives
<strong>Aperçu</strong>: Cette formation complète de niveau intermédiaire est destinée aux agents de santé de première ligne qui s’occupent de cas suspects ou confirmés de maladie à virus Ebola (MVE). Elle porte sur les domaines suivants : transmission de la MVE (en s’intéressant en particulier aux mesures de lutte contre l’infection) ; diagnostic de la maladie ; et prise en charge des cas, avec une présentation générale des centres de traitement d’Ebola (CTE) et des informations sur les traitements expérimentaux. Ces modules présentent des stratégies complètes sur la sécurité des patients et des agents de soins et la préparation à la riposte. La formation pourra être utile aux cliniciens de tout secteur du système de santé, notamment ceux qui travaillent dans des postes de santé, prodiguent des soins de santé primaires ou sont employés par des hôpitaux nationaux ou de district. Une attention particulière est accordée aux soins dispensés dans les CTE (WHO).
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Ebola: Prise en charge clinique des cas d'Ebola
Subject
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Contenu Français
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Online course created by the WHO. This course is also available in <a href="https://repository.netecweb.org/items/show/285">English</a>.
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2018
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2022-01-19 by Beth Beam
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Clinical Care Guidelines
Critical Care
Ebola
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French
Infection Prevention and Control
Patient Care
Personal Protective Equipment (PPE)
R-PPE
Therapeutics
-
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Krein, S. L., J. Mayer, M. Harrod and et al. (2018). "Identification and characterization of failures in infectious agent transmission precaution practices in hospitals: A qualitative study." JAMA Internal Medicine 178(8): 1051-1057.
Abstract
Importance: Using personal protective equipment (PPE) and transmission-based precautions are primary strategies for reducing the transmission of infectious agents. Objective: To identify and characterize failures in transmission-based precautions, including PPE use, by health care personnel that could result in self-contamination or transmission during routine, everyday hospital care. Design, Setting, and Participants: This qualitative study involved direct observation inside and outside patient rooms on clinical units from March 1, 2016, to November 30, 2016. Observations occurred in the medical and/or surgical units and intensive care units at an academic medical center and a Veterans Affairs hospital, as well as the emergency department of the university hospital. Trained observers recorded extensive field notes while personnel provided care for patients in precautions for a pathogen transmitted through contact (eg, Clostridium difficile, methicillin-resistant Staphylococcus aureus) or respiratory droplet (eg, influenza). Specific occurrences involving potential personnel self-contamination were identified through a directed content analysis. These occurrences were further categorized, using a human factors model of human error, as active failures, such as violations, mistakes, or slips. Main Outcomes and Measures: Number and type of failures involving use of transmission-based precautions.Results In total, 325 room observations were conducted at 2 sites. At site 1, a total of 280 observations were completed (196 in medical/surgical units, 64 in intensive care units, and 20 in emergency departments). At site 2, there were 45 observations (36 in medical/surgical units and 9 in the intensive care unit). Of the total observations, 259 (79.7%) occurred outside and 66 (20.3%) inside the room. Two hundred eighty-three failures were observed, including 102 violations (deviations from safe operating practices or procedures), 144 process or procedural mistakes (failures of intention), and 37 slips (failures of execution). Violations involved entering rooms without some or all recommended PPE. Mistakes were frequently observed during PPE removal and encounters with challenging logistical situations, such as badge-enforced computer logins. Slips included touching one’s face or clean areas with contaminated gloves or gowns. Each of these active failures has a substantial likelihood of resulting in self-contamination. The circumstances surrounding failures in precaution practices, however, varied not only across but within the different failure types.Conclusions and Relevance Active failures in PPE use and transmission-based precautions, potentially leading to self-contamination, were commonly observed. The factors that contributed to these failures varied widely, suggesting the need for a range of strategies to reduce potential transmission risk during routine hospital care.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Pay online.
URL
https://www.ncbi.nlm.nih.gov/pubmed/29889934
Read Online
Online location of the resource.
http://dx.doi.org/10.1001/jamainternmed.2018.1898
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Identification and Characterization of Failures in Infectious Agent Transmission Precaution Practices in Hospitals
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Using personal protective equipment (PPE) and transmission-based precautions are primary strategies for reducing the transmission of infectious agents.
Creator
An entity primarily responsible for making the resource
Sarah L. Krein, PhD, RN; Jeanmarie Mayer, MD; Molly Harrod, PhD; Lauren E. Weston, MPH; Lynn Gregory, NP; Laura Petersen, MHSA; Matthew H. Samore, MD; Frank A. Drews, PhD
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-08-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Contact Transmission
Donning and Doffing
Droplet Transmission
Infection Prevention and Control
Occupational Exposure
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
Staff Support
Staffing
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
In Person Course
Document relating to an in person course.
URL
https://cdn.who.int/media/docs/default-source/ebola/introduction-to-ebola-disease.pdf?sfvrsn=26c6c127_1
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Introduction to Ebola Disease: Managing Infectious Hazards
Creator
An entity primarily responsible for making the resource
WHO
Subject
The topic of the resource
General
Description
An account of the resource
WHO Ebola disease course slides, description of the virus and infection prevention and control
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-09
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Communications
Decontamination
Donning and Doffing
Ebola
Emergency Department
Emergency Management
Identify
Infection Prevention and Control
Inform
International Response
Isolate
Isolation/Biocontainment
Lab
Laboratory
Patient Care
Patient Transport
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
Pre-hospital Transport
Public Health
R-PPE
Special Pathogens
Training
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Online Course
Access portal to an online course.
URL
https://openwho.org/courses/ebola-clinical-management
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Approximately 6 hours.
Access
Description of access information (e.g. itunes).
Free with free OpenWHO account.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Ebola: Clinical management of Ebola virus disease
Creator
An entity primarily responsible for making the resource
WHO
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
This comprehensive intermediate level course is for clinicians caring for patients with suspected or confirmed Ebola virus disease (EVD). Modules provide information on screening and triage, infection prevention and control, laboratory diagnostics, organization of the Ebola Treatment Centre (ETC), clinical care of patients in the ETC, and investigational therapeutic agents. (WHO)
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-07-05
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Clinical Care Guidelines
Critical Care
Ebola
Infection Prevention and Control
Patient Care
Personal Protective Equipment (PPE)
R-PPE
R-T&C
Therapeutics
-
https://repository.netecweb.org/files/original/cd54427e289b74108a6db4e1f37d5b65.pdf
f6bc92c7dcb42167ccc19ba206afd678
PDF Text
Text
PROCEDURE TITLE: Personal Protective Equipment in the SCDU
APPLICABLE FACILITIES: (check all that apply)
□EUH □EUOSH □EWWH □EUHM □EJCH
EFFECTIVE DATE:
□ESJH
□TEC
□ESA
□ERH
ORIGINATION DATE:
SCOPE: The SCDU follows a defined set of protocols for Staff working within the Unit. Because the
SCDU must be prepared for a wide range of infectious agents, plans exist to respond as appropriate
based on the agent and clinical presentation of the patient. Consideration must be given to
appropriate safe transport into and out the Unit, as well as the safe delivery of care for patients while
in the Unit.
PURPOSE: To establish procedures for donning and doffing Personal Protective Equipment (PPE) in
a safe manner, in order to prevent the spread of serious communicable diseases.
PROCEDURE:
There are general requirements for PPE that are dependent with the type of pathogen. It is important
to recognize these general requirements to help ensure the selection and maintenance of optimal
protection.
For consideration with Coronaviruses and Novel Influenzas:
Staff outside
patient room
(nurse station/
resource nurse)
Asymptomatic,
exposed to
pathogen
(Symptoms: fever,
chills, body aches,
cough, dyspnea)
Staff assisting
with waste
management
(SCDU Only)
•
Standard
precautions
PROCEDURE/GUIDELINE TITLE
•
•
•
•
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
EVS staff
managing waste
•
•
•
•
•
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
Patient room
staff (RN/MD)
Anteroom
staff/Buddy
•
•
•
•
•
PAPR
Coverall
Apron
Double
gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
EVD Diagnostic Lab
Staff
(SCDU Only)
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
1 of 7 v.1
�•
Symptomatic,
exposed to
pathogen
Standard
precautions
•
•
•
•
•
Symptomatic,
confirmed
De-escalation
when no longer
contagious–to be
determined
Standard
precautions
•
•
•
•
Standard
precautions
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
•
•
•
•
•
•
•
•
Standard
precautions
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
•
•
•
•
•
•
•
•
•
PAPR
Coverall
Apron
Double
gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
PAPR
Coverall
Apron
Double
gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
Standard
precautions
Standard
precautions
Standard
precautions
EVS staff
managing waste
Anteroom
staff/Buddy
Patient room staff
(RN/MD)
Should be
vaccinated
Should be
vaccinated
Should be
vaccinated
Should be vaccinated
Standard precautions
For consideration with Smallpox:
Staff outside
patient room
(nurse station/
resource nurse)
Staff assisting
with waste
management
(SCDU Only)
Should be
vaccinated
Should be
vaccinated
Asymptomatic,
exposed to
Smallpox
(Symptoms: fever,
body aches, nausea,
vomiting, sore throat,
rash starting in
mouth)
•
Standard
precautions
•
•
•
•
•
Symptomatic,
exposed to
Smallpox
Standard
precautions
PROCEDURE/GUIDELINE TITLE
•
•
•
•
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
•
•
•
•
•
•
•
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
•
•
•
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
•
•
•
•
•
EVD Diagnostic Lab
Staff
(SCDU Only)
PAPR
Coverall
Apron
Double
gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
PAPR
Coverall
Apron
Double
gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
2 of 7 v.1
�•
Symptomatic,
confirmed
Smallpox
All scabs have
fallen off
Standard
precautions
•
•
•
•
Standard
precautions
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
•
•
•
•
Standard
precautions
Impervious
gown or
coverall
Booties
N95 mask
Face shield
Double gloves
•
•
•
•
•
Standard
precautions
PAPR
Coverall
Apron
Double
gloves
Booties
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
Standard
precautions
Standard precautions
Anteroom
staff/Buddy
Patient room staff
(RN/MD/NT/
Phlebotomist)
•
•
•
•
•
PAPR
Coverall
Apron
Double gloves
Booties
Standard precautions
(typically 3 weeks)
For consideration with Viral Hemorrhagic Fevers:
Staff assisting
with waste
management
Staff outside
patient room
(nurse station/
resource nurse)
EVS staff
managing waste
Standard
precautions
Standard
precautions
•
Suspected—
symptomatic
(SCDU staff will
handle the waste
stream and room
decontamination)
Standard
precautions
•
•
•
•
Positive—
asymptomatic
(SCDU staff will
handle the waste
stream and room
decontamination)
Standard
precautions
•
•
•
•
•
PROCEDURE/GUIDELINE TITLE
(SCDU Only)
(SCDU Only)
•
Suspected—
asymptomatic
EVD Diagnostic Lab
Staff
Impervious
gown
Booties
Surgical mask
Face shield
(goggles if
face shield is
not available)
Double gloves
Coverall
Apron
Surgical mask
Face shield
(goggles if
face shield is
not available)
Double gloves
Standard
precautions
Standard
precautions
•
•
•
•
•
•
•
•
•
•
Coverall
Apron
Surgical mask
Face shield
(goggles if face
shield is not
available)
Double gloves
Coverall
Apron
Surgical mask
Face shield
(goggles if face
shield is not
available)
Double gloves
n/a
•
•
•
•
•
Coverall
Apron
Booties
Double
gloves
Face shield
(goggles if
face shield is
Impervious
gown
•
Booties
•
Surgical mask
•
Double gloves
•
Impervious
gown
•
Impervious hair
cover
•
Booties
•
Surgical mask
•
Face shield
(goggles if face
shield is not
available)
•
Double gloves
*See Reference
below
•
Coverall
•
Apron
•
Booties
•
Double gloves
•
Face shield
(goggles if face
shield is not
available)
•
•
•
•
Coverall
Double gloves
Booties
PAPR Hood
•
•
•
•
Coverall
Double gloves
Booties
PAPR Hood
•
•
•
•
Coverall
Double gloves
Booties
PAPR Hood
3 of 7 v.1
�not
available)
Positive—
asymptomatic
(SCDU staff will
handle the waste
stream and room
decontamination)
Positive—
symptomatic
(SCDU staff will
handle the waste
stream and room
decontamination)
Standard
precautions
•
•
•
•
•
Standard
precautions
•
•
•
•
•
Coverall
Apron
Surgical mask
Face shield
(goggles if
face shield is
not available)
Double gloves
Coverall
Apron
Surgical mask
Face shield
(goggles if
face shield is
not available)
Double gloves
•
•
•
•
•
•
•
•
•
•
Coverall
Apron
Surgical mask
Face shield
(goggles if face
shield is not
available)
Double gloves
Coverall
Apron
Surgical mask
Face shield
(goggles if face
shield is not
available)
Double gloves
•
•
•
•
•
•
•
•
•
Coverall
Apron
Booties
Double
gloves
Face shield
(goggles if
face shield is
not
available)
Coverall
Double
gloves
Booties
For waste
management
—apron and
PAPR Hood
•
Surgical mask
•
•
•
•
•
•
Coverall
Apron
Booties
Double gloves
Face shield
(goggles if face
shield is not
available)
Surgical mask
•
•
•
•
•
Coverall
Double gloves
Booties
Apron
PAPR Hood
•
•
•
•
Coverall
Double gloves
Booties
PAPR Hood
•
•
•
•
•
Coverall
Double gloves
Booties
Apron
PAPR Hood
Donning and Doffing PAPR-Level PPE in the SCDU
Entering the SCDU
1.
Complete Check-in Form (temperature).
2.
Sign in outside anteroom.
3.
Check gauges.
4.
Check signs.
5.
Enter anteroom.
Donning SCDU PPE for Anteroom (not immediately entering patient room)
1.
Enter locker room.
2.
Remove jewelry (preferably leave jewelry at home).
3.
Remove clothing and shoes and place in locker.
4.
Don disposable scrubs, socks and shoes dedicated to unit.
5.
Enter anteroom.
6.
Don belt and battery.
7.
Check motor.
8.
Put motor in the PAPR Hood and set aside.
9.
Don biohazard coverall.
10.
Don inner gloves and tape to biohazard coverall.
11.
Don outer gloves.
12.
Don booties.
13.
Sanitize gloves.
14.
Put apron aside.
PROCEDURE/GUIDELINE TITLE
4 of 7 v.1
�Donning SCDU PPE for Patient Room
1.
After entering anteroom:
2.
Enter Locker Room.
3.
Remove jewelry.
4.
Remove clothing and shoes and place in locker.
5.
Don disposable scrubs, socks and shoes dedicated to unit
6.
Re-enter anteroom.
7.
Don belt and battery.
8.
Check motor.
9.
Put motor in the PAPR Hood and set aside.
10.
Don biohazard coverall.
11.
Don inner gloves and tape to biohazard.
12.
Don outer gloves.
13.
Don booties.
14.
Sanitize gloves.
15.
Plug in PAPR Hood, put on apron and PAPR Hood.
16.
Zip up and tie up PAPR Hood and apron.
17.
Check gauges and signs.
18.
Enter patient’s room.
Doffing SCDU PPE for Patient Room
1.
Ensure qualified individual is in place to monitor doffing protocol.
2.
Remove apron.
3.
Remove one bootie, then step onto chemical mat*; repeat with second bootie.
4.
Sanitize gloves.
5.
Remove outer gloves (beaking method).
6.
Sanitize inner gloves.
7.
Remove tape.
8.
Sanitize inner gloves.
9.
Remove biohazard coverall.
10.
Sanitize inner gloves.
11.
Enter anteroom (anteroom staff should be donned in face shield).
12.
Remove PAPR Hood.
13.
Sanitize inner gloves.
14.
Remove inner gloves (beaking method).
15.
Wash hands with soap and water.
16.
Remove belt, battery and motor.
17.
Enter locker room.
18.
Remove and dispose of disposable scrubs and socks.
19.
Shower for 5 minutes, shampooing hair.
20.
Don clothes.
21.
Enter anteroom.
22.
Exit anteroom.
Donning and Doffing High-Level PPE in the SCDU
Donning High-Level PPE
PROCEDURE/GUIDELINE TITLE
5 of 7 v.1
�1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Change into hospital scrubs.
Remove jewelry.
Enter clean corridor.
Don inner gloves.
Don impervious gown.
Don outer gloves.
Don booties.
Sanitize gloves.
Check gauges and signs.
Enter anteroom.
Sanitize gloves.
Don face shield.
Enter patient room.
High-Level PPE Doffing
1.
Remove booties (stepping on mat*).
2.
Sanitize gloves.
3.
Remove outer gloves.
4.
Sanitize gloves.
5.
Remove gown.
6.
Sanitize gloves.
7.
Remove face shield.
8.
Sanitize gloves.
9.
Enter anteroom.
10.
Remove gloves.
11.
Wash hands thoroughly.
12.
Enter clean corridor.
13.
Change out of hospital scrubs
Opening Doors and Changing Gloves in the SCDU
Prior to Opening Any Door:
1.
Sanitize gloves.
Changing Gloves:
1.
Sanitize gloves.
2.
Remove outer gloves (beaking method).
3.
Sanitize inner gloves.
4.
Don outer gloves.
RELATED DOCUMENT(S)/LINK(S):
PROCEDURE/GUIDELINE TITLE
6 of 7 v.1
�8838_SCDU Doffing 8839_SCDU Doffing 8840_SCDU Doffing 8841_SCDU Doffing 8842_SCDU Doffing 8843_CDU Donning
High Level PPE from High
patient
Level
room.docx
PPE from PAPR
Patient
PPE
Room
frominpatient
Anteroom.docx
PAPR
room.docx
PPE from Patient
PPERoom
fromin
patient
Anteroom.docx
room
High
in locker
Level PPE
room.docx
for patient room.docx
8855_SCDU AP 4Cleaning Supply List.docx
8844_SCDU
8845_SCDU
8846_SCDU
PPE and
Donning in locker room.docx
Donning PAPR PPE for
Donning
patientPPE
room.docx
from hall.docx
DEFINITIONS: (If applicable)
REFERENCES AND SOURCES OF EVIDENCE:
KEY WORDS:
REVIEW/APPROVAL SUMMARY:
APPROVAL BODY/BODIES:
REVIEW/REVISION DATES: 02/09/18
PROCEDURE/GUIDELINE TITLE
APPROVAL DATE:
7 of 7 v.1
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 1
https://repository.netecweb.org/files/original/0e037d1a525b5c251a3ba66f3d23c9fc.pdf
e3e3dc7cce10ad77281282bda724d474
PDF Text
Text
8838
DOFFING HIGH LEVEL PPE
PATIENT ROOM
1. Approach red line
2. Remove one bootie then step onto chemical
mat; repeat with second bootie
3. Sanitize gloves
4. Remove outer gloves (beaking method)
5. Sanitize inner gloves
6. Remove gown/coverall
7. Sanitize inner gloves
8. Enter anteroom
Updated 3/13/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 2
https://repository.netecweb.org/files/original/1694e3536da5f3fdec12b7e5148865dd.pdf
240da483a6b595aa36ed81ac33051790
PDF Text
Text
8839
DOFFING HIGH LEVEL PPE
ANTEROOM
1. Enter anteroom—anteroom nurse should be
wearing face shield.
2. Remove hair cover
3. Sanitize inner gloves
4. Remove face shield
5. Sanitize inner gloves
6. Remove facemask
7. Sanitize gloves
8. Remove inner gloves (beaking method)
9. Wash hands with soap and water
10. Enter locker room
Updated 3/13/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 3
https://repository.netecweb.org/files/original/14de37fcd7c920bd7013b4aef74b8c89.pdf
88566c9b6ca05942c066e19dd429f4c3
PDF Text
Text
8840
DOFFING PAPR PPE
PATIENT ROOM
1. Approach red space
2. Remove apron
3. Remove one bootie then step onto chemical
mat; repeat with second bootie
4. Sanitize gloves
5. Remove outer gloves (beaking method)
6. Sanitize inner gloves
7. Remove tape
8. Sanitize inner gloves
9. Remove coverall
10. Sanitize inner gloves
11. Enter anteroom
Updated 3/13/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 4
https://repository.netecweb.org/files/original/06a3465294fddd9a753f9280c99afd99.pdf
15c848b06cc1cf02ee05c40ce6ab6839
PDF Text
Text
8841
DOFFING PAPR PPE
ANTEROOM
1. Enter anteroom—anteroom nurse should be
wearing face shield.
2. Remove hood
3. Sanitize inner gloves
4. Remove inner gloves (beaking method)
5. Wash hands with soap and water
6. Remove belt, battery, and motor
7. Enter locker room
Updated 3/13/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 5
https://repository.netecweb.org/files/original/c7a3008a6849c71f8ad4db267ec36d15.pdf
f9cb0e84149f6b690c5fbdddf9318e4d
PDF Text
Text
8842
DOFFING PPE FROM PATIENT ROOM
LOCKER ROOM
1. Enter locker room
2. Remove shoes, clean shoes with bleach wipes,
and return shoes to slot
3. Remove and dispose of disposable scrubs and
socks
4. Shower for 5 minutes, shampooing hair
5. Don clothes
6. Enter anteroom
7. Exit anteroom
Updated 3/10/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 6
https://repository.netecweb.org/files/original/9432eb0e40cc6ed2534fec1095989895.pdf
3f8fbc64246b807d647d23d935981b17
PDF Text
Text
8843
DONNING HIGH-LEVEL PPE
ANTEROOM
1.
Don inner gloves
2.
Don gown/coverall and create thumbhole
3.
Don outer gloves
4.
Don booties
5.
Sanitize hands
6.
Don surgical mask
7.
Don face shield
8.
Don impervious hair cover
9.
Check gauges
10.
Check signs
11.
Enter patient’s room
Updated 3/13/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 7
https://repository.netecweb.org/files/original/2efca9760a26a669f3f949d193d511ac.pdf
09af008548fa60207adead4384df6d23
PDF Text
Text
8844
DONNING PPE
LOCKER ROOM
1. Enter locker room
2. Remove jewelry
3. Remove clothing and place in locker
4. Don disposable scrubs and socks
5. Don shoes dedicated to unit
6. Enter anteroom
Updated 3/10/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 8
https://repository.netecweb.org/files/original/ca01c74b2cf2214d2317c0cd6457e1b0.pdf
ba7a25bd2b66bb833fd32400b982a1c7
PDF Text
Text
8845
DONNING PAPR-LEVEL PPE
ANTEROOM
1.
Don inner gloves
2.
Don belt and battery
3.
Check motor and size helmet
4.
Put motor in the hood and set aside
5.
Don coverall
6.
Tape first pair of gloves to coverall
7.
Don outer gloves
8.
Don booties
9.
Sanitize hands
10.
Plug in
11.
Put on hood
12.
Zip up
13.
Tie up hood
14.
Put on apron
15.
Check gauges
16.
Check signs
17.
Enter patient’s room
Updated 3/13/2016
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 9
https://repository.netecweb.org/files/original/705f1c6d18d97886973268c89f2a0462.pdf
1a98fcf72e508a00d41b8e7d9aafd22f
PDF Text
Text
8846
DONNING PPE
CLEAN CORRIDOR
1. Sign in
2. Enter anteroom
3. Enter locker room
Updated 3/10/2016
�
Dublin Core
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Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 10
https://repository.netecweb.org/files/original/ded9ba8041e9cf52737a57e50efc0702.pdf
f836c63294947a0fdcd7c290b56d1a54
PDF Text
Text
8855
PPE and Cleaning Supply List
High Level PPE
Step Down PPE
Cleaning Supplies
Item Description
Item Description
Item Description
HOOD MEDICAL FILTER DISP
GOWN BIOHAZARD PE COATED
DISINFECTING DETERGENT 4X 1GAL
BAG AUTOCLAVE BIOHAZ ORANGE 38X47
GOWN DISP IMP YELLOW FULL COV
SANI-CLOTH AF3
CLOSURE ELASTIC AUTOCLAVE BAG
GOWN SURGICAL XL ASTOUND W/TOWEL
SANI-CLOTH XLG 8X14 PURPLE TOP
COVERALL APT WHITE MD
MASK FLUIDSHIELD
BLEACH WIPES
COVERALL APT WHITE LG
BAG AUTOCLAVE BIOHAZ ORANGE 38X47
SANITIZER HAND FOAM 535ML PURELL
COVERALL APT WHITE XL
CLOSURE ELASTIC AUTOCLAVE BAG
ABSORBENT 21GR
COVERALL APT WHITE 2XL
COVER BOOT PROSHIELD
UNDERPAD XSTRENGTH 30X36
COVERALL APT WHITE 3XL
GLOVE NITRILE CHEMO EXT CUFF SM
APRON PLASTIC DISP 30 X 44IN
GLOVE NITRILE CHEMO EXT CUFF MD
SCRUB PANTS MED DISP
GLOVE NITRILE CHEMO EXT CUFF LG
SCRUB PANTS LG DISP
GLOVE NITRILE CHEMO EXT CUFF XL
SCRUB PANTS XLG DISP
GLOVE EXAM NITRILE CHEMO BLUE XLG
SCRUB PANTS 2XL DISP
GLOVE EXAM NITRILE ETS PF XL
SCRUB PANTS 3XL DISPOSABLE
SCRUB SHIRT MED DISP
SCRUB SHIRT LG DISP
SCRUB SHIRT XLG DISP
SCRUB SHIRT 2XL DISP
SCRUB SHIRT 3XL DISPOSABLE
SANITARY MESH BRIEF
SANITARY MESH BRIEF XXL PK/2
COVER BOOT PROSHIELD
GLOVE NITRILE CHEMO EXT CUFF SM
GLOVE NITRILE CHEMO EXT CUFF MD
GLOVE NITRILE CHEMO EXT CUFF LG
GLOVE NITRILE CHEMO EXT CUFF XL
GLOVE EXAM NITRILE CHEMO BLUE XLG
GLOVE EXAM NITRILE ETS PF XL
TAPE MASKING 2IN
SLIPPER TERRY TREAD XXLG
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####) part 11
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
Dublin Core
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Title
A name given to the resource
PROCEDURE-Personal Protective Equipment in the SCDU (####)
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Resources - National Ebola Training and Education Center - Emory Protocols
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-02-09
Contributor
An entity responsible for making contributions to the resource
2022-02-04 by Jill Morgan PPE group general asset - Emory - Archive
2022-11-16 by Jill/Britton - on SPORSA mark active
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-11-16
Relation
A related resource
Y - PPE pos 101 qualtrics 321; PPE pos 102 qualtrics 322
Y - D0.1PPE/D0.2PPE Qualtrics # 321
Y - D0.1PPE/D0.2PPE Qualtrics # 322
Infection Prevention and Control
Occupational Exposure
Occupational Health
Personal Protective Equipment (PPE)
R-PPE
Standard Operating Procedure (SOP)
-
https://repository.netecweb.org/files/original/a64838abc50ffa61664848e8b366e791.pdf
5fcd3b40077e60a4c50575b5d1107a86
PDF Text
Text
PROCEDURE TITLE: Management of Defective Personal Protective Equipment While in the
SCDU
APPLICABLE FACILITIES: (Check all that apply)
☐EUH ☐EUOSH ☐EWWH ☐EUHM
EFFECTIVE DATE: Click here to enter a date.
☐EJCH ☐ESJH ☐TEC ☐ESA ☐ERH
ORIGINATION DATE: Click here to enter a date.
SCOPE: The SCDU follows a defined set of protocols for Staff working within the Unit. Because the
SCDU must be prepared for a wide range of infectious agents, plans exist to respond as appropriate,
based on the agent and clinical presentation of the patient. Consideration must be given to
appropriate safe transition into and out of the Unit, as well as the safe delivery of care for staff and
patients while in the Unit.
PURPOSE: To establish the process for managing defective personal protective equipment while in
the Serious Communicable Disease Unit. Examples of breaches include visible contamination of the
MaxAir Powered Air Purifying Respirator (PAPR) filter and/or hood, tears in any personal protective
equipment (PPE) that expose the skin, or breakdown or discoloration in PPE.
PROCEDURE:
1. If any Serious Communicable Disease Unit personnel have a breach in personal protective
equipment while in the patient care room, the healthcare worker will immediately notify the
anteroom staff. The resource nurse should be notified immediately to don and begin role as
anteroom nurse. The anteroom nurse should be prepared to assist with patient care and doffing
of the healthcare worker in the patient’s room.
2. In the event skin is exposed during the breach, the area is immediately cleaned with disinfectant
wipes. If the area is visibly contaminated, the area should be cleaned of bodily fluids and then the
exposed skin should be cleaned vigorously with soap and water. If there are breaks in the patient
skin (scratch, bite, etc.), please see the exposure SOP.
3. If the anteroom buddy witnesses a breach in PPE, he/she will immediately notify the staff member
in the patient care area.
4. Visible Contamination of PAPR:
a. For situations where there is visible contamination of the MaxAir PAPR filter, shroud, or
hood, the staff member should immediately unplug the motor from the battery as to not
inadvertently create airborne particles within the PAPR.
b. The healthcare worker with the breach will begin the doffing process per protocol with
buddy in place, ensuring that all areas of contamination have been identified by anteroom
buddy.
c. If visible contamination is identified, the contaminant should be wiped with a hospitalapproved disinfectant wipe.
d. For contact and droplet precautions:
i. Remove apron
ii. Sanitize gloves
iii. Remove shoe covers
Management of Defective Personal Protective Equipment While in the SCDU
1 of 3
�iv. Sanitize gloves
v. Remove PAPR hood with guidance from anteroom buddy to minimize contact with
any visible contamination on the hood and dispose of per protocol
vi. Sanitize gloves
vii. Remove outer gloves
viii. Sanitize gloves
ix. Remove tape
x. Sanitize gloves
xi. Remove coverall
xii. Sanitize gloves
xiii. Ensure anteroom buddy is in full PPE then enter anteroom
xiv. Buddy will remove belt, battery, and motor and inspect healthcare worker for visible
contamination
xv. Remove inner gloves
xvi. Sanitize hands
xvii. Wash hands
xviii. Enter shower room, wipe shoes with bleach wipe, remove shoes, remove scrubs
without going over hair, and shower
xix. Buddy thoroughly cleans motor with bleach followed by belt and battery and then
repeat cleaning of motor once dry
xx. Notify SCDU physician, program director, and occupational health
e. For airborne precautions:
i. Doff per protocol—PAPR hood should remain in place until healthcare worker is out
of the patient care room because of the airborne nature of the pathogen
ii. Ensure anteroom buddy is in full PPE then enter anteroom
iii. Enter anteroom
iv. Remove PAPR hood with guidance from anteroom buddy to minimize contact with
any visible contamination on the hood and dispose of per protocol
v. Sanitize gloves
vi. Buddy will remove belt, battery, and motor and inspect healthcare worker for visible
contamination
vii. Remove inner gloves
viii. Sanitize hands
ix. Wash hands
x. Enter shower room, wipe shoes with bleach wipe, remove shoes, remove scrubs
without going over hair, and shower
xi. Buddy thoroughly cleans motor with bleach followed by belt and battery and then
repeat cleaning of motor once dry
xii. Notify SCDU physician, program director, and occupational health and complete an
employee incident report.
5. Tears or degradation of gloves
a. If tear or degradation occurs of the outer glove, sanitize gloves, doff outer gloves using
“beak method,” sanitize gloves, and don new outer gloves
b. If tear or degradation occurs with inner gloves and exposes skin:
i. While in the patient care area but not during doffing, the healthcare worker will
immediately notify the anteroom staff and begin the doffing process.
Management of Defective Personal Protective Equipment While in the SCDU
2 of 3
�1. Sanitize gloves, doff defective glove using “beak method”, don new inner
glove (may need to be passed in from anteroom) to affected hand, sanitize
gloves, don new outer glove to affected hand.
2. Doff per protocol.
3. After showering and leaving anteroom, notify SCDU physician, program
director, and occupational health and complete an employee incident report.
ii. During the doffing process, sanitize gloves, doff defective inner glove(s) using “beak
method,” don new inner gloves, and continue doffing process
6. Tear and breaches in other PPE
a. For any tears or breaches in the coverall, the healthcare worker should immediately report
the breach and begin the doffing process after ensuring the anteroom buddy is in place.
Tape should be placed over any breach to mitigate potential risks.
b. For PPE that can easily be replaced without compromising the healthcare worker, such as
shoe covers, aprons, and outer gloves, the PPE should be doffed per protocol and
replaced, sanitizing gloves between each step.
c. Notify the Notify SCDU physician and program director for any concerns about PPE.
RELATED DOCUMENT(S)/LINK(S):
•
•
PPE in the SCDU ####
Occupational Injury Management EVD Protocol (8853)
DEFINITIONS: (If applicable)
REFERENCES AND SOURCES OF EVIDENCE:
KEY WORDS: Personal Protective Equipment, Breach, tear
REVIEW/APPROVAL SUMMARY: Please select all Approving Bodies:
☐EUH MEC ☐ EUHM MEC ☐ESJH MEC ☐EJCH MEC ☐CNE Council ☐System Operations
REVIEW/REVISION DATES: 2/11/2018
Management of Defective Personal Protective Equipment While in the SCDU
APPROVAL DATE: Click here to enter a
date.
3 of 3
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Management of Defective Personal Protective Equipment While in the SCDU (####)
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PROCEDURE-Management of Defective Personal Protective Equipment While in the SCDU (####)
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Resources - National Ebola Training and Education Center - Emory Protocols
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-02-12
Contributor
An entity responsible for making contributions to the resource
2022-02-04 by Jill Morgan - PPE group general asset review - Emory - Archive
2022-11-16 - by Jill/Britton - on SPORSA mark active
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-11-16
Relation
A related resource
Y - PPE row 25 score 0
Decontamination
Infection Prevention and Control
Occupational Exposure
Occupational Health
Personal Protective Equipment (PPE)
R-PPE
Standard Operating Procedure (SOP)
-
Dublin Core
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Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Jennings, B. M., K. A. Yeager, N. R. Feistritzer, M. M. Gullatte and K. K. Martyn (2018). "Enacting high reliability principles while caring for people with Ebola Virus Disease." Am J Infect Control.
Abstract
<div>
<h4>BACKGROUND:</h4>
<p>Fear surrounds Ebola Virus Disease (EVD) because it is highly infectious. Yet members of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) had to overcome that fear when caring for patients with EVD.</p>
<h4>PURPOSE:</h4>
<p>The analysis reported here illustrates how the members of EUH's SCDU tacitly enacted high reliability (HR) principles while caring for patients with EVD.</p>
<h4>METHODS:</h4>
<p>A qualitative study was conducted to describe the experience of members of the EUH SCDU who worked with EVD patients in 2014. We completed 17 semi-structured interviews involving registered nurses, physicians, and support personnel (eg, laboratory technicians). Interview recordings were transcribed and analyzed using conventional content analysis. Exploring HR principles was not among the questions guiding this exploration, but the participants repeatedly described concepts related to HR.</p>
<h4>RESULTS:</h4>
<p>The goal of the SCDU team was to save patients' lives while protecting their own lives. Rigorous training and meeting high standards were required to make the team. The fear surrounding EVD set in motion the enactment of HR principles. HR principles served to alleviate failures or breakdowns in infection prevention and control, thus keeping patients and staff safe.</p>
<h4>CONCLUSIONS:</h4>
<p>These findings illustrate that it is possible to move HR principles from theory to practice in high-risk situations. HR principles were essential to safety and to infection prevention and control.</p>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
pay online - or through clinicalkey, or elsevier subscription
URL
https://www.ncbi.nlm.nih.gov/pubmed/29784444
Read Online
Online location of the resource.
https://www.ajicjournal.org/article/S0196-6553(18)30461-9/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Enacting high reliability principles while caring for people with Ebola Virus Disease
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Fear surrounds Ebola Virus Disease (EVD) because it is highly infectious. Yet members of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital (EUH) had to overcome that fear when caring for patients with EVD.
Creator
An entity primarily responsible for making the resource
Jennings B. M., Yeager K. A., Feistritzer N. R., Gullatte M. M., Martyn K. K.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-18
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Relation
A related resource
Y - D0.1Tx/D0.2Tx Qualtrics # 822, original #
Y - D0.1PM/D0.2PM Qualtrics # 910, original # 7
Fitness for Duty
Infection Prevention and Control
Nursing
Occupational Health
Personal Protective Equipment (PPE)
Personnel Management
R-PM
R-PPE
R-Res&Pub
Site Managers
Staff Retention
Staff Rotation Schedules
Staff Support
Staffing
Staffing Model
Trained Observer
Treatment and Care
Waste
-
https://repository.netecweb.org/files/original/cbbdf99db5ef62736b6b79200214662f.pdf
9d7ea40c89486cbc4eda7a30e7f16abb
PDF Text
Text
�PPE 101
Transmission Based Precautions From First Point of Contact
�Course Objectives
1
Recognize components of maintaining a safe work
environment
2
Differentiate safe and risky behavior when
using PPE
3
Recognize safe and risky behavior in donning and
doffing PPE in patient care scenarios
�Germs
Susceptible
Host
Reservoirs
HOLES!
Escape
Route
Form
of
Transmission
Cycle of Transmission
Cycle of Transmission
Cycle of Transmission
�Glossary Terms
Germs, PPE, Fomites, ABHR Defined
GERMS
ABHR
Contamination
Inoculation
Fomite
PPE
Will apply to any kind of virus, bacteria or fungus that can cause illness in
humans
Alcohol Based Hand Rubs
Making something unclean by contact with a polluting substance
The introduction of a pathogen into another living organism
Objects or materials that may harbor infectious material
Refers to just about everything we wear to prevent contamination or
inoculation
�Germs
Susceptible
Host
Reservoirs
Escape
Route
HOLES!
Form
of
Transmission
Cycle of Transmission
Cycle of Transmission
Cycle of Transmission
�Germs, Reservoirs and Escape Routes
Direct Spread – Their GERMS, Our Hands and Mucous Membranes
Direct inoculation occurs:
when someone coughs or
sneezes near us
Direct inoculation can also occur
over longer distances
�Cycle of Transmission
Susceptible
Host
Reservoirs
HOLES!
Escape
Route
Form
of
Transmission
Cycle of Transmission
Cycle of Transmission
Germs
�Modes of Transmission
Alarming
Amoy Gardens
Hotel Restaurant
SARS transmission through
ventilation system several
floors away
– fecal to inhaled
Norovirus from
aerosolized vomitus
- inhaled/swallowed
across a room
Zika, EVD in Semen
Presence versus transmissibility risk
�The Best PPE is Still Intact Skin
Effective barriers
In order for any PPE to be
effective it has to be intact –
we look for the holes in our
gloves, we wouldn’t put on a
ripped gown
And Likewise,
Our skin has to be INTACT
for it to be a effective barrier
�Importance of Intact Skin
There are many ways
that our skin may
NOT be intact!
�The Risk of Open Mucous Membranes
As great as intact skin is, it does have a downside
Our skin is VERY sensitive
A little piece
of hair next to
our eye
An itchy
nose
Sliding
glasses
We might touch our faces
15 times (or more) every hour!
Falling
hair
�“Cover your holes”
�Indirect Inoculation with Our Hands
Highly Sensitive and Hard to Ignore
Probably for good reason it’s hard to ignore the little tickling
sensation we get when something is too close to our eyes and
eyelashes, or touches our nose hairs.
We touch or cover our mouths with our hands when we are deep in
thought, when we yawn or cough or sneeze (yay, please!), out of
habit alone or when we are afraid we have spinach in our teeth.
In or out of PPE this is a problem when we are in someone else’s
biome.
�The Contaminations Risk We Don’t See
The Shedding of skin
Body area and the # of microorganisms shed
Saliva &
Nasal Fluid
Back
10 million/gram
100 million
1 million
Scalp
100-1000
Forehead
Hand
10,000-100,000
1-10 million
Armpit
Feet
1 million
1-20 million
Groin
Institute of Validation Technology “People in Cleanrooms: Understanding and Monitoring the Personnel Factor” Tim Sandle Dec 16 2014
�Entering the Patient Environment
”The world is covered in a fine patina of feces”
• You enter a person's biome when you enter whatever space they have
been occupying for a period of time – their home or hospital room
• Even more true in a confined space with an open toilet
• Toilets aerosolize waste and create clouds of fecal matter that slowly drift
down to room surfaces over the course of hours. The drier the air in the
room, the more likely the particles will stay suspended
Salmonella has been found in a biofilm just below the surface of toilet water 50 days after
the bowl was seeded
C. diff has been found in the air above the toilet 90 minutes after flushing
�Limits of PPE
Indirect Inoculation
Remember all those times a day we touch our faces?
We don't intend to, but by interacting with the patient and their
environment we can contaminate ourselves and our clothing
And we then carry that contamination to our mucous membranes
�What Makes PPE Necessary
Germs can be in any body fluid, on any person, flung far and wide
from many orifices, and from reservoirs like toilets
The entire patient environment can become contaminated
Our bodies are sensitive, especially around our mucous
membranes
We touch our eyes, nose and mouth more often than we realize
�Controlling Exposure
CDC – Components to Healthcare Worker Safety
Training and Administrative Controls such as Isolation Policies
Engineering Controls such as negative pressure rooms
Work Practice, Behavior
PPE for Healthcare Workers
*********************************************************
Self Identification and Isolation
�Promoting Self-Isolation
�PPE
None of us want to make patients, clients, feel like they are dirty or that we
are afraid of them. We all have seen the heartfelt letters, articles and blog
posts about not wearing gloves to enhance the real feeling of human
interaction
If your skin is intact, and if you have performed hand hygiene, there is
nothing wrong with touching people
BUT we can not pretend to know who is MRSA positive or whose hands
were not washed recently or well
DO NOT touch your mucous membranes until you have washed or sanitized your hands
�PPE
?
?
Question
?
?
If you could only choose to wear one type of PPE
what would it be?
�PPE
What we know about hand hygiene
1
Soap and water versus ABHR (besides C.Diff)
2
ABHR takes less time, kills more GERMS:
• Need to use the right amount (5-10ml)
• Areas most frequently missed – thumbs, between fingers, finger tips
3
ABHR can be used on gloved hands
4
Not effective if soiled
�PPE
Behavior in PPE - Gloves
Gloves
The most ubiquitous form of PPE everyone wears them now
Hand sanitize before donning, after doffing
Find a repeatable method to doff gloves
without contaminating yourself
Drop directly into trash - no shooting,
throwing
�PPE
Behavior in PPE - Gloves
Gloves
1. Put gloves only on clean hands
2. Wear two pair*
3. Find a method for removal that is less likely to cause self contamination
4. NEVER touch yourself with your gloved hands
5. The patient’s environment will be covered in their biome. Don’t think you can avoid contact
because you’ll “only be in there for a minute”
6. You can use ABHR on gloved hands
7. Consider the use of extended cuff gloves
8. Always perform hand hygiene after removing gloves
9. NEVER lose sight of the cuff of your glove
�PPE
Gowns
From what does an isolation gown protect you?
When do you decide what kind of gown you need?
What other methods might be used if you encounter wet
surfaces, copious fluids?
When your gown fabric is fluid resistant or impervious,
where do the fluids that are resisted go?
�PPE
Gowns
End users should decide what level of protection is needed based on
“...anticipated degree of contact with infectious material and potential for
blood and body fluid penetration”
Liquid penetration of gowns is not always visible
Body fluids, including blood, are more likely (than water) to penetrate
and carry microorganisms with them
The presence of body fluids during routine care can not
consistently be anticipated
Blogs.cdc.gov How Well Do You Think You are Protected Dr. Selcen Kilind-Balci
�Review of PPE Guidance and Products
ANSI/AAMI Standards
Critical
Zones
Level
Test Methods Used
Expected Barrier
Effectiveness
1
Impact Penetration
Minimal water resistance
2
Impact Penetration &
Hydrostatic Pressure
Low water resistance
3
Impact Penetration &
Hydrostatic Pressure
Moderate water resistance
4
ASTM F1670 Synthetic
Blood & ASTM F1671
Viral Penetration Test
Blood and viral penetration
resistance
�PPE
N95 and Surgical or Isolation Masks
�PPE
Placing a surgical or isolation mask on a coughing patient can significantly
reduce the dispersion distance
Adding easy to grab tabs onto N95 straps may decrease self-contamination
during mask removal, as does utilizing two pair of gloves
The security of the fit of an N95 mask decrease substantially during use for
routine bedside care procedures
User seal checks, which should be performed immediately before entry to
an isolation area, are not reliable for detecting even gross leakage
/
Surgical or isolation masks are primarily designed for source control –
protecting a clean environment from the wearer
Am J Infect Control 2017 Sep 1;45(9):974-978 Reliability of N95 respiratory protection before, during, and after nursing procedures J Hosp Infect. 2011 Mar;77(3):252-6 Sensitivity of the user-seal-check in
determining the fit of N95 respirators PLoS One. 2012;7(12):e50845 Exhaled air dispersion during coughing with and without wearing a surgical or N95 mask J Occup Environ Hyg. 2016 Oct 2;13(10):794-801
Assessing the efficacy of tabs on filtering facepiece respirator straps to increase proper doffing techniques while reducing contact transmission pathogens
�Behavior in PPE and HCW Safety
Change the culture
• HIV changed healthcare culture, made routine glove use accepted
•
Ebola, in its own way, has also changed healthcare culture
• Taking a comprehensive history - Travel, pets, farms and exotics,
immunizations, sick contacts
• Focus on PPE use
• PPE Competency
• Research on efficacy of PPE, materials and methods
•
Encourage patient self-isolation with signage and mask stands
�PPE
Eye Protection
Goggles
Face shields
Integrated shield on mask
Protection: Regular prescription-type wear = 83% contamination
Loupes = 50% contamination
Facemask with shield = 30% contamination
Study was done with a single position during a single orthopaedic procedure
�PPE
Eye Protection
Options
for Eye protection
Good use of
eye protection
Poor use of
eye protection
�PPE
Eye Protection – Face shields
{we have a few NETEC
photos of folks using
shield, I will look for one}
�PPE
Gown and Gloves – Doffing
When worn together, as they frequently are, the gown can be rolled up with
gloved hands
We encourage people to grab the gown at the sides, (as a less likely to be
contaminated site), and bring the sides forward, gathering or rolling in a manner
that keeps the dirty side toward the inside
Having a neck attachment that breaks away is safer than having to reach up near
face, neck, hair to untie or un-velcro
You can remove the gloves and the gown together once the interior aspect of the
gown is on the outside. Avoid touching the gown to your clothing or skin and
deposit it directly into trash
�PPE - Contact Isolation without aerosols likely
Donning sequence
Doffing sequence
�Droplet Precautions without Aerosols Likely
Donning sequence
Doffing sequence
�PPE
Patients are being educated to watch HCWs and make sure
that we are all performing hand hygiene before each first
contact.
If the HCW has already donned gloves to enter the room,
should they hand sanitize their gloves?
Remove gloves, perform hand hygiene then re-apply gloves?
Tell the patient they have already performed hand hygiene?
�Adding Eye Protection to Respiratory Protection
�Airborne Precautions
Donning sequence
Doffing sequence
�Enhanced – Enteric – C-diff – Precautions Donning
�Enhanced – Enteric – C-diff – Precautions Doffing
�Behavior in PPE – HCW Safety
7.6 million
healthcare workers in the US workforce
About half of those are RN’s or LPN’s
Somewhere between 9 - 42 HCW’s per million,
so
68 - 319
die annually from occupational infections
�Questions about N95 Respirator
Can I re-use my N95 respirator?
Re-use is defined as removing, storing and re-applying the same
respirator. It is only recommended under some pretty strict
conditions: that you protected the front of the respirator from
potential contamination by adding a face shield or that no
aerosol generating procedures, including the patient coughing,
occurred while you were in their immediate area AND that the
respirator is not wet from your own exhaled breath .*
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
�Questions About N95 Respirator
Do I need to change my N95 between patients,
if they all have the same symptoms?
If you are moving from room to room, examining or
treating many people who may have the same germ,
this is considered “extended use” of an N95, and can
be done for up to 8 hours or until the inside of the
respirator is wet or makes breathing difficult. *
https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html
�Questions About N95 Respirator
Where and when do I take OFF my N95?
Remove the respirator once you are out of the patient care environment – for
most of us this means once we have left the room and closed the door behind
us.
It can be difficult to find and grasp the straps or strings of respirator, especially
with gloved hands. You can make this easier by placing a folded over piece of
tape on the center of the straps before you put it on. That gives you a tab to
hold onto and pull to facilitate respirator removal .
�Training in PPE
JAMA Intern Med. doi:10.1001/jamainternmed.2015.4535 Published online October 12, 2015.
�Behavior in PPE – HCW Safety
Two guidelines borrowed from Fire/EMS
First
Second
Don’t Be a Victim!
Whether it’s time out of work due to illness or a
Never Event like a staff member getting Ebola,
encourage behavior that keeps staff safe.
Is the scene safe?
It is both tempting and rewarding to run into
rooms to stop a fall, an alarm, a beeping pump or to
reconnect a ventilator circuit. How can we encourage
staff to remember to protect themselves?
�Behavior in PPE - HCW Safety
Does your institution inadvertently reward dangerous behavior?
Call light timers
Alarm fatigue strategies
Awards for “selflessness”
Does leadership set a good and consistent example?
Consider evaluating current donning and doffing competency
Include glove removal, hand hygiene (ABHR and handwashing)
�Behavior in PPE - HCW Safety
Safer Behavior
• Situational awareness – what have I touched, what in this room/environment may be
contaminated, is this procedure/treatment/intervention likely to involve body fluids?
• Planning ahead – put supplies and equipment where and when they are needed
without dirtying environment, wearing two pair of gloves, placing gloves or hand
sanitizer where it can be reached safely, leave a pen in the patient care area
• Utilizing alternative barriers when fluids are or may be encountered
• Securing eyeglasses so they don’t slide
• Adding tabs to mask string/elastic
• Making sure to wash or hand sanitize before touching eyes, nose or mouth
�Hand Hygiene
• Before eating
• Before putting gloves on
• Before and after having direct
contact with a patient’s intact skin
(taking a pulse or blood pressure,
performing physical examinations,
lifting the patient in bed)
• After contact with blood, body
fluids or excretions, mucous
membranes, non-intact skin, or
wound dressings
• After contact with inanimate
objects (including medical
equipment) in the immediate
vicinity of the patient
• If hands will be moving from a
contaminated-body site to a
clean-body site during patient
care
• After glove removal
• After using a restroom
https://www.cdc.gov/handhygiene/providers/index.html
�Changes to Patient Care Environment
Safer Environments
•
•
•
•
•
•
•
•
•
Place hand sanitizer where it is visible when opening door
Place trash bins where they are needed for appropriate doffing
Have gloves and hand sanitizer within easy reach of staff performing patient care
Use chux or other physical barriers if care requires leaning against/over bed
Curtains should not come in contact with staff clothing
Toilet covers!
Rotate pumps and monitors so the displays can be seen from door or window
Pens, pens, pens!
If your staff carry phones, can they be easily disinfected?
• Do they get left OUT of room, or IN pocket?
�Behavior in PPE - Summary
What We Can Do
1. Consider adding the donning and doffing of your facilities contact PPE
ensemble to your list of annual competencies
2. Discuss safer strategies – Time Out Model
3. Model good behavior and techniques
4. Empower all levels of staff to point out breaches without reprisal
5. Assure staff that their safety and well-being is important
6. Err on the side of caution, protect until proven
��
Dublin Core
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Title
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PPE 101
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Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
In Person Course
Document relating to an in person course.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE 101
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Past in Person Course Presentation - Recognize components of maintaining a safe work environment. Differentiate safe and risky behavior when using PPE. Recognize safe and risky behavior in donning and doffing PPE in patient care scenarios.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Contributor
An entity responsible for making contributions to the resource
2023-10-17 by Darrell Ruby, T & E group, check with PPE on updates for page 29.
2023-10-27 by Jill Morgan. I think once we have new HICPAC recommendations for mask v. respirator we may need to update this, but right now, I think its still fine.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-10-17
Donning and Doffing
Personal Protective Equipment (PPE)
R-PPE
R-T&E
-
https://repository.netecweb.org/files/original/9f0d2bea6fa4f89392f7d2319426a3e0.pdf
254e9091b9add248abd5eead88190523
PDF Text
Text
�PPE 201:
Critically Thinking about PPE
�Learning Objectives
• Learners will identify and select the PPE components needed
in the care and management of wet patients with potentially
hazardous and communicable diseases such as Ebola and
other special pathogens
• Learners will develop SOP for wet PPE donning and doffing,
using appropriate equipment
• Learners will assess strengths and weakness of PPE SOP
�Snapshot of the Session
1
Introductions
2
Review of PPE guidance and products
3
Donning and doffing
4
Debrief and case studies
5
Review and conclude
�Review of PPE Guidance and Products
Considerations when selecting PPE
•
•
•
•
•
•
Disease transmission characteristics
Expert guidance
Staff safety and comfort
Supply chain and item availability
Standardization of PPE for all staff
Layout of patient care area
�Review of PPE Guidance and Products
Clinical Severity
Dry versus Wet
�Review of PPE Guidance and Products
ANSI/AAMI Standards
Critical
Zones
Level
Test Methods Used
Expected Barrier Effectiveness
1
Impact Penetration
Minimal water resistance
2
Impact Penetration &
Hydrostatic Pressure
Low water resistance
3
Impact Penetration &
Hydrostatic Pressure
Moderate water resistance
4
ASTM F1670 Synthetic Blood
& ASTM F1671 Viral
Penetration Test
Blood and viral penetration
resistance
�Review of PPE Guidance and Products
Personal Protective Equipment
Head Covers
Masks
Respirators
Eye Protection
Gloves
Gowns
Coveralls
Disposable Boots
�Review of PPE Guidance and Products
PPE Multiple Combinations
Facilities may and do differ in the types and brands of PPE used
�Group Work – Ms. A’s Scenario
Ms. A’s Scenario
Setting the scene:
• Ms. A is a 38-year-old nun who was working in a Catholic church in Baunchi, Nigeria, where she was
exposed to patients with Lassa fever. She became ill and has been diagnosed with Lassa Fever and has
been medically evacuated to your facility for treatment.
Clinical presentation:
• En route she developed high fevers, profuse watery diarrhea, and respiratory distress requiring intubation
• Upon arrival she had a temperature of 100.9°F with a BP of 112/54 mmHg and a HR of 82 bpm
• She is on mechanical ventilation (A/C mode)
Clinical management:
• She is on a propofol drip at 30 mcg/hr
• A Foley catheter is in place, and she has had approximately 50ml/hr of urine output overnight
• She has a RIJ running LR at 150ml/hr
• She continues to have large volume stool of 6 liters over the last 24 hours and 2 liters of NGT secretions
collected in the suction canister
• She is also receiving levofloxacin and doxycycline for empiric antibiotic coverage
�PPE 201
Wet Donning and Doffing
�Introduction
There are a variety of options available for personal protective equipment
(PPE). The NETEC has developed the following PPE donning and doffing
protocol based on CDC guidance for U.S. healthcare settings when
managing patient with confirmed Ebola or evaluating persons under
investigation (PUIs) for Ebola who are clinically unstable or have bleeding,
vomiting, or diarrhea.
For additional information on CDC recommendation, please visit:
https://www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html
�Wet PPE Donning - PAPR
Donning location
•
Should take place in a designated safe donning area
Before Donning, Healthcare workers donning PPE should:
•
•
•
•
Wear surgical scrubs or comfortable clothing under the PPE
Remove all personal items (e.g., jewelry, watches, cell phones, pagers,
pens)
Secure hair away from face
Secure eye glasses, if worn
�Wet PPE Donning - PAPR
1
Engage Trained Observer
2
Gather and Inspect PPE Prior to Donning
•
•
•
•
•
•
Single-use (disposable) impermeable coverall
Powered-air purifying respirator (PAPR)
A pair of single-use (disposable) gloves
A pair of single-use (disposable) extended cuff gloves
A pair of single-use (disposable) shoe covers
Single-use (disposable) apron
�Wet PPE Donning - PAPR
3
Don inner gloves
4
Don coverall
•
•
•
•
•
Perform hand hygiene prior to donning gloves
Ensure the coverall is large enough to allow unrestricted movement
Ensure cuffs of inner gloves are tucked under the sleeve of the coverall
If a PAPR with a self-contained filter and blower unit that is integrated
inside the helmet is used, the belt and battery unit must be put on before
donning the impermeable gown or coverall so that the belt and battery
unit are contained under the gown or coverall
If a PAPR with external belt-mounted blower is used, then the blower and
tubing must be on the outside of gown or coverall to ensure proper airflow
�Wet PPE Donning - PAPR
5
Don outer gloves
6
Don shoe covers
•
•
Put on the second pair of gloves (with extended cuffs)
Ensure the cuffs are pulled over the sleeves of the gown or coverall
�Wet PPE Donning - PAPR
7
Don PAPR
8
Don apron
• If a single shroud PAPR hood is used, regardless of the type of PAPR, then a
single-use hood that extends to the shoulders and fully covers the neck must
also be used. Be sure that the hood covers all of the hair and the ears, and that it
extends past the neck to the shoulders
• If the PAPR hood has a double shroud, the inner shroud should be tucked into
the gown or coverall
�Wet PPE Donning - PAPR
9
Verify
•
•
After completing the donning process, the integrity of the ensemble
should be verified (e.g., there should be no cuts or tears in the PPE)
You should be able to perform range of movement without
disturbing PPE
�Wet PPE Donning - PAPR
10
Perform hand hygiene
Enter the hot zone
�Wet PPE Doffing - PAPR
Doffing location
•
1
PPE should be doffed in the designated safe PPE doffing area. As with
all PPE doffing (even during training), care should be taken to avoid
self-contamination
Engage trained observer
�Wet PPE Doffing - PAPR
2
Inspect PPE:
•
•
•
Inspection is performed while still inside the hot zone
Inspect the PPE for visible contamination, cuts, or tears before
beginning the doffing process
If any PPE is visibly contaminated, disinfect by using an *EPA-registered
disinfectant wipe
Exit the hot zone
Enter the warm zone
�Wet PPE Doffing - PAPR
3
Disinfect Outer Gloves:
4
Doff apron and disinfect outer gloves
•
•
•
Disinfect outer gloves with either an *EPA-registered disinfectant wipe
or ABHR
Dispose of apron into the designated waste container
Disinfect outer gloves with either an *EPA-registered disinfectant wipe
or ABHR
�Wet PPE Doffing - PAPR
5
Doff shoe covers
6
Disinfect and doff outer gloves:
•
•
•
•
Dispose of shoe covers into the designated waste container
Disinfect outer gloves with either an *EPA-registered disinfectant wipe
or ABHR
Remove and discard outer gloves, taking care not to contaminate inner
gloves
Dispose of outer gloves into the designated waste container
�Wet PPE Doffing - PAPR
7
Inspect and disinfect inner gloves:
•
•
•
Inspect the inner gloves’ outer surfaces for visible contamination, cuts,
or tears
If an inner glove is visibly soiled, disinfect the glove with either an *EPAregistered disinfectant wipe or ABHR, remove the inner gloves, perform
hand hygiene with ABHR on bare hands, and don a new pair of gloves
If there is no visible contamination and no cuts or tears on the inner
gloves, then disinfect the inner-gloves with either an *EPA-registered
disinfectant wipe or ABHR
�Wet PPE Doffing - PAPR
8
Doff coverall:
• Avoid contact of scrubs with outer surface of gown or coverall during
removal
• If a PAPR with external belt-mounted blower unit is used, remove the beltmounted blower unit and place all reusable PAPR components in an area or
container designated for the collection of PAPR components for disinfection
• Pull gown or coverall away from body, touching only the inside of it to roll it
inside out
• Dispose of gown or coverall into the designated waste container
�Wet PPE Doffing - PAPR
9
Disinfect inner gloves:
10
Doff respirator
•
Disinfect inner gloves with either an *EPA-registered disinfectant wipe or
ABHR
• If a PAPR with a self-contained blower in the helmet is used:
• Remove and discard disposable hood
• Disinfect inner gloves with either an *EPA-registered disinfectant wipe or ABHR
• Remove helmet, belt, and battery unit. The healthcare worker may need help
removing the PAPR
• Place all reusable PAPR components in an area or container designated to
collect PAPR components for disinfection
• If a PAPR with external-mounted blower is used, switch off the PAPR motor, and
disconnect the tubing from the motor prior to removing the hood. The healthcare
worker my need help removing the hood with the tubing connected
�Wet PPE Doffing - PAPR
11
Disinfect and doff inner gloves:
•
•
•
12
Disinfect inner gloves hands with either an *EPA-registered disinfectant
wipe or ABHR
Remove and discard gloves, taking care not to contaminate bare hands
during removal process
Dispose of gloves into the designated waste container
Perform hand hygiene
�Wet PPE Doffing - PAPR
13
Inspect:
•
The healthcare worker should inspect their clothing and skin for
signs of contamination
Exit the warm zone
Enter the cold zone
�Wet PPE Donning Checklist - PAPR
1. Engage trained observer
2. Gather and inspect PPE prior to donning
3. Don inner gloves
4. Don coverall
5. Don outer gloves
6. Don shoe covers
7. Don PAPR
8. Don apron
9. Verify
10. Perform hand hygiene
�Wet PPE Doffing Checklist - PAPR
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Engage trained observer
Inspect PPE
Disinfect Outer Gloves
Doff apron
Doff shoe covers
Disinfect and doff outer gloves
Inspect and disinfect inner gloves
Doff coverall
Disinfect inner gloves
Doff respirator
Disinfect and doff inner gloves
Perform hand hygiene
Inspect
�Wet PPE Donning - N95
Donning location
•
Should take place in a designated safe donning area
Before Donning, Healthcare workers donning PPE should:
•
•
•
•
Wear surgical scrubs or comfortable clothing under the PPE
Remove all personal items (e.g., jewelry, watches, cell phones, pagers,
pens)
Secure hair away from face
Secure eye glasses, if worn
�Wet PPE Donning – N95
1
Engage Trained Observer
2
Gather and Inspect PPE Prior to Donning
•
•
•
•
•
•
•
•
Single-use (disposable) impermeable gown or coverall
NIOSH Certified N95 respirator
Single-use (disposable) surgical hood extending to shoulders
Single-use (disposable) face shield
A pair of single-use (disposable) gloves
A pair of single-use (disposable) extended cuff gloves
A pair of single-use (disposable) boot covers
Single-use (disposable) apron
�Wet PPE Donning – N95
3
Don boot covers
4
Don inner gloves
•
Perform hand hygiene prior to donning gloves
�Wet PPE Donning – N95
5
Don gown or coverall
6
Don N95 Respirator
•
•
•
•
Ensure it is large enough to allow unrestricted movement
Ensure the gloves are tucked under the sleeve of the gown or coverall
Wear size indicated at fit test
Perform a seal check
�Wet PPE Donning – N95
7
Don surgical hood
8
Don apron
• The hood is worn over the N95 straps
• The hood should cover all hair and extend past the neck and shoulders
• Ensure the hood completely covers the ears and neck
•
This will provide an extra layer over the front of your PPE
�Wet PPE Donning – N95
9
Don outer gloves
10
Don face shield
• Ensure the cuffs are pulled over the sleeves of the gown or coverall
• If the coverall has a knitted cuff, ensure it is completely covered
•
This goes over your N95 respirator and surgical hood
�Wet PPE Donning – N95
11
Verify
•
•
After completing the donning process, the integrity of the ensemble
should be verified (e.g., there should be no cuts or tears in the PPE)
You should be able to perform range of movement without
disturbing PPE
�Wet PPE Donning – N95
12
Perform hand hygiene
Enter the hot zone
�Wet PPE Doffing – N95
Doffing location
•
1
PPE should be doffed in the designated safe PPE doffing area. As with
all PPE doffing (even during training), care should be taken to avoid
self-contamination
Engage trained observer
�Wet PPE Doffing – N95
2
Inspect PPE
•
•
•
Inspection is performed while still inside the hot zone
Inspect the PPE for visible contamination, cuts, or tears before
beginning the doffing process
If any PPE is visibly contaminated, disinfect by using an *EPA-registered
disinfectant wipe
Exit the hot zone
Enter the warm zone
�Wet PPE Doffing – N95
3
Disinfect Outer Gloves:
4
Doff apron and disinfect outer gloves
•
•
•
Disinfect outer gloves with either an *EPA-registered disinfectant wipe
or ABHR
Dispose of apron into the designated waste container
Disinfect outer gloves with either an *EPA-registered disinfectant wipe
or ABHR
�Wet PPE Doffing – N95
5
Re-inspect PPE:
•
•
6
Inspect the PPE for visible contamination, cuts, or tears before
beginning the doffing process
If any PPE is visibly contaminated, disinfect by using an *EPAregistered disinfectant wipe
Disinfect and doff outer gloves:
•
•
•
Disinfect outer gloves with either an *EPA-registered disinfectant wipe
or ABHR
Remove and discard outer gloves, taking care not to contaminate inner
gloves
Dispose of outer gloves into the designated waste container
�Wet PPE Doffing – N95
7
Inspect and disinfect inner gloves:
•
•
•
Inspect the inner gloves’ outer surfaces for visible contamination, cuts,
or tears
If an inner glove is visibly soiled, disinfect the glove with either an *EPAregistered disinfectant wipe or ABHR, remove the inner gloves, perform
hand hygiene with ABHR on bare hands, and don a new pair of gloves
If there is no visible contamination and no cuts or tears on the inner
gloves, then disinfect the inner-gloves with either an *EPA-registered
disinfectant wipe or ABHR
�Wet PPE Doffing – N95
8
Doff face shield:
• Tilt head slightly forward and grasp the rear strap and pull the face shield gently over
your head allowing it to fall forward, then discard.
• Care must be taken not to touch your face when removing the face shield.
• Avoid touching the front surface of the face shield.
�Wet PPE Doffing – N95
9
Disinfect inner gloves:
10
Doff surgical hood:
•
Disinfect inner gloves with either an *EPA-registered disinfectant wipe or
ABHR
• Unfasten (if applicable) and gently remove, and discard.
�Wet PPE Doffing – N95
11
Disinfect inner gloves:
•
Disinfect inner gloves hands with either an *EPA-registered disinfectant
wipe or ABHR
�Wet PPE Doffing – N95
12
Remove gown or coverall:
•
•
•
Depending on gown design and location of fasteners, the healthcare worker
can untie fasteners, have the doffing assistant or “buddy” unfasten the
gown, or gently break fasteners.
Avoid contact with scrubs or disposable garments with outer surface of
gown during removal. Pull gown away from body, rolling inside out and
touching only the inside of the gown.
To remove coverall, tilt head back to reach zipper or fasteners. Unzip or
unfasten coverall completely before rolling down and turning inside out.
Avoid contact of scrubs with outer surface of coverall during removal,
touching only the inside of the coverall.
�Wet PPE Doffing – N95
13
Disinfect inner gloves:
14
Doff Boot Covers
•
Disinfect inner gloves hands with either an *EPA-registered disinfectant
wipe or ABHR
�Wet PPE Doffing – N95
15
Disinfect and change inner gloves
16
Remove N95 respirator:
•
•
Remove the N95 respirator by tilting the head slightly forward, grasping
first the bottom tie or elastic strap, then the top tie or elastic strap, and
remove without touching the front of the N95 respirator.
Discard N95 respirator
�Wet PPE Doffing – N95
17
Disinfect inner gloves:
18
Disinfect washable shoes
•
•
Disinfect with either an *EPA-registered disinfectant wipe or ABHR.
Use an *EPA-registered disinfectant wipe to wipe down every external
surface of the washable shoes.
�Wet PPE Doffing – N95
19
Disinfect and remove inner gloves:
20
Perform hand hygiene:
•
•
Take care not to contaminate bare hands during the process
Perform hand hygiene with ABHR
�Wet PPE Doffing – N95
21
Inspect:
•
•
The healthcare worker should inspect their clothing and skin for
signs of contamination
If contamination is identified, the garments should be carefully
removed and the wearer should shower immediately
Exit the warm zone
Enter the cold zone
�Donning Wet PPE Checklist – N95
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Engage trained observer
Gather and inspect PPE prior to donning
Don boot covers
Don inner gloves
Don gown or coverall
Don 95 respirator
Don surgical hood
Don apron
Don outer gloves
Don face shield
Verify
Perform hand hygiene
�Doffing Wet PPE Checklist – N95
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Engage trained observer
Inspect PPE
Disinfect Outer Gloves
Doff apron
Re-inspect PPE
Disinfect and doff outer
gloves
Inspect and disinfect inner
gloves
Doff face shield
Disinfect inner gloves
Doff surgical hood
Disinfect inner gloves
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Doff gown or coverall
Disinfect inner gloves
Doff boot covers
Disinfect and change inner
gloves
Doff N95 respirator
Disinfect inner gloves
Disinfect washable shoes
Disinfect and remove inner
gloves
Perform hand hygiene
Inspect
�Debrief
Let’s talk….
�Virtual Toolbox
CDC
• PPE Guidance
• Wet patients
• Dry patients
WHO
• Donning & doffing posters
• PPE for use in filovirus disease outbreak –
Rapid advice guideline
�Group Work
Mr. B’s Scenario
Setting the scene:
• Mr. B is a previously healthy 45-year-old man who returned from a humanitarian mission in the
Democratic Republic of Congo 7 days ago.
Clinical presentation:
• He presents to the Emergency Department where he is diaphoretic and is noted to have
a maculopapular rash that involves his neck, trunk, and upper arms.
• He is febrile to 102.8°F with a BP of 105/75 mmHg, HR 101 bpm, RR 18/min, and O2
saturation of 94% RA.
• The only medication he is taking is atovaquone/proguanil for malaria prophylaxis.
�What PPE Would You Use
Ms. C’s Scenario
Setting the scene:
• Ms. C is a 28-year-old woman who works in an advertising firm in New York. She recently
participated in an Umrah pilgrimage to Mecca and has returned 5 days ago.
Clinical presentation:
• She was feeling well during her travels, but last night developed a fever with muscle aches and a
cough.
• She took ibuprofen for the fever, but the cough got worse overnight.
• She presents to Urgent Care, where she is noted to be calm but breathing at 22
respirations/minute.
• She has a temperature to 100.1F, BP 105/70 mmHg, HR 84 bpm, and O2 saturation of 96% on
room air.
• A chest x-ray is performed which demonstrated patchy opacities in both lung bases.
�What PPE Would You Use
Mr. D’s Scenario
Setting the scene:
• Mr. D is a 52-year-old banker who was on a business trip in Hong Kong 3 days ago. While there,
he participated in a tour of rural districts in Guangdong Province. He has a history of congestive
heart failure that is controlled with captopril and carvedilol. His only other medication is aspirin.
Clinical presentation:
• He develops a productive cough and fever, and presents to the Emergency Department, where he
is febrile to 102.3F.
• He is using accessory muscles to breath, and quickly deteriorates so that intubation is required in
the ED to maintain respiratory protection.
• He has copious thick gray secretions from his oropharynx, and requires 70% FiO2 on the
mechanical ventilator.
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE 201
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
In Person Course
Document relating to an in person course.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE 201
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Past in Person Course Presentation - Identify and select the PPE components needed in the care and management of wet patients with potentially hazardous and communicable diseases such as Ebola and other special pathogens. Develop SOP for wet PPE donning and doffing, using appropriate equipment. Assess strengths and weakness of PPE SOP.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Contributor
An entity responsible for making contributions to the resource
2023-10-30 by Darrell Ruby/Amy Mead - submit asset update - Consider adding in context on difference between a trained observer and a doffing assistant.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-10-30
Donning and Doffing
Personal Protective Equipment (PPE)
R-PPE
R-T&E
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
In Person Course
Document relating to an in person course.
URL
https://repository.netecweb.org/exhibits/show/leadership
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Leadership: Mitigation, Preparation, Response, and Recovery
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Past in Person Course Presentation - Determine methods and tools to consider when developing staffing models. Identify training and competency tools and demonstrate how to apply them to sustain readiness. Define fun and interactive strategies to engage team members and encourage team building.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Relation
A related resource
Y - PPE pos 82 qualtrics 303
Y - D0.1PPE/D0.2PPE Qualtrics # 303
Y - D0.1PM/D0.2PM Qualtrics # 907, original # 5
Y - D0.1PM/D0.2PM Qualtrics # 910, original # 7
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM) - no longer a course offered in person, may be worth revisiting for a lms module (can't archive - SPORSA)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-14
R-PPE
Staff Support
Staffing
Staffing Model
-
https://repository.netecweb.org/files/original/8bb2bd8641e4d01fdcbc29c724fbe4e0.pdf
5601f1c9375bd1b4f43acc79b93ce8ae
PDF Text
Text
Personal Protective Equipment:
Developing a Train-the Trainer
Program
Angie Vasa BSN, RN, CCRN
Sharon Vanairsdale, MS, APRN, ACNSBC, NP-C, CEN
NETEC Spring 2017
https://netec.org
Funded by ASPR & CDC
�Objectives
• Review key concepts of personal protective
equipment (PPE).
• Clarify competency: Theory, Practice and Use.
• Discuss strategies for developing PPE courses.
• Discuss ways of maintaining ongoing PPE competency.
NETEC Spring 2017
https://netec.org
�What is Personal
Protective Equipment?
• Equipment worn to minimize exposure to workplace
injuries and illnesses…”
• OSHA mandates training of workplace PPE
• When PPE is necessary.
• What type of PPE is necessary.
• How to properly put it on and take it off.
• Limitations of the PPE.
• Proper care, maintenance and disposal of PPE.
(Occupational Safety and Health Administration-OSHA)
NETEC Spring 2017
https://netec.org
�Isn’t PPE something HCWs
use every day?
• Yes!
• Except:
•
•
•
•
NETEC Spring 2017
https://netec.org
NOT PAPR level
NOT consistently
NOT correctly
NOT with confidence
�Considerations When
Selecting PPE
•
•
•
•
•
•
NETEC Spring 2017
https://netec.org
Disease transmission characteristics
Expert guidance
Staff safety and comfort
Supply chain and item availability
Standardization of PPE for all staff
Layout of patient care area
�Wet and Dry PPE
Examples
NETEC Spring 2017
https://netec.org
�PPE Multiple
Combinations
Facilities may and do differ in the types and brands of
PPE used.
NETEC Spring 2017
https://netec.org
�PPE Implementation
• Donning and doffing PPE safely requires:
• Education
• Training
• Demonstrated competency
• Observation by a skilled observer
NETEC Spring 2017
https://netec.org
�Who Needs Training?
Level of PPE and scope of work GUIDE training content!
• Nurses
•
•
•
•
•
•
Emergency Department
Clinic Staff
Intensive Care Nurses
L&D Nurses
NICU Nurses
Pediatric Nurses
• Lab Personnel
• Lab Transport Personnel
• Environment Services
• Physicians
•
•
•
•
•
•
•
Internal Medicine
Emergency Medicine
Critical Care
Infectious Diseases
Obstetricians
Pediatricians
Anesthesiology
• Radiology Staff
• Maintenance
Who has been trained at your facility? Anyone not listed here?
NETEC Spring 2017
https://netec.org
�Training and Competency
Requirements
• Regional ETC
– Rostered staff receive quarterly training in infection control,
safety, and patient care.
– Rostered staff receive JIT refresher training within 72 hours
when activated.
• State-Designated ETC
– Rostered staff trained in safely donning and doffing PPE .
• Assessment hospitals
– ED staff trained at least annually in infection control and safety.
– ICU staff trained at least annually in infection control and
safety.
• Frontline Facilities
NETEC Spring 2017
https://netec.org
�Strategies for Training
• Competency based assessment
• Drills/exercises
• These exercises incorporate skills training in addition
to standard donning and doffing practices.
• Train the Trainer programs
• Consider the need for trained trainers in
biocontainment units, emergency departments, clinics
and frontline hospitals.
• JIT: Just in Time Training
NETEC Spring 2017
https://netec.org
�How Does Your Organization:
1. Assess competency?
2. Maintain team competency?
3. Sustain organizational readiness?
NETEC Spring 2017
https://netec.org
�What is Competence?
• “A cluster of related abilities, commitments, knowledge, and
skills that enable a person (or an organization) to act
effectively in a job or situation.”
(http://www.businessdictionary.com/definition/competence.html#ixzz4ElfRJJjn)
• “Whatever is required to so something adequately.” (Pollock,
1981)
• The ability to perform a task with desirable outcomes under
the varied circumstances of the real world.” (Benner, 1982)
• “The effective application of knowledge and skill in the work
setting.” (del Bueno, 1990)
NETEC Spring 2017
https://netec.org
�Assessing Skill Domains
Del Bueno, D. (1980)
Technical
Critical
Thinking
Interpersonal
Examples
Clinical/Technical Skills
Critical Thinking Skills
Interpersonal Skills
Cognitive skills
Problem solving
Communication
Knowledge
Priority setting
Collaboration
Psychomotor skills
Ethics
Delegation
Technical understanding
Clinical reasoning
Directing others
NETEC Spring 2017
https://netec.org
�Matching Method to
Domain
11 Verification Methods
Competency Domain(s) Measured
Test/Exams
Technical: Knowledge & Cognition
Return Demonstrations
Technical: Psychomotor Skills
Evidence of Daily Work
Technical
Case Studies
Critical thinking
Exemplars
Critical thinking & Interpersonal
Peer Review
Critical thinking & Interpersonal
Self Assessment
Critical thinking
Discussion/Reflection Groups Critical thinking; Linked with Mock Event: All 3
Domains
Presentations
Technical: Knowledge & understanding
Mock Events/Surveys
Technical + Critical thinking + Interpersonal
QI Monitors
Technical + Critical thinking + Interpersonal
NETEC Spring 2017
https://netec.org
�Team Competencies
http://pda.rnao.ca/content/teamwork-competency-and-defining-behaviours
• How do you define team competency?
• What are team competencies?
• How do you measure team competencies?
NETEC Spring 2017
https://netec.org
�Team Competencies
• Works collaboratively together with others to
achieve group goals and objectives.
§
§
Collaboration
Relationships/Partnerships
• No amount of teamwork can compensate for
clinical/technical proficiency.
• The foundation of teamwork builds on technical proficiency
and protocol compliance.
NETEC Spring 2017
https://netec.org
http://pda.rnao.ca/content/teamwork-competency-and-defining-behaviours
�Outcomes of Team
Competencies: Team STEPPS
• Knowledge
§
Shared Mental Model
• Attitudes
§
§
Mutual Trust
Team Orientation
• Performance
§
§
§
§
§
NETEC Spring 2017
https://netec.org
Adaptability
Accuracy
Productivity
Efficiency
Safety
�Why Do Errors Occur –
Some Obstacles
• Workload fluctuations
• Interruptions
• Fatigue
• Multitasking
• Failure to follow up
• Poor handoffs
• Ineffective
communication
• Not following protocol
• Excessive professional
courtesy
• Halo effect
• Passenger syndrome
• Hidden agenda
• Complacency
• High-risk phase
• Strength of an idea
• Task (target) fixation
http://www.ahrq.gov/professionals/education/curriculumtools/teamstepps/longtermc
are/module1/igltcintro.html#s18
NETEC Spring 2017
https://netec.org
�Interactive Questions
What type of training models have been
implemented in your facilities?
•
•
•
•
NETEC Spring 2017
https://netec.org
Train the Trainer
Just in Time
Competency Based Assessment
Drills and Exercises
�Drills and Exercises
• Utilize annual training
calendar—Include
multifaceted training
modalities.
• Progress in exercise
complexity eg: table top,
functional, full scale.
• Always include donning
and doffing PPE.
• Consider inclusion of skill
specific activities.
NETEC Spring 2017
https://netec.org
�Benefit of Training
Trainers
• Train-the-trainer model is less costly than the
traditional methods.
• Allows for courses to be tailored to specific issues.
• Can be an effective method for broadly
disseminating evidence-based public health
principles.
NETEC Spring 2017
https://netec.org
�Train the Trainer Model
• Identify who your trainers will be:
•
•
•
•
•
Clinical Nurse Specialists
Educators
Infection Prevention
Staff Nurses
Biosafety
• Determine how you will assess competence.
• Determine how often will you provide refresher
training and support.
NETEC Spring 2017
https://netec.org
�Training the Trainers
• Create training materials.
• Include rationales for all steps.
• Include instructional graphics.
• Include general principles and unit specific processes.
• Support the Trainers.
• Follow up training to keep trainers current.
• Update on any policy changes.
• Validate trainers competency in educating and
performing the task.
NETEC Spring 2017
https://netec.org
�Excerpt from NBU
Training Manual
NETEC Spring 2017
https://netec.org
�Just In Time
• Videos: specific to your protocols.
• Distribution and accessibility of standard
operating procedures (SOP)
• Hands-on sessions.
• Schedule small group learning for staff who qualify.
• Consider consulting teams, staff returning from leave
of absence or staff who express desire.
NETEC Spring 2017
https://netec.org
�Interactive Activity
• A patient with a fever and cough presents to your
ED. You learn he just returned from the Middle
East one week ago. What PPE would you don?
• A patient with alerted mental status presents with
vomiting and diarrhea. Her daughter states she
recently returned from West Africa after assisting
with Ebola survivor care. What PPE would you
don?
NETEC Spring 2017
https://netec.org
�CDC PPE Coaching App
Dff
afe
Contact Bob@33sparks.com with additional Questions or Information Requests
NETEC Spring 2017
https://netec.org
�What Resources are
Available through NETEC?
• In-person didactic and collaborative training courses.
• In-person skills courses.
• Available resources on the www.netec.org website for
facilities and coalitions to use and enhance their own
training and education materials.
• Robust Learning Management System, allowing
facilities and healthcare workers free access to
courses specifically tailored to their needs.
• Exercise templates for coalitions, facilities and
frontline healthcare workers to utilize.
NETEC Spring 2017
https://netec.org
�Resources
• NETEC: www.netec.org
• Regional ETC: 10 Regional Centers
• CDC: www.cdc.gov
• Local Public Health
• Local Medical Response Service i.e: OMMRS
NETEC Spring 2017
https://netec.org
�NETEC Spring 2017
https://netec.org
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE Training the Trainer
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
In Person Course
Document relating to an in person course.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE Training the Trainer
Creator
An entity primarily responsible for making the resource
NETEC
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Past In Person Course Presentation.<br /><br />Objectives:<br />
<ul>
<li>Review key concepts of personal protective equipment (PPE).</li>
<li>Clarify competency: Theory, Practice and Use.</li>
<li>Discuss strategies for developing PPE courses.</li>
<li>Discuss ways of maintaining ongoing PPE competency.</li>
</ul>
Date
A point or period of time associated with an event in the lifecycle of the resource
2017
Relation
A related resource
Y - D0.1TE/D0.2TE Qualtrics # 407
Contributor
An entity responsible for making contributions to the resource
2023-10-30 by Darrell Ruby/Amy Mead - submit asset update - Outdated information on NETEC resources available, old tiered structure verbiage.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-10-30
Personal Protective Equipment (PPE)
R-PPE
R-T&E
Staff Support
Staffing
-
https://repository.netecweb.org/files/original/7f012c07a5bc17736514d83ddbbbcde9.doc
e557ff2c5ccd70f4f2103dc76e9fcafe
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PAPR Level PPE - Doffing full Checklist
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PAPR Level PPE - Doffing full Checklist
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
Infection Control
Description
An account of the resource
PPE Checklist
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-17
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Checklist
Donning and Doffing
Example
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/79b171e8cd07139261826af1ed180dc6.doc
f5bc62521c9279a9d274828b70590a6d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
HIGH Level PPE - Donning full Checklist
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
HIGH Level PPE - Donning full Checklist
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
Infection Control
Description
An account of the resource
PPE Checklist
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-17
Contributor
An entity responsible for making contributions to the resource
2022-02-04 by Jill Morgan PPE general Emory
2022-11-16 by Jill/Britton - on SPORSA mark active
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-11-16
Relation
A related resource
Y - PPE pos 101 qualtrics 321; PPE pos 103 qualtrics 323
Y - D0.1PPE/D0.2PPE Qualtrics # 321
Y - D0.1PPE/D0.2PPE Qualtrics # 323
Checklist
Donning and Doffing
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/f93a9eb7d52970f6b1a3d97990a6d245.doc
5e3c8b3348d244f1eb1ec8bd823075c9
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
HIGH Level PPE - Doffing Full Checklist
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Checklist
Checklist for processes.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
HIGH Level PPE - Doffing Full Checklist
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
Infection Control
Description
An account of the resource
PPE Checklist
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-05-17
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Checklist
Donning and Doffing
Example
Personal Protective Equipment (PPE)
R-PPE
-
https://repository.netecweb.org/files/original/b2d9ff8ca0123da7abe383f7e9f987c5.xlsx
0043893e13965cfa71d258a1fd32b188
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Unit Inventory List
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Unit Inventory List
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Leadership Toolbox, Preparedness: Serious Communicable Disease Unit Inventory List
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-25
Contributor
An entity responsible for making contributions to the resource
2023-10-17 by Darrell Ruby, T & E group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-10-17
Leadership Toolbox
Personal Protective Equipment (PPE)
Preparedness Tools
Protocol
R-PPE
R-T&E
Special Pathogens
-
https://repository.netecweb.org/files/original/a97cccb778448dabceb9386a7f3b91a9.docx
f659db41f2459aee0174569579e7cacd
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Provider Down Protocol
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Protocol
Protocol documentation
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Provider Down Protocol
Creator
An entity primarily responsible for making the resource
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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Decedent Management
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c3bde9da074da0f6c9bade43ebab1285
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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Author Manuscript
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
Published in final edited form as:
Microbiol Spectr. 2016 June ; 4(3): . doi:10.1128/microbiolspec.EI10-0011-2016.
Preparing for Serious Communicable Diseases in the United
States: What the Ebola Virus Epidemic Has Taught Us
Jay B Varkey, MD [Assistant Professor of Medicine] and
Emory University School of Medicine
Bruce S Ribner, MD, M.P.H. [Professor of Medicine]
Emory University School of Medicine
Author Manuscript
INTRODUCTION
The largest and deadliest outbreak of Ebola virus disease began on December 2, 2013 when
a 2 year old child developed an illness characterized by fever, black stools, and vomiting in a
town called Meliandou, Guinea—a remote and sparsely populated village of 31 households
approximately 20 miles from the borders of Liberia and Sierra Leone.(1) The exact source of
infection is unclear but likely involved contact with an infected animal. The child died on the
5th day of his illness.(2)
Author Manuscript
Over the next three weeks, the child's 3 year old sister, mother and grandmother also died.
Two women from a nearby village attended the funeral of the child's grandmother; they died
three weeks later. A midwife from the child's village was hospitalized and subsequently
died. Two healthcare workers who worked at the hospital where the midwife was admitted
also became ill and died. Multiple family members who attended the funerals of the
healthcare workers also became ill and died.(2) By then, the illness, initially thought to be
cholera, had spread to several surrounding districts as well as the capital of Guinea, Conkary
—a city of 2 million people.(1)
Author Manuscript
By March 2014, cases were identified in neighboring Liberia and the disease was identified
as being caused by the Ebola virus. In April 2014, cases of Ebola virus disease (EVD) were
identified in Sierra Leone. Guinea, Liberia and Sierra Leone had previously never
experienced an outbreak of EVD. All previous EVD outbreaks had occurred in mostly rural
villages in the central African nations of the Democratic Republic of Congo, Sudan, Gabon,
Uganda and the Republic of the Congo. Prior to 2013, the largest documented EVD outbreak
occurred in 2000-2001 in the Gulu District of Uganda and resulted in over 400 cases and
over 200 deaths.(3) As of December 2015, the West Africa EVD outbreak has resulted in
over 28,000 cases and over 11,000 deaths in Guinea, Liberia and Sierra Leone—more than
all previous EVD outbreaks combined.(4)
The 42 day waiting period after the last known case of EVD had recovered ended in Sierra
Leone on November 7, 2015 and ended in Guinea on December 28, 2015. In Liberia, as of
the time of writing this chapter, the 42 day waiting period will end on January 14, 2016.(4)
Ending the West Africa EVD outbreak required an unprecedented international response.
For the United States, participation in the international response to the West Africa EVD
�Varkey and Ribner
Page 2
Author Manuscript
outbreak provided an opportunity to learn important lessons in 4 key domains critical to
preparing for future outbreaks of EVD and other serious communicable diseases: 1. Safe and
Effective Patient Care; 2. The Role of Experimental Therapeutics and Vaccines; 3. Infection
Control; 4. Hospital and Community Preparedness.
SAFE AND EFFECTIVE PATIENT CARE
Author Manuscript
There are no specific therapies approved by the US Food and Drug Administration for the
treatment of EVD. Therefore, the primary treatment for EVD is supportive care, specifically
fluid replacement and electrolyte management. Prior to the West Africa outbreak, the ability
of health care workers to provide aggressive supportive care was often hampered by the
resource limitations in many central African Ebola treatment centers.(5) Oral rehydration,
though readily available even in resource-limited settings, may have been inadequate given
the severe fluid losses (5-10 liters per day) caused by EVD-associated gastroenteritis and the
intractable nausea and vomiting that frequently accompanies this illness.(6, 7) Similarly, the
ability to safely provide intravenous fluids for rehydration and correction of electrolyte
abnormalities was often limited by inadequate staffing, limited supplies of intravenous
fluids, and inadequate or unavailable laboratory testing.(5) When laboratory testing was
available, as during the 2000 outbreak of Sudan ebolavirus in Uganda, it demonstrated that
renal failure, liver failure, hypocalcemia, hypoalbuminemia and an elevated D-Dimer were
associated with increased mortality.(8)
Author Manuscript
The historic size of this West Africa EVD outbreak required an international response that
resulted in both the construction of new Ebola treatment units in Guinea, Liberia and Sierra
Leone, as well as the treatment of 27 individuals in Western Europe and the United States.
As a result, the ability of heath care workers to provide aggressive supportive care was
enhanced. In Conakry, Guinea, aggressive supportive care may have contributed to a reduced
case fatality rate compared to other more resource-limited areas of the country and
compared to historical cohorts.(6) Among patients evacuated to Western Europe and the
United States, the majority of patients had significant electrolyte abnormalities
(hyponatriemia, hypokalemia, hypocalcemia and hypomagnesemia) diagnosed by laboratory
monitoring. The patients received multiple different, sometimes overlapping, interventions
including supportive care. The case-fatality proportion of patients treated in Western Europe
and the United States was 18.5% which is substantially lower than the mortality seen in
West Africa ETUs.(9)
Author Manuscript
The treatment of EVD patients in resource-enhanced settings like Western Europe and the
United States also allowed patients with EVD-associated multiorgan system failure to
receive, for the first time, advanced critical care interventions like mechanical ventilation
and renal replacement therapy.(10) Multi-organ system failure in EVD historically, and
during the West Africa outbreak, has been associated with poor outcomes.(11) However,
11/27 patients treated in Western Europe and the United States required advanced critical
care interventions (non-invasive mechanical ventilation, mechanical ventilation, vasopressor
or inotropic support, and renal replacement therapy); six of the 11 survived.(9) In addition,
the experience of providing critical care support to patients with EVD demonstrated that
invasive interventions like mechanical ventilation and renal replacement therapy can be
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�Varkey and Ribner
Page 3
Author Manuscript
performed safely if performed by trained health care workers who strictly adhere to infection
control practices.(10)
Author Manuscript
The clinical care of patients with EVD does not end with the resolution of viremia. EVD
survivors can develop a diverse array of complications during convalescence. Survivors of
the 2007 outbreak of Bundibugyo ebolavirus in Uganda developed joint pain, sleep
disturbances, and neurological abnormalities including hearing loss, memory loss and
confusion. In addition, ocular complaints including retro-orbital pain and blurred vision
were common.(12) Ocular complaints including sight-threatening uveitis has also been
described in survivors of the 1995 outbreak of Zaire ebolavirus in Kikwit, Democratic
Republic of Congo.(13) In a small survey of 85 EVD survivors of the West Africa, 40% of
participants reported “eye problems.”(14) During the current outbreak, one survivor
developed severe uveitis during convalescence and viable Ebola virus was isolated from his
anterior eye chamber 9 weeks after clearance of viremia.(15)
The pathogenesis of complications that occur during EVD convalescence is unclear but may
be multifactorial. It has been hypothesized that some of the complications may be related to
post-viral auto-immune disease.(12) It has also been postulated that complications may be
from persistent viral replication in immune-privileged sites.(15) Persistent viable Ebola virus
has been isolated from semen and aqueous humor of EVD survivors.(15, 16) In addition, one
survivor developed meningoencephalitis 10 months after she had cleared her viremia, and
Ebola virus was isolated from her cerebrospinal fluid.(17) It is unclear whether Ebola virus
persists in other bodily fluids or tissues that are thought to be immune-privileged (e.g.
synovial fluid). Prospective cohort studies are underway in West Africa that will hopefully
elucidate the causes of complications that occur to EVD survivors during convalescence.
Author Manuscript
ROLE OF EXPERIMENTAL THERAPEUTICS
Author Manuscript
While the key to surviving Ebola virus disease is aggressive supportive care, it is possible
that the discovery of effective therapeutic agents may improve patient outcomes.
Unfortunately, disproportionate media attention to unproven therapeutics during the recent
Ebola outbreak led to unrealistic expectations and the almost universal compassionate use of
experimental therapeutics in patients repatriated to resource-rich centers. Of the 27 patients
treated in resource-rich centers, 70% received at least two investigational therapeutics (9),
despite the fact that none had human efficacy or safety data; patients experienced a wide
range of possible adverse effects. These adverse effects included systemic inflammatory
response syndrome, hypotension, elevated transaminase levels, and transfusion-associated
acute lung injury. It is of interest to note that two of the agents that were felt to be the most
promising at the beginning of the outbreak were ultimately found to offer no survival
benefits (see below). The use of therapeutics and vaccines in resource-limited environments
will face a number of challenges, including supply and distribution uncertainty,
administration difficulties with agents that must be given parenterally or intravenously, and
the difficulties of utilizing oral agents in patients with intractable nausea and emesis (18).
Above all, it is imperative that the search for a “magic bullet” not detract from a focus on
supplying aggressive supportive care to all patients presenting with Ebola virus infection.
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�Varkey and Ribner
Page 4
Author Manuscript
Author Manuscript
Therapeutics currently considered the best candidates for efficacy in patients infected with
the Ebola virus fall into two categories: boosting of passive immunity and pharmaceutical
antivirals. Recovery from Ebola virus disease is associated with the production of antibody
against the virus (19, 20). It has therefore been hypothesized that the boosting of passive
immunity until the host can produce antibody may be of benefit. In a prior outbreak in 1995,
8 patients with Ebola virus infection were given whole blood from outbreak survivors (21)
Seven of the 8 patients survived, for a mortality rate of 12.5%, which compared with a
mortality rate of 80% in patients who did not receive such transfusions. However, due to the
small numbers and other confounding factors this survival difference was not felt to be
definitive evidence of efficacy (22). Studies of convalescnet serum in non human primates
have been inconclusive. While the administration of convalescent whole blood transfusion to
rhesus macaques was not found to be protective (23), infected rhesus macaques who
received multiple administrations of purified, polyclonal, species-matched IgG from
vaccinated animals did appear to be protected (22). In addition to the use of convalescent
antibodies, pooled antibodies produced in vitro have been studied. ZMapp, a combination of
3 chimeric human/murine IgG1 monoclonal antibodies produced by a tobacco plant
(Nicotiana benthamiana) has recently been developed (24). In a non human primate trial,
ZMapp was 100% protective against Ebola virus infection even when administered 5 days
after the animals were infected. While anecdotal evidence supports the efficacy of this
preparation in a few of the patients who survived the current outbreak (25), no randomized
controlled studies have been completed to date. A definitive answer as to the role of passive
immunity in treating patients with Ebola virus disease will await more robust trials in
humans.
Author Manuscript
Author Manuscript
Pharmaceutical antivirals directed against the Ebola virus have fallen into two categories:
small-molecule inhibitors of virus entry and endosomal escape, and compounds that block
viral replication. In the first category is a product called TKM-100802, a small interfering
ribonucleic acid that silences RNA replication by enzymatic cleavage of mRNA.
TKM-100802 targets the L polymerase, viral protein VP24 and VP35 (26). In both guinea
pig and non human primate challenge studies, this agent was found to offer protection (27,
28). Unfortunately, in one of the few randomized controlled trials in humans to be performed
during the current outbreak, this agent was not found to offer a survival advantage in humans
and the trial was halted (29). Favipiravir, a broad spectrum antiviral that inhibits RNAdependent RNA polymerase, also showed promise in initial animal studies, but again was
not found to offer a survival advantage in a randomized trial involving humans. However, a
post hoc analysis did suggest that favipiravir might be of benefit in patients presenting early
in disease with lower viral loads (30). Other agents that have shown promise in in vitro or
animal studies include GS-5734, BCX4430 and AVI7537 (18, 26). As these agents have not
been evaluated in randomized human trials, their efficacy in humans is yet to be determined.
VACCINES
The high mortality rate associated with Ebola virus infection has added urgency to the
search for effective vaccines. Practical difficulties in performing controlled clinical trials for
Ebola vaccines are that Ebola outbreaks tend to be unpredictable and sporadic, and the
ethical concerns about using a placebo control in the face of exposure to a highly lethal
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�Varkey and Ribner
Page 5
Author Manuscript
disease. In 2002, the FDA promulgated the “animal rule” as an alternative pathway to
license products against highly lethal pathogens such as Ebola (31). The animal rule has 4
conditions: 1. animal efficacy data (GLP); 2. immune correlate establishment and protection
in animals; 3. human safety and immunogenicity data (GCP); 4. induction of an immune
correlate in humans. It is anticipated that an effective vaccine will need to elicit both
humoral and cell mediated immunity against the Ebola virus. Vaccines for pre-exposure (no
identified exposure to the virus) and post-exposure (identified exposure to the virus) use
have slightly different requirements. A vaccine for pre-exposure use would optimally induce
protection after one, or at most 2, vaccinations. It should protect against multiple strains of
the Ebola virus. It should have minimal adverse effects. A vaccine for post-exposure use
should produce rapid induction of immunity. For all vaccines, ability to tolerate suboptimal
storage conditions will be important, given the supply chain issues in most parts of the world
where the Ebola virus is endemic.
Author Manuscript
Author Manuscript
Attenuated and inactivated vaccines have not shown protection in non-human primate
studies (32), and there have been safety concerns due to the risk of incomplete inactivation.
Genetic and subunit vaccines have resulted in incomplete protection (33, 34). The leading
candidate vaccines at the present time are vector-based: a live, recombinant vesicular
stomatitis virus (VSV) vaccine, and a replication-incompetent adenoviral vector vaccine.
Both of these vaccines promote immunity to the Ebola virus glycoprotein. The Ebola virus
glycoprotein is responsible for attachment and fusion between the viral and host membranes
and produces inhibition of host immune responses. In non human primate models, an
antiglycoprotein antibody level of 1:3700 and above allows the animal to survive subsequent
lethal challenges with Ebola virus. The VSV vaccine encodes for the Ebola glycoprotein
instead of the VSV glycoprotein. The immunity produced by this vaccine is primarily
humoral. In non human primates, one dose of vaccine induces immunity and is 100%
protective at 14 months(35). As the vaccine virus is capable of replication, the majority of
volunteers exhibit some adverse events: 90% reported systemic symptoms, including fever,
chills, myalgia and headache (36). Pre exposure studies with this vaccine are limited. In one
post exposure study, 7651 individuals in Guinea who were contacts of patients with
laboratory confirmed EVD were vaccinated either immediately or 21 days following
exposure. In the immediate vaccination group there were no cases of Ebola virus disease
with symptom onset at least 10 days after randomization, whereas in the delayed vaccination
group there were 16 cases of Ebola virus disease from seven clusters, showing a vaccine
efficacy of 100% (37).
Author Manuscript
The adenovirus vaccine encodes for the Ebola glycoprotein of two Ebola strains: Zaire and
Sudan. Unlike the VSV vaccine, it promotes cellular as well as humoral immunity (38). As
preexisting immunity to the adenovirus is more common than immunity to VSV, alternate
immunization strategies such as multiple doses must be utilized. In human volunteers, minor
adverse reactions were seen in 70% (fever and transient leukopenia) (39). Human trials in
endemic areas are planned.
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�Varkey and Ribner
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Author Manuscript
INFECTION CONTROL
Prior to the West Africa EVD outbreak, there were relatively limited data in the medical
literature to help guide infection control practices when caring for patients with EVD in the
United States. The literature that was available was based on the experience of caring for
patients with EVD in central Africa—a setting markedly different to modern hospitals in the
United States.(40) As of December 2015, 11 patients with EVD have been treated in the
United States; ten of the 11 patients were treated in specialized biocontainment patient care
units at Emory University Hospital, the University of Nebraska Medical Center and the
National Institutes of Health Clinical Center. The eleventh was cared for in an isolation unit
developed in Bellevue Hospital Center. In these settings, key lessons were learned to guide
infection control policies and procedures to safely care for patients with EVD and other
serious communicable diseases.
Author Manuscript
Author Manuscript
Although biocontainment patient care units are not required to treat a patient with EVD (41),
specific features in the design of these facilities make them ideal environments to effectively
treat patients with serious communicable diseases while minimizing the risk of transmission
to healthcare workers, other patients, and the public.(42) In biocontainment patient care
units, including the Serious Communicable Diseases Unit (SCDU) at Emory University
Hospital (see Figure 1), individual patient care rooms are designed to deliver a level of care
equivalent to that of a standard ICU, allowing healthcare workers to provide aggressive
supportive care to patients who may be critically ill. To maintain staff safety, the SCDU
includes dedicated space for staff changing areas and to store personal protective equipment
(PPE). Patient care rooms are constructed with seamless surfaces for walls and floors to
facilitate effective surface disinfection. To maintain the safety of other hospitalized patients
and healthcare workers, the SCDU is located in a secured area of Emory University Hospital
that is separate from other patient care areas. All entrances and exits in the SCDU are
continuously monitored and limited only to healthcare workers and other individuals
authorized to be in the unit (43).
The SCDU is also designed to safely care for patients with diseases that, unlike Ebola, can
be spread through the airborne route. Specifically, air in the patients’ rooms is under net
negative pressure relative to the surrounding areas. Air in the patient rooms has laminar air
flow across the patient bed and all air from the patient rooms undergoes high-efficiency
particulate air filtration before being 100% exhausted to the outside. The outside exhaust is
geographically separate from any hospital air intake locations and is high enough to allow
for dilutional disbursement (43).
Author Manuscript
Independent of the specific design features of the treatment facility, the West African EVD
outbreak clearly demonstrated that establishing a trained, competent, interdisciplinary team
of providers and emphasizing a culture of safety are critical to effectively care for patients
with EVD.(44,45) To staff the SCDU, a core team of nurses, physicians and other healthcare
workers with expertise in infectious diseases, critical care and an expressed interest in caring
for patients with serious communicable diseases were identified. In order to be part of the
team, all providers were required to demonstrate a commitment to practice and promote a
“culture of safety.” In a culture of safety, all team members commit to strictly adhere to safe
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�Varkey and Ribner
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Author Manuscript
and effective practices outlined in standard operating protocols and are empowered to ask
questions and voice concerns as they arise. Team members were also required to meet the
following criteria: 1. Participate in regularly scheduled drill exercises; 2. Demonstrate
competency in infection control practices with specific emphasis on protocols for donning
and doffing PPE, specimen handling and waste management.(43) Providers who were
unable to demonstrate these competencies were not permitted to provide direct patient care
to patients with EVD. Drills, training sessions, and competency verification are performed
every 3-6 months.
Author Manuscript
The selection of appropriate PPE for the clinical care team is a critical step to maintaining
staff safety when caring for a patient with EVD. The specific type of PPE used by healthcare
workers caring for patients with EVD should include a coverall or surgical gowns with head
cover that leave no skin exposed. An apron and shoe covers should be added when there is a
high risk of exposure to infectious body fluids. At least two sets of gloves should be worn
including an outer glove that has extended cuffs. Although Ebola virus is not transmitted
through the air, wearing a powered air purifying respirator or N-95 respirator together with a
faceshield protects the face and mucus membranes from exposure to infectious fluids and
provides additional protection if aerosol-generating procedures are performed.(46)
Regardless of the specific type of PPE selected, it is imperative that PPE provide adequate
protection but remain comfortable for healthcare workers. It is especially important that
direct care providers receive adequate training and demonstrate competency in donning and
doffing PPE. Inappropriate donning and doffing of PPE has been identified as a possible risk
factor for EVD acquisition among healthcare workers.(47) Therefore, it is imperative that
healthcare workers donning and doffing PPE should always be monitored by partners to
ensure strict adherence to proper procedures.
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In addition to the core group of nurses and physicians providing direct care to patients with
EVD, laboratory technologists are critical members of the interdisciplinary team who need
to maintain strict adherence to infection control practices. Patients with EVD have a high
viral load that can reach levels of >108 viral particles/ml of body fluid. Ebola virus is highly
infectious with an infectious dose that has been estimated to be as low as 0.001 ml of blood.
(48) As a result, it is critical that hospitals that care for patients with EVD develop detailed
standard operating protocols to maintain safety during laboratory specimen collection,
transport and processing. Guidelines from the Centers for Disease Control and Prevention
(CDC) state that hospital clinical laboratories can safely handle specimens from patients
with EVD if risk mitigation strategies (engineering controls, administrative and work
controls, use of appropriate PPE) are implemented.(49) The American Society for
Microbiology has, however, issued guidelines suggesting that specimens from patients with
EVD should be limited to point-of-care (POC) testing equipment and performed either in the
patient's room or in a biological safety cabinet in an isolated area.(50) The SCDU at Emory
University Hospital established a self-contained POC laboratory and processed all
specimens within a 4-foot laminar flow biosafety containment hood.(51) All laboratory
technologists involved in the transport and processing of specimens containing Ebola virus
should receive PPE training and demonstrate competency in donning and doffing.
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Hospitals preparing to care for patients with EVD also require a multidisciplinary team to
develop standard protocols for the management of regulated medical waste. This team
should include environmental services, infection prevention and control, biosafety officers,
hospital administration, public health officials, and others with expertise in hazardous waste
removal. All waste from patients with EVD is disposed in compliance with local, state, and
federal regulations. EVD patient care waste is defined and regulated by the United States
Department of Transportation as a Category A infectious substance. Therefore, all solid
medical waste generated in the SCDU during the care of patients with EVD was sterilized in
an autoclave that allowed the waste to be transported and disposed safely as regular medical
waste. For units that do not have access to an autoclave, contractors who transport and
dispose of Category A waste have special procedures in place for the packaging of such
waste. Although CDC guidelines state that liquid waste may be disposed of without
treatment in to sanitary sewers, local waste treatment authorities may have different
requirements.(52) In the SCDU, a disinfectant was added to all liquid waste in accordance
with manufacturers’ directions prior to disposal in the sanitary sewer.
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Because of the low infectious dose of Ebola virus, health care workers who care for patients
with EVD must develop standard protocols to ensure that environmental surfaces in the
direct patient care area, laboratory and in the waste stream receive regular cleaning with an
appropriate effective disinfectant. The United States Environmental Protection Agency
(EPA) has identified EPA-registered disinfectants with a label claim of potency at least
equivalent to that for a non-enveloped virus which meet CDC criteria for use against Ebola
virus.(53, 54) All disinfectants should be used by trained health care workers in accordance
with manufacturers’ instructions. Strict adherence to regular cleaning significantly reduces
the risk of Ebola virus transmission from bodily fluids and fomites in the environment.(40)
For terminal cleaning of the environment after discharge of a patient with Ebola virus
disease, it is essential that meticulous attention be paid to disinfection of all surfaces. Most
units have followed this with a supplemental disinfection modality such as vaporized
hydrogen peroxide or a UV generator.(55)
HOSPITAL AND COMMUNITY PREPAREDNESS FOR EMERGING
INFECTIOUS DISEASES
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One of the key lessons that the Ebola outbreak of 2013-2015 has taught us is that the United
States and the world were ill prepared to address an outbreak of an emerging infectious
disease (56, 57, 58). This lesson was particularly jarring given that outbreaks of SARS
(severe acute respiratory syndrome), H1N1 influenza, and MERS (Middle East respiratory
syndrome) have marked the last decade. Partially due to this lack of preparation, the Ebola
outbreak has dwarfed all other outbreaks of Ebola virus disease in terms of number infected
and mortality. On the international front, factors that have been identified as contributing to
the unprecedented extent of this outbreak have been identified (Table 1).(58, 59)
In addition to the lack of preparedness for isolating and managing infected patients, the
delay in implementing research protocols to evaluate treatment algorithms, therapeutic
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agents, and vaccines means that many questions regarding these interventions will not be
resolved prior to the next outbreak.
In response to this outbreak, many initiatives, both globally and in the United States, have
begun. On the international arena, an independent, multinational Commission on a Global
Health Risk Framework for the Future has been established to recommend a more effective
global architecture for mitigating the threat of epidemic infectious diseases.(57, 60) The
U.S. National Academy of Medicine is the secretariat for this commission. In addition, an
independent Panel convened by the World Health Organization has proposed an agenda for
change (Table 2) which has been largely accepted by WHO administration.(61)
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The United States has also witnessed a marked increase in activities focused on emergency
preparedness for emerging infectious diseases. In 2015 Congress appropriated $5.48 billion
to the effort to control Ebola virus infection.(62) These funds will be utilized to address a
number of areas that require strengthening in order to improve the U.S. response to
emerging infectious diseases. Under the Hospital Preparedness Program of the Assistant
Secretary for Preparedness and Response (ASPR), funding was distributed to the states and
to other grantees to enhance state, local and healthcare system preparedness. These funds
were also designed to create one regional Ebola and other special pathogen treatment center
in each of the ten Health and Human Services regions.(63) In addition, the Centers for
Disease Control and Prevention has developed a tiered approach to manage patients with
possible or confirmed Ebola virus disease or infections caused by other serious
communicable pathogens.(41) Under this strategy, acute healthcare facilities can serve one
of three roles: frontline healthcare facility; Ebola assessment hospital; or Ebola treatment
center. Frontline healthcare facilities should, in coordination with local and state health
authorities, be able to rapidly identify and triage patients who are suspected of being
infected with the Ebola virus. Ebola assessment hospitals are facilities prepared to receive
and isolate suspect patients and care for the patient until a diagnosis of Ebola virus disease
can be confirmed or ruled out and until discharge or transfer is completed. Ebola treatment
centers are facilities that plan to care for and manage a patient with confirmed Ebola virus
disease for the duration of the patient's illness. As the Ebola virus outbreak in West Africa is
contained, the focus of this network should gradually shift to other serious communicable
diseases, although exactly what these infectious diseases should be is yet to be resolved.
ASPR has also funded the National Ebola Training and Education Center (NETEC) to
develop a robust educational program to improve infectious disease emergency preparedness
in the United States. The NETEC will be using a multipronged approach including: site
visits for regional Ebola treatment units; establishment of a web based learning management
system; development of exercise templates for entities to test their state of preparedness; and
a research agenda to answer some of the fundamental questions regarding the treatment of
patients with Ebola virus disease and other serious communicable pathogens. The goal of
the site visits and exercises is to demonstrate that an institution-wide approach is essential
when it comes to managing patients with serious communicable diseases. Areas of
preparedness that will receive targeted attention are listed in (Table 3) . One of the most
challenging areas for many facilities is to develop a laboratory that can safely evaluate
patients for serious communicable pathogens in a timely manner while at the same time
testing for other, more common, rapidly fatal diseases such as malaria and typhoid fever.
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CONCLUSIONS
The EVD outbreak that began in Guinea in December 2013 has been the largest and
deadliest EVD outbreak in human history. The outbreak cruelly demonstrated the significant
degree to which developing nations, like those in West Africa, are vulnerable to serious
morbidity and mortality caused by the rapid spread of serious communicable diseases like
EVD. Paradoxically, the outbreak has also resulted in the largest number of EVD survivors
in history. Therefore, it is critical, that the unprecedented international response that helped
end the EVD outbreak be sustained to build the infrastructure of vulnerable developing
nations. Building and maintaining adequate healthcare infrastructure will be critical to
manage the prevalent and poorly understood complications that can occur in EVD survivors
as well as to prevent future outbreaks.
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The West African EVD outbreak also demonstrated again that emerging infectious diseases
have no borders. As such, it is imperative that developed nations with advanced healthcare
systems, like the United States, identify lessons that can be learned from the West African
EVD outbreak. Specifically, key lessons learned in 4 domains: 1. Safe and Effective Patient
Care; 2. The Role of Experimental Therapeutics and Vaccines; 3. Infection Control; 4.
Hospital and Community Preparedness will hopefully help both the United States and the
international community more effectively respond to future outbreaks of EVD and other
emerging serious communicable diseases in the future.
REFERENCES
Author Manuscript
Author Manuscript
1. World Health Organization. Origins of the 2014 Ebola Epidemic: One Year Into the Ebola
Epidemic. http://www.who.int/csr/disease/ebola/one-year-report/virus-origin/en/
2. Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba N, Soropogui B, Sow MS,
Keïta S, De Clerck H, Tiffany A, Dominguez G, Loua M, Traoré A, Kolié M, Malano ER, Heleze E,
Bocquin A, Mély S, Raoul H, Caro V, Cadar D, Gabriel M, Pahlmann M, Tappe D, SchmidtChanasit J, Impouma B, Diallo AK, Formenty P, Van Herp M, Günther S. Emergence of Zaire Ebola
virus disease in Guinea. N Engl J Med. 2014; 371(15):1418–25. [PubMed: 24738640]
3. Centers for Disease Control and Prevention. Outbreaks Chronology: Ebola Virus Disease. http://
www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html
4. World Health Organization. Ebola Situation Report-30 December. 2015. http://apps.who.int/ebola/
current-situation/ebola-situation-report-30-december-2015
5. Fowler RA, Fletcher T, Fischer WA, Lamontagne F, Jacob S, Brett-Major D, Lawler JV, Jacquerioz
FA, Houlihan C, O'Dempsey T, Ferri M, Adachi T, Lamah MC, Bah EI, Mayet T, Schieffelin J,
McLellan SL, Senga M, Kato Y, Clement C, Mardel S, Vallenas Bejar De Villar RC, Shindo N,
Bausch D. Caring for critically ill patients with Ebola virus disease. Perspectives from West Africa.
Am J Respir Crit Care Med. 2014; 190(8):733–7. [PubMed: 25166884]
6. Bah EI, Lamah MC, Fletcher T, Jacob ST, Brett-Major DM, Sall AA, Shindo N, Fischer WA 2nd,
Lamontagne F, Saliou SM, Bausch DG, Moumié B, Jagatic T, Sprecher A, Lawler JV, Mayet T,
Jacquerioz FA, Méndez Baggi MF, Vallenas C, Clement C, Mardel S, Faye O, Faye O, Soropogui B,
Magassouba N, Koivogui L, Pinto R, Fowler RA. Clinical presentation of patients with Ebola virus
disease in Conakry, Guinea. N Engl J Med. 2015; 372(1):40–7. [PubMed: 25372658]
7. Schieffelin JS, Shaffer JG, Goba A, Gbakie M, Gire SK, Colubri A, Sealfon RS, Kanneh L, Moigboi
A, Momoh M, Fullah M, Moses LM, Brown BL, Andersen KG, Winnicki S, Schaffner SF, Park DJ,
Yozwiak NL, Jiang PP, Kargbo D, Jalloh S, Fonnie M, Sinnah V, French I, Kovoma A, Kamara FK,
Tucker V, Konuwa E, Sellu J, Mustapha I, Foday M, Yillah M, Kanneh F, Saffa S, Massally JL,
Boisen ML, Branco LM, Vandi MA, Grant DS, Happi C, Gevao SM, Fletcher TE, Fowler RA,
Bausch DG, Sabeti PC, Khan SH, Garry RF. KGH Lassa Fever Program; Viral Hemorrhagic Fever
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�Varkey and Ribner
Page 11
Author Manuscript
Author Manuscript
Author Manuscript
Author Manuscript
Consortium; WHO Clinical Response Team. 2014. Clinical illness and outcomes in patients with
Ebola in Sierra Leone. N Engl J Med. 371(22):2092–100. [PubMed: 25353969]
8. Rollin PE, Bausch DG, Sanchez A. Blood chemistry measurements and D-Dimer levels associated
with fatal and nonfatal outcomes in humans infected with Sudan Ebola virus. J Infect Dis 196
Suppl. 2007; 2:S364–71.
9. Uyeki TM, Mehta AK, Davey RT, Liddell AM, Wolf T, Vetter P, Schmiedel S, Grünewald T, Jacobs
M, Arribas JR, Evans L, Hewlett AL, Brantsaeter AB, Ippolito G, Rapp C, Hoepelman AIM,
Gutman J, the Working Group of the U.S.-European Clinical Network on Clinical Management of
Ebola Virus Disease Patients in the U.S. and Europe. Clinical management of Ebola virus disease
patients in the U.S. and Europe. N Engl J Med. 2016 in press.
10. Connor MJ Jr, Kraft C, Mehta AK, Varkey JB, Lyon GM, Crozier I, Ströher U, Ribner BS, Franch
HA. Successful delivery of RRT in Ebola virus disease. J Am Soc Nephrol. 2015; 26(1):31–7.
[PubMed: 25398785]
11. Sueblinvong V, Johnson DW, Weinstein GL, Connor MJ Jr, Crozier I, Liddell AM, Franch HA,
Wall BR, Kalil AC, Feldman M, Lisco SJ, Sevransky JE. Critical Care for Multiple Organ Failure
Secondary to Ebola Virus Disease in the United States. Crit Care Med. 2015; 43(10):2066–75.
[PubMed: 26196353]
12. Clark DV, Kibuuka H, Millard M, Wakabi S, Lukwago L, Taylor A, Eller MA, Eller LA, Michael
NL, Honko AN, Olinger GG Jr, Schoepp RJ, Hepburn MJ, Hensley LE, Robb ML. Long-term
sequelae after Ebola virus disease in Bundibugyo, Uganda: a retrospective cohort study. Lancet
Infect Dis. 2015; 15(8):905–12. [PubMed: 25910637]
13. Kibadi K, Mupapa K, Kuvula K, Massamba M, Ndaberey D, Muyembe-Tamfum JJ, Bwaka MA,
De Roo A, Colebunders R. Late ophthalmologic manifestations in survivors of the 1995 Ebola
virus epidemic in Kikwit, Democratic Republic of the Congo. J Infect Dis. 1999; 179(Suppl
1):S13–4. [PubMed: 9988158]
14. Trenchard, T. Survivors cope with new Ebola after-effects. Al-Jazeera; 2014. http://
www.aljazeera.com/news/africa/2014/12/survivors-cope-with-new-ebola-aftereffects-2014121573521561384.html
15. Varkey JB, Shantha JG, Crozier I, Kraft CS, Lyon GM, Mehta AK, Kumar G, Smith JR,
Kainulainen MH, Whitmer S, Ströher U, Uyeki TM, Ribner BS, Yeh S. Persistence of Ebola Virus
in Ocular Fluid during Convalescence. N Engl J Med. 2015; 372(25):2423–7. [PubMed:
25950269]
16. Mate SE, Kugelman JR, Nyenswah TG, Ladner JT, Wiley MR, Cordier-Lassalle T, Christie A,
Schroth GP, Gross SM, Davies-Wayne GJ, Shinde SA, Murugan R, Sieh SB, Badio M, Fakoli L,
Taweh F, de Wit E, van Doremalen N, Munster VJ, Pettitt J, Prieto K, Humrighouse BW, Ströher
U, DiClaro JW, Hensley LE, Schoepp RJ, Safronetz D, Fair J, Kuhn JH, Blackley DJ, Laney AS,
Williams DE, Lo T, Gasasira A, Nichol ST, Formenty P, Kateh FN, De Cock KM, Bolay F,
Sanchez-Lockhart M, Palacios G. Molecular Evidence of Sexual Transmission of Ebola Virus. N
Engl J Med. 2015; 373(25):2448–54. [PubMed: 26465384]
17. Fink, S. Ebola Survivor From Scotland Is Critically Ill. New York Times; 2015. http://
www.nytimes.com/2015/10/15/world/europe/scottish-nurse-who-had-ebola-is-back-inhospitaland-critically-ill.html
18. World Health Organization. Potential Ebola therapies and vaccines: Interim guidance. 2014. http://
www.who.int/csr/resources/publications/ebola/potential-therapies-vaccines/en/
19. Kraft CS, Hewlett AL, Koepsell S, Winkler AM, Kratochvil CJ, Larson L, Varkey JB, Mehta AK,
Lyon GM 3rd, Friedman-Moraco RJ, Marconi VC, Hill CE, Sullivan JN, Johnson DW, Lisco SJ,
Mulligan MJ, Uyeki TM, McElroy AK, Sealy T, Campbell S, Spiropoulou C, Ströher U, Crozier I,
Sacra R, Connor MJ Jr, Sueblinvong V, Franch HA, Smith PW, Ribner BS. Nebraska
Biocontainment Unit and the Emory Serious Communicable Diseases Unit. Clin Infect Dis. 2015;
61(4):496–502. [PubMed: 25904375]
20. McElroy AK, Akondy RS, Davis CW, Ellebedy AH, Mehta AK, Kraft CS, Lyon GM, Ribner BS,
Varkey J, Sidney J, Sette A, Campbell S, Ströher U, Damon I, Nichol ST, Spiropoulou CF, Ahmed
R. Human Ebola virus infection results in substantial immune activation. Proc Natl Acad Sci U S
A. 2015; 112(15):4719–24. [PubMed: 25775592]
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�Varkey and Ribner
Page 12
Author Manuscript
Author Manuscript
Author Manuscript
Author Manuscript
21. Mupapa K, Massamba M, Kibadi K, Kuvula K, Bwaka A, Kipasa M, Colebunders R, MuyembeTamfum JJ. Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent
patients. International Scientific and Technical Committee. J Infect Dis. 1999 179 Suppl. 1999;
1:S18–23.
22. Dye JM, Herbert AS, Kuehne AI, Barth JF, Muhammad MA, Zak SE, Ortiz RA, Prugar LI, Pratt
WD. Postexposure antibody prophylaxis protects nonhuman primates from filovirus disease. Proc
Natl Acad Sci U S A. 2012; 109(13):5034–9. [PubMed: 22411795]
23. Jahrling PB, Geisbert JB, Swearengen JR, Larsen T, Geisbert TW. Ebola hemorrhagic fever:
evaluation of passive immunotherapy in nonhuman primates. J Infect Dis 196 Suppl. 2007;
2:S400–3.
24. Qiu X, Wong G, Audet J, Bello A, Fernando L, Alimonti JB, Fausther-Bovendo H, Wei H, Aviles
J, Hiatt E, Johnson A, Morton J, Swope K, Bohorov O, Bohorova N, Goodman C, Kim D, Pauly
MH, Velasco J, Pettitt J, Olinger GG, Whaley K, Xu B, Strong JE, Zeitlin L, Kobinger GP.
Reversion of advanced Ebola virus disease in nonhuman primates with ZMapp. Nature. 2014;
514(7520):47–53. [PubMed: 25171469]
25. Lyon GM, Mehta AK, Varkey JB, Brantly K, Plyler L, McElroy AK, Kraft CS, Towner JS,
Spiropoulou C, Ströher U, Uyeki TM, Ribner BS, Emory Serious Communicable Diseases Unit.
Clinical care of two patients with Ebola virus disease in the United States. N Engl J Med. 2014;
371(25):2402–9. [PubMed: 25390460]
26. Wong G, Qiu X. Development of experimental and early investigational drugs for the treatment of
Ebola virus infections. Expert Opin Investig Drugs. 2015; 24(8):999–1011.
27. Geisbert TW, Lee AC, Robbins M, Geisbert JB, Honko AN, Sood V, Johnson JC, de Jong S,
Tavakoli I, Judge A, Hensley LE, Maclachlan I. Postexposure protection of non-human primates
against a lethal Ebola virus challenge with RNA interference: a proof-of-concept study. Lancet.
2010; 375(9729):1896–905. [PubMed: 20511019]
28. Geisbert TW, Hensley LE, Kagan E, Yu EZ, Geisbert JB, Daddario-DiCaprio K, Fritz EA, Jahrling
PB, McClintock K, Phelps JR, Lee AC, Judge A, Jeffs LB, MacLachlan I. Postexposure protection
of guinea pigs against a lethal ebola virus challenge is conferred by RNA interference. J Infect Dis.
2006; 193(12):1650–7. [PubMed: 16703508]
29. Pollack, A. Clinical trial of experimental ebola drug is halted. New York Times; 2015. http://
www.nytimes.com/2015/06/20/health/clinical-trial-of-experimental-ebola-drug-is-halted.html?
_r=0
30. Sissoko, D.; Folkesson, E.; Abdoul, M.; Beavogi, AH.; Gunther, S.; Shepherd, S.; Danel, C.;
Mentre, F.; Anglaret, X.; Malvy, D. Favipiravir in patients with Ebola virus disease: Early results
of the JIKI trial in Guinea.. Conference on Retroviruses and Opportunistic Infections (CROI);
Seattle, Washington. 2015. Abstract 103-ALB
31. Sullivan NJ, Martin JE, Graham BS, Nabel GJ. Correlates of protective immunity for Ebola
vaccines: implications for regulatory approval by the animal rule. Nat Rev Microbiol. 2009; 7(5):
393–400. [PubMed: 19369954]
32. Geisbert TW, Pushko P, Anderson K, Smith J, Davis KJ, Jahrling PB. Evaluation in nonhuman
primates of vaccines against Ebola virus. Emerg Infect Dis. 2002; 8(5):503–7. [PubMed:
11996686]
33. Reynard O, Mokhonov V, Mokhonova E, Leung J, Page A, Mateo M, Pyankova O, GeorgesCourbot MC, Raoul H, Khromykh AA, Volchkov VE. Kunjin virus replicon-based vaccines
expressing Ebola virus glycoprotein GP protect the guinea pig against lethal Ebola virus infection.
J Infect Dis 204 Suppl. 2011; 3:S1060–5.
34. Hoenen T, Groseth A, Feldmann H. Current ebola vaccines. Expert Opin Biol Ther. 2012; 12(7):
859–72. [PubMed: 22559078]
35. Qiu X, Fernando L, Alimonti JB, Melito PL, Feldmann F, Dick D, Ströher U, Feldmann H, Jones
SM. Mucosal immunization of cynomolgus macaques with the VSVDeltaG/ZEBOVGP vaccine
stimulates strong ebola GP-specific immune response. PLoS One. 2009; 4(5):e5547. [PubMed:
19440245]
36. Agnandji ST, Huttner A, Zinser ME, Njuguna P, Dahlke C, Fernandes JF, Yerly S, Dayer JA,
Kraehling V, Kasonta R, Adegnika AA, Altfeld M, Auderset F, Bache EB, Biedenkopf N,
Borregaard S, Brosnahan JS, Burrow R, Combescure C, Desmeules J, Eickmann M, Fehling SK,
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�Varkey and Ribner
Page 13
Author Manuscript
Author Manuscript
Author Manuscript
Author Manuscript
Finckh A, Goncalves AR, Grobusch MP, Hooper J, Jambrecina A, Kabwende AL, Kaya G, Kimani
D, Lell B, Lemaître B, Lohse AW, Massinga-Loembe M, Matthey A, Mordmüller B, Nolting A,
Ogwang C, Ramharter M, Schmidt-Chanasit J, Schmiedel S, Silvera P, Stahl FR, Staines HM,
Strecker T, Stubbe HC, Tsofa B, Zaki S, Fast P, Moorthy V, Kaiser L, Krishna S, Becker S, Kieny
MP, Bejon P, Kremsner PG, Addo MM, Siegrist CA. Phase 1 Trials of rVSV Ebola Vaccine in
Africa and Europe - Preliminary Report. N Engl J Med. 2015 Epub ahead of print.
37. Henao-Restrepo AM, Longini IM, Egger M, Dean NE, Edmunds WJ, Camacho A, Carroll MW,
Doumbia M, Draguez B, Duraffour S, Enwere G, Grais R, Gunther S, Hossmann S, Kondé MK,
Kone S, Kuisma E, Levine MM, Mandal S, Norheim G, Riveros X, Soumah A, Trelle S, Vicari
AS, Watson CH, Kéïta S, Kieny MP, Røttingen JA. Efficacy and effectiveness of an rVSV-vectored
vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination
cluster-randomised trial. Lancet. 2015; 386(9996):857–66. [PubMed: 26248676]
38. Sullivan NJ, Hensley L, Asiedu C, Geisbert TW, Stanley D, Johnson J, Honko A, Olinger G, Bailey
M, Geisbert JB, Reimann KA, Bao S, Rao S, Roederer M, Jahrling PB, Koup RA, Nabel GJ.
CD8+ cellular immunity mediates rAd5 vaccine protection against Ebola virus infection of
nonhuman primates. Nat Med. 2011; 17(9):1128–31. [PubMed: 21857654]
39. Ledgerwood JE, Costner P, Desai N, Holman L, Enama ME, Yamshchikov G, Mulangu S, Hu Z,
Andrews CA, Sheets RA, Koup RA, Roederer M, Bailer R, Mascola JR, Pau MG, Sullivan NJ,
Goudsmit J, Nabel GJ, Graham BS, VRC 205 Study Team. A replication defective recombinant
Ad5 vaccine expressing Ebola virus GP is safe and immunogenic in healthy adults. Vaccine. 2010;
29(2):304–13. [PubMed: 21034824]
40. Bausch DG, Towner JS, Dowell SF, Kaducu F, Lukwiya M, Sanchez A, Nichol ST, Ksiazek TG,
Rollin PE. Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. J
Infect Dis 196 Suppl. 2007; 2:S142–7.
41. Centers for Disease Control and Prevention. Hospital preparedness: A tiered approach. 2014. http://
www.cdc.gov/vhf/ebola/healthcare-us/preparing/treatment-centers.html
42. Smith PW, Anderson AO, Christopher GW, Cieslak TJ, Devreede GJ, Fosdick GA, Greiner CB,
Hauser JM, Hinrichs SH, Huebner KD, Iwen PC, Jourdan DR, Kortepeter MG, Landon VP,
Lenaghan PA, Leopold RE, Marklund LA, Martin JW, Medcalf SJ, Mussack RJ, Neal RH, Ribner
BS, Richmond JY, Rogge C, Daly LA, Roselle GA, Rupp ME, Sambol AR, Schaefer JE, Sibley J,
Streifel AJ, Essen SG, Warfield KL. Designing a biocontainment unit to care for patients with
serious communicable diseases: a consensus statement. Biosecur Bioterror. 2006; 4(4):351–65.
[PubMed: 17238819]
43. Hewlett AL, Varkey JB, Smith PW, Ribner BS. Ebola virus disease: preparedness and infection
control lessons learned from two biocontainment units. Curr Opin Infect Dis. 2015; 28(4):343–8.
[PubMed: 26098504]
44. Feistritzer NR, Hill C, Vanairsdale S, Gentry J. Care of patients with Ebola virus disease. J Contin
Educ Nurs. 2014; 45:479–481. [PubMed: 25365183]
45. Schwedhelm S, Beam EL, Morris RD, Sebastian JG. Reflections on interprofessional team-based
clinical care in the Ebola epidemic: the Nebraska medicine experience. Nurs Outlook. 2015;
63:27–29. [PubMed: 25645479]
46. Centers for Disease Control and Prevention. Guidance on Personal Protective Equipment (PPE) To
Be Used By Healthcare Workers during Management of Patients with Confirmed Ebola or Persons
under Investigation (PUIs) for Ebola who are Clinically Unstable or Have Bleeding, Vomiting, or
Diarrhea in U.S. Hospitals, Including Procedures for Donning and Doffing PPE. 2015. http://
www.cdc.gov/vhf/ebola/healthcare-us/ppe/guidance.html
47. MacIntyre CR, Chughtai AA, Seale H, Richards GA, Davidson PM. Uncertainty, risk analysis and
change for Ebola personal protective equipment guidelines. Int J Nurs Stud. 2015; 52(5):899–903.
[PubMed: 25575750]
48. Iwen PC, Smith PW, Hewlett AL, Kratochvil CJ, Lisco SJ, Sullivan JN, Gibbs SG, Lowe JJ, Fey
PD, Herrera VL, Sambol AR, Wisecarver JL, Hinrichs SH. Safety considerations in the laboratory
testing of specimens suspected or known to contain Ebola virus. Am J Clin Pathol. 2015; 143(1):
4–5. [PubMed: 25511134]
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
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49. Centers for Disease Control and Prevention. Guidance for U.S. Laboratories for Managing and
Testing Routine Clinical Specimens When There is a Concern About Ebola Virus Disease. 2015.
http://www.cdc.gov/vhf/ebola/healthcare-us/laboratories/safe-specimen-management.html
50. American Society for Microbiology. Interim laboratory guidelines for handling/testing specimens
from cases or suspected cases of hemorrhagic fever virus (HFV). 2014. https://www.asm.org/
images/PSAB/Ebola9-10-14.pdf
51. Hill CE, Burd EM, Kraft CS, Ryan EL, Duncan A, Winkler AM, Cardella JC, Ritchie JC, Parslow
TG. Laboratory test support for Ebola patients within a high-containment facility. Lab Med. 2014;
45(3):e109–11. [PubMed: 25184220]
52. Centers for Disease Control and Prevention. Procedures for safe handline and management of
Ebola-associated waste. 2014. http://www.cdc.gov/vhf/ebola/healthcareus/cleaning/handlingwaste.html
53. Centers for Disease Control and Prevention. Interim guidance for environmental infection control
in hospitals for Ebola virus. 2015. http://www.cdc.gov/vhf/ebola/healthcareus/cleaning/
hospitals.html
54. United States Environmental Protection Agency. List L: Disinfectants for use against the Ebola
virus. 2015. http://www.epa.gov/pesticide-registration/list-l-disinfectants-use-against-ebola-virus
55. Lowe JJ, Olinger PL, Gibbs SG, Rengarajan K, Beam EL, Boulter KC, Schwedhelm MM, Hayes
AK, Kratochvil CJ, Vanairsdale S, Frislie B, Lewis J, Hewlett AL, Smith PW, Gartland B, Ribner
BS. Environmental infection control considerations for Ebola. Am J Infect Control. 2015; 43(7):
747–9. [PubMed: 25934067]
56. Gates B. The next epidemic--lessons from Ebola. N Engl J Med. 2015; 372(15):1381–4. [PubMed:
25853741]
57. Dzau VJ, Rodin J. Creating a Global Health Risk Framework. N Engl J Med. 2015; 373(11):991–3.
[PubMed: 26244878]
58. World Health Organization. Report of the Ebola interim assessment panel. 2015. http://
www.who.int/csr/resources/publications/ebola/ebola-interim-assessment/en/
59. World Health Organization. Factors that contributed to undetected spread of the Ebola virus and
impeded rapid containment. 2015. http://www.who.int/csr/disease/ebola/one-year-report/
factors/en/
60. National Academy of Medcine. Global health risk framework. 2016. http://nam.edu/initiatives/
global-health-risk-framework/
61. World Health Organization. WHO Secretariat response to the report of the Ebola interim
assessment panel. 2015. http://www.who.int/csr/resources/publications/ebola/who-responsetoebola-report.pdf
62. Wayne, Alex. Congress nearly grants Obama's Ebola wish list with $5.4B. Bloomberg. 2014. http://
www.bloomberg.com/news/articles/2014-12-10/congress-nearly-grants-obama-s-ebola-wish-listwith-5-4b
63. U.S. Department of Health & Human Services. HHS invests in enhancing domestic preparedness
efforts for Ebola. 2015. http://www.hhs.gov/about/news/2015/02/20/hhs-invests-in-enhancingdomestic-preparedness-efforts-for-ebola.html
Author Manuscript
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Figure 1.
Schematic of the Serious Communicable Diseases Unit (SCDU), Emory University Hospital
Author Manuscript
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
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Table 1
Author Manuscript
Factors Contributing to 2013-2015 Ebola Outbreak (58, 59)
• Failure of member States to implement the core capacities called for under the International Health Regulations (2005)
• The implementation of travel bans and other measures that interfered with the response to the outbreak
• Delays in the declaration of a Public Health Emergency of International Concern (PHEIC) by WHO
• Lack of familiarity with Ebola by healthcare providers and public health officials in West Africa
• The unique introduction of Ebola into an urban setting for the first time as opposed to rural villages
• Poor public health infrastructure due to years of civil war
• A severe shortage of healthcare workers exacerbated by the many healthcare workers who became infected with the Ebola virus early in the
outbreak
• Closure of healthcare facilities and departure of foreign healthcare workers due to perceived danger as the outbreak peaked
• High risk funeral and burial practices in West African countries
• Community resistance due to suspicion of the government and lack of familiarity with Ebola
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Table 2
Author Manuscript
WHO's Agenda for Change (61)
• Strengthening of the International Health Regulations
• Identifying addition resources to support public health infrastructure in member states
• Implementation of objective measures to assess core capacities of member states
• Altering the WHO structure and culture to improve emergency preparedness and response capacity
• Development of a global health emergency workforce to respond to outbreaks and emergencies with health consequences
• Improved integration of health security and humanitarian systems
• Development of a unified WHO program for outbreaks and emergencies
• Development of an “R and D Blueprint” to accelerate research and development on diagnostics, vaccines and therapeutics during outbreaks
and health emergencies
• Establishment of a WHO Contingency Fund for Emergencies to establish adequate international financing for pandemics and other health
emergencies
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Table 3
Author Manuscript
Emergency Medical Services and Emergency Department preparedness
• Patient transport
• Staffing
• PPE and donning/doffing procedures
• HCW Monitoring and management of exposures
• Lab safety and capacity
• Environmental infection control
• Waste management
• Coordinated communication
• Management of special populations
Author Manuscript
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Author Manuscript
Microbiol Spectr. Author manuscript; available in PMC 2016 June 27.
�
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Preparing for Serious Communicable Diseases in the United States: What the Ebola Virus Epidemic Has Taught Us
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Discover
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
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https://www.ncbi.nlm.nih.gov/pubmed/27337477
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922497/
Citation
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Varkey, J. B. and B. S. Ribner (2016). "Preparing for Serious Communicable Diseases in the United States: What the Ebola Virus Epidemic Has Taught Us." Microbiol Spectr 4(3).
Abstract
Ending the West Africa Ebola virus disease (EVD) outbreak required an unprecedented international response. For the United States, participation in the international response to the West Africa EVD outbreak provided an opportunity to learn important lessons in four key domains critical to preparing for future outbreaks of EVD and other serious communicable diseases: (i) safe and effective patient care, (ii) the role of experimental therapeutics and vaccines, (iii) infection control, and (iv) hospital and community preparedness.
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Title
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Preparing for Serious Communicable Diseases in the United States: What the Ebola Virus Epidemic Has Taught Us
Creator
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Varkey, J. B. and B. S. Ribner
Subject
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General
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Ending the West Africa Ebola virus disease (EVD) outbreak required an unprecedented international response.
Date
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2016-06-01
Type
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Publication
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2022-01-10 by PPE group Shawn Gibbs
Coverage
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2025-01-10
Antibodies
Contact Transmission
Critical Care
Droplet Transmission
Ebola
Epidemic
Infection Prevention and Control
Outbreaks
Patient Care
Personal Protective Equipment (PPE)
Prophylaxis
Public Health
R-PPE
R-Res&Pub
Therapeutics
Vaccine Study
Viral Hemorrhagic Fever
-
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Discover
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
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A peer reviewed publication.
URL
https://www.ajicjournal.org/article/S0196-6553(14)00434-9/abstract
Citation
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Swanhorst, J., K. Boulter, A. Vasa, B. Boeckman and M. Schwedhelm (2014). "A detailed instructional process for donning and doffing level C personal protective equipment in a healthcare setting." American Journal of Infection Control 42(6): S93.
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Abstract
Use of Level C personal protective equipment is an uncommon practice in the routine provision of nursing care. The Nebraska Biocontainment Unit (NBU) developed a procedure to instruct healthcare professionals in the use of Level C personal protective equipment for the care of a highly infectious patient. The complexity of the procedure necessitated the development of a step- by- step picture guided poster to educate staff in the proper sequencing and use of the equipment.
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A detailed instructional process for donning and doffing level C personal protective equipment in a healthcare setting
Creator
An entity primarily responsible for making the resource
Swanhorst, J., K. Boulter, A. Vasa, B. Boeckman and M. Schwedhelm
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Training and Exercises
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2014-06-09
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Use of Level C personal protective equipment is an uncommon practice in the routine provision of nursing care.
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Publication
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2022-01-10 by PPE group Shawn Gibbs
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2025-01-10
Donning and Doffing
Personal Protective Equipment (PPE)
R-PPE
-
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
URL
https://www.ncbi.nlm.nih.gov/pubmed/28636442
Read Online
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6532632/
Citation
Citation information for the publication itself.
Kratochvil, C. J., L. Evans, B. S. Ribner, J. J. Lowe, M. C. Harvey, R. C. Hunt, A. J. Tumpey, R. P. Fagan, M. M. Schwedhelm, S. Bell, J. Maher, C. S. Kraft, N. V. Cagliuso, Sr., S. Vanairsdale, A. Vasa and P. W. Smith (2017). "The National Ebola Training and Education Center: Preparing the United States for Ebola and Other Special Pathogens." Health Secur 15(3): 253-260.
Abstract
The National Ebola Training and Education Center (NETEC) was established in 2015 in response to the 2014-2016 Ebola virus disease outbreak in West Africa. The US Department of Health and Human Services office of the Assistant Secretary for Preparedness and Response and the US Centers for Disease Control and Prevention sought to increase the competency of healthcare and public health workers, as well as the capability of healthcare facilities in the United States, to deliver safe, efficient, and effective care to patients infected with Ebola and other special pathogens nationwide. NYC Health + Hospitals/Bellevue, Emory University, and the University of Nebraska Medical Center/Nebraska Medicine were awarded this cooperative agreement, based in part on their experience in safely and successfully evaluating and treating patients with Ebola virus disease in the United States. In 2016, NETEC received a supplemental award to expand on 3 initial primary tasks: (1) develop metrics and conduct peer review assessments; (2) develop and provide educational materials, resources, and tools, including exercise design templates; (3) provide expert training and technical assistance; and, to add a fourth task, create a special pathogens clinical research network.
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pay online - or through Liebert connect, author manuscript free on PubMed Central
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The National Ebola Training and Education Center: Preparing the United States for Ebola and Other Special Pathogens
Creator
An entity primarily responsible for making the resource
Kratochvil, C. J., L. Evans, B. S. Ribner, J. J. Lowe, M. C. Harvey, R. C. Hunt, A. J. Tumpey, R. P. Fagan, M. M. Schwedhelm, S. Bell, J. Maher, C. S. Kraft, N. V. Cagliuso, Sr., S. Vanairsdale, A. Vasa and P. W. Smith
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The National Ebola Training and Education Center (NETEC) was established in 2015 in response to the 2014-2016 Ebola virus disease outbreak in West Africa.
Date
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2017-06-01
Type
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Publication
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2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Ebola
Isolation/Biocontainment
NETEC
Personal Protective Equipment (PPE)
R-PPE
Special Pathogens
Training
-
https://repository.netecweb.org/files/original/1ec9018aafadda2013b7f83d0d67e5e5.pdf
136dd47d8e6050d2dc197296e070c31a
PDF Text
Text
Hindawi
BioMed Research International
Volume 2017, Article ID 7458242, 2 pages
https://doi.org/10.1155/2017/7458242
Letter to the Editor
Comment on (Ebola Virus Infection among Western Healthcare
Workers Unable to Recall the Transmission Route)
Mark G. Kortepeter,1,2,3 Theodore J. Cieslak,4 Elena H. Kwon,5 Philip W. Smith,6
Christopher J. Kratochvil,7,8,9 and Angela L. Hewlett10
1
Medical Division, Laulima Government Solutions, Orlando, FL, USA
US Army Medical Research Institute of Infectious Diseases (USAMRIID), Fort Detrick, MD, USA
3
College of Public Health, University of Nebraska, Omaha, NE, USA
4
Nebraska Biocontainment Unit and College of Public Health, University of Nebraska, Omaha, NE, USA
5
Medical Division, USAMRIID, 1425 Porter Street, Fort Detrick, MD 21702, USA
6
College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
7
University of Nebraska Medical Center, Omaha, NE, USA
8
Nebraska Medicine, Omaha, NE, USA
9
UNeHealth, Omaha, NE, USA
10
Division of Infectious Diseases and Nebraska Biocontainment Unit, University of Nebraska Medical Center, Omaha, NE, USA
2
Correspondence should be addressed to Mark G. Kortepeter; mark.kortepeter@gmail.com
Received 14 February 2017; Accepted 3 August 2017; Published 20 September 2017
Academic Editor: Gelin Xu
Copyright © 2017 Mark G. Kortepeter et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
We read with interest the recent paper by Petti et al. entitled
“Ebola Virus Infection among Western Healthcare Workers
Unable to Recall the Transmission Route” [1]. Although the
article relies on prior reports from healthcare organizations
or magazine and newspaper articles rather than direct interviews with the patients themselves, we still believe the article
potentially validates some of our concerns related to caring
for patients infected with Ebola virus.
During the 2014–16 Ebola virus outbreak in West Africa,
healthcare workers were at greater risk of infection than the
population at large [2]. The African healthcare environment
is much less controlled than a developed-world healthcare
facility; however, as noted by Petti et al. [1], in both developed
and underdeveloped settings, even contacts deemed to be
low risk ended up becoming infected. Without an easily
identifiable breach in personal protective measures, such as a
recognized mucosal splash or needle stick, it is impossible to
pinpoint definitively the exact moment or mechanism of
exposure.
We still have much to learn regarding potential exposure
mechanisms and exposure routes in the clinical setting.
Therefore, as we have argued previously, there is no room for
error with a disease like Ebola that leads to the production of
copious amounts of body fluids with high viral titers, along
with the usual challenges of following infection control and
safety protocols to the letter in any healthcare setting [3]. This
is why we continue to advocate for the utilization of high-level
containment care units, when such facilities are available, for
viral hemorrhagic fevers that have demonstrated infection
of healthcare workers, like Ebola, Marburg, Crimean Congo
hemorrhagic fever, and Lassa viruses, and potentially others
[4]. This option protects caregivers through sophisticated
engineering controls (directional airflow, hot/cold designations to identify graduated infection risk, and pass-through
autoclaves), restricted access, staff who are well-practiced in
donning and doffing protocols, and other unique infection
control practices needed to limit spread to healthcare workers
[5].
�2
Disclosure
The views expressed herein are those of the authors and do
not reflect the official policy or position of the US Army
Medical Research Institute of Infectious Diseases, the Medical
Research and Materiel Command, the US Army Medical
Department, the Department of the Army, Department of
Defense, or the US Government. The views expressed also do
not reflect those of the School of Public Health or University
of Nebraska Medical Center.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
References
[1] S. Petti, C. Protano, G. A. Messano, and C. Scully, “Ebola virus
infection among western healthcare workers unable to recall the
transmission route,” BioMed Research International, vol. 2016,
Article ID 8054709, 2016.
[2] World Health Organization, “Health worker infections in
Guinea, Liberia, and Sierra Leone: a preliminary report,” 2015,
http://www.who.int/csr/resources/publications/ebola/healthworker-infections/en/.
[3] M. G. Kortepeter, P. W. Smith, A. Hewlett, and T. J. Cieslak,
“Caring for patients with Ebola: a challenge in any care facility,”
Annals of Internal Medicine, vol. 162, no. 1, pp. 68-69, 2015.
[4] M. G. Kortepeter, E. H. Kwon, A. L. Hewlett, P. W. Smith, and T.
J. Cieslak, “Containment care units for managing patients with
highly hazardous infectious diseases: a concept whose time has
come,” Journal of Infectious Diseases, vol. 214, pp. S137–S141,
2016.
[5] A. L. Hewlett, J. B. Varkey, P. W. Smith, and B. S. Ribner,
“Ebola virus disease: preparedness and infection control lessons
learned from two biocontainment units,” Current Opinion in
Infectious Diseases, vol. 28, no. 4, pp. 343–348, 2015.
BioMed Research International
�
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Comment on "Ebola Virus Infection among Western Healthcare Workers Unable to Recall the Transmission Route"
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
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https://www.ncbi.nlm.nih.gov/pubmed/29085841
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Kortepeter, M. G., T. J. Cieslak, E. H. Kwon, P. W. Smith, C. J. Kratochvil and A. L. Hewlett (2017). "Comment on "Ebola Virus Infection among Western Healthcare Workers Unable to Recall the Transmission Route"." Biomed Res Int 2017: 7458242.
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Kortepeter, M. G., T. J. Cieslak, E. H. Kwon, P. W. Smith, C. J. Kratochvil and A. L. Hewlett
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Infection Control
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We read with interest the recent paper by Petti et al. entitled “Ebola Virus Infection among Western Healthcare Workers Unable to Recall the Transmission Route”...
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2022-01-10 by PPE group Shawn Gibbs
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2025-01-10
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Ebola
Infection Prevention and Control
Occupational Exposure
Occupational Health
Personal Protective Equipment (PPE)
R-PM
R-PPE
R-Res&Pub
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https://repository.netecweb.org/files/original/f6d74bc9187747a3044c10f7908b5ee7.pdf
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Text
Special Report
Laboratory Test Support for Ebola Patients
Within a High-Containment Facility
Charles E. Hill, MD, PhD,1 Eileen M. Burd, PhD,1 Colleen S. Kraft, MD,1 Emily L. Ryan, PhD,1
Alexander Duncan, MD,1 Anne M. Winkler, MD,1 John C. Cardella,2 James C. Ritchie, PhD,1
Tristram G. Parslow, MD, PhD1*
Lab Med Summer 2014 45:e109-e111
DOI: 10.1309/LMTMW3VVN20HIFS
Two adult United States (US) nationals contracted the
Ebola virus while on a humanitarian mission in Africa
amidst a large Ebola outbreak there. They were admitted to our medical center (Emory University Hospital in
Atlanta, GA) during the first week of August 2014 for treatment. Both survived their illness and were released after
approximately 3 weeks of inpatient care. We received approximately 3 days’ advance notice that the first patient
would be transported from Africa to our medical center;
the second patient arrived 3 days after the first. The diagnosis in each case had been confirmed virologically by
detecting Ebola-specific nucleic acid in blood specimens
sent to a World Health Organization laboratory in Europe;
however, few details of either patient’s condition had been
available to us before their arrival. Herein, we summarize
the approach we used to plan for and provide laboratory
diagnostic testing during their treatment.
Both patients were admitted to a specialized isolation
unit that had been established at our hospital 12 years
previously, in collaboration with the Centers for Disease
Abbreviations
US, United States; CDC, Centers for Disease Control and Prevention;
HIV, human immunodeficiency virus; POC, point-of-care; DIC, disseminated intravascular coagulation; INR, international normalized ratio;
CBC, complete blood count; PCR, polymerase chain reaction
Keywords
Ebola Virus, high-containment unit, point-of-care laboratory testing,
infection prevention, personal protective equipment
Department of Pathology and Laboratory Medicine, 1Emory University
and 2Emory Medical Laboratories, Atlanta, GA
*To whom correspondence should be addressed.
tparslo@emory.edu
Control and Prevention (CDC), as a resource for safely
quarantining, evaluating, and caring for small numbers of
patients with unidentified or highly contagious infectious
diseases. At the core of this unit are 3 patient rooms that
are physically separate from other patient-care areas of the
hospital, are maintained under negative air pressure, and
have highly restricted access. A small, specially trained
team of volunteer caregivers (primarily infectious disease
physicians and critical care nurses) who have planned and
rehearsed for incidents of this type for more than a decade
staffs the facility.
The degree of containment afforded by this facility substantially exceeds CDC guidelines for managing Ebola,1
a nonairborne pathogen that is transmitted principally via
bodily fluids or direct contact and is readily inactivated by
conventional disinfectants. The risk and routes of contagion with Ebola are judged to be comparable to those of
human immunodeficiency virus (HIV) or of the hepatitis B
or C viruses, pathogens that are handled safely and routinely in conventionally equipped hospitals and clinical laboratories using universal, contact, and droplet precautions.
Given the availability of this specialized quarantine facility
at our institution, however, it was deemed appropriate to
use it in caring for these patients in order to afford maximal
safety and reassurance to our hospital staff and patients,
to avoid disrupting other hospital operations, and to respect the heightened public and media attention prevailing
at the time, as these were the first cases of Ebola infection
to be treated in North America.
The previously established operating procedures for the
isolation facility anticipated that the subspecialist nurses
working within it would perform all venipunctures and other
specimen collection procedures. Also, these nurses would
perform a limited menu of assays using standard point-ofcare (POC) instruments situated inside the unit. It had been
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�Special Report
anticipated that other diagnostic testing for most types of
infectious agents could be performed safely in the clinical
laboratories of the hospital using established protocols.
During final preparations for the arrival of these patients,
however, it was agreed, in an abundance of caution, that
no diagnostic specimens of any kind would leave the unit
for testing, with the exception of any that might be collected by and delivered to the CDC or other appropriate
government health agencies. That policy was communicated to laboratory staff and physicians before the arrival
of the 2 patients infected with Ebola. We believe, in retrospect, that this policy was highly effective and beneficial
in alleviating any initial concerns about potential exposure
among phlebotomists and laboratory personnel. Nevertheless, it created the need for us to offer a broader range of
POC tests within the unit that might be required for optimal
care of patients infected with Ebola. In addition, this policy
made it impractical for us, within the limited time available,
to train clinician staff to calibrate, validate, and operate the
instruments necessary to perform those additional tests.
In response, our strategy was to establish a self-contained
POC laboratory that could support all requisite testing
within the quarantine facility itself and to develop a team
of volunteer clinical pathologists and laboratory technical
staff with expertise in POC testing who could perform all
assays on site. We designed our test menu in close consultation with the infectious disease specialists caring for
these patients, taking into account the available literature
on the natural history of Ebola disease. Fatal outcomes of
Ebola hemorrhagic fever are most commonly linked to disseminated intravascular coagulation (DIC) eventuating in
multiorgan failure, septic shock, or acute hepatic necrosis.
We therefore selected the following instruments to provide core metabolic, coagulation, microbiologic, and other
assays:
• Chemistry analyzer (Abaxis Piccolo Xpress [ABAXIS,
Inc, Union City, CA]) to perform chemistry profiles;
magnesium, phosphate, and liver-enzyme assays; etc)
• Arterial blood-gas analyzer (GEM Premier 4000
[Werfen, Barcelona, Spain])
• Automated urinalysis analyzer (CLINITEK Status
[Siemens Corp., Munich, Germany)]
• Coagulation analyzer (CoaguChek [F. Hoffman-
La Roche, Ltd, Basel, Switzerland]) for determinations
of prothrombin time and international normalized ratio
(INR)
• Hematology analyzer (pocH 100i [Sysmex Corporation, Kobe, Japan]) for complete blood count (CBC)
• Malaria POC device (Alere BinaxNOW [Alere, Inc,
Waltham, MA])
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• Polymerase chain reaction (PCR)–based microbiological analyzer (BioFire FilmArray [BioFire Diagnostics,
Inc, Salt Lake City, UT]) designed to detect a panel of
viral, bacterial, fungal, or parasitic pathogens, many
of which might be found in patients returning from
a resource-poor region and might complicate care.
Among other pathogen-specific markers, this instrument detects Ebola viral RNA, a capability that we
believe could have value for monitoring progression of
and recovery from Ebola infection in this setting.
Most of these instruments were housed together within a
4-foot laminar flow biosafety containment hood located
in a small, dedicated room in the isolation facility. The exceptions were the complete blood count (CBC) analyzer
and the BioFire instrument, which were placed on a table
adjacent to the hood. This configuration positioned all instruments a few feet outside the doors of the rooms that
housed the 2 patients. The nurses collected specimens in
those rooms, sealed the specimens in double bags, placed
them in a plastic transport box, and delivered them to the
laboratory room for testing. Results were reported manually using a networked laptop computer located on the
table beside the hood. All testing was performed by a clinical pathologist or a clinical laboratory technologist experienced in POC testing; each of these individuals had been
trained in the safe handling of infectious pathogens generally and in the specific operating procedures developed for
this isolation facility. A total of 10 volunteers (2 pathology
faculty and 8 laboratory staff) were trained to carry out
laboratory testing in the isolation unit; 2 of them were present whenever testing was performed. All personnel wore
disposable impermeable Tyvek suits (DuPont, Wilmington,
DE), double gloves, foot covers, protective eyewear, and
face shields. This personal protective equipment, like all
other materials used or generated in the facility, was sterilized after use by autoclaving within the isolation unit before
being disposed as regulated medical waste.
Other than the first day of admission for each of the 2 patients, the testing was conducted daily on a routine basis
in a single morning session. Although our laboratory team
was on call to provide after-hours service on a rotating
basis around the clock, this type of service was not required during these 2 patients’ hospital stay.
To minimize the risk of generating aerosols, we did not perform any centrifugation. Instead, we performed all separations of serum and plasma via gravity settling. Any blood
or blood product transfusions would have been performed
under emergency release criteria using available supplies
www.labmedicine.com
�Special Report
of universal donor products (eg, group-O red blood cells or
group-AB plasma).
In this report we offer a description of, and our underlying
rationale for, the approach we took in providing laboratory
test support for our 2 patients infected with Ebola virus,
given the particular circumstances and the facilities available to us. Our approach exceeded the requirements of
the CDC for safe management of patients infected with
Ebola. This description is not intended as a recommendation or endorsement of any specific instruments, tests, or
procedures. The test menu and procedures we performed
proved to be fully sufficient for the care of our 2 patients;
however, the menu and procedures may require refinement over longer courses of treatment or for management
of other cases. We feel privileged to have been able to
contribute to the care of these patients and hope that this
information will be useful to other healthcare professionals
in addressing similar cases. LM
References
1.
Infection Prevention and Control Recommendations for
Hospitalized Patients with Known or Suspected Ebola
Hemorrhagic Fever in U.S. Hospitals. Centers for Disease
Control and Prevention Web site. Available at: http://www.
cdc.gov/vhf/ebola/hcp/infection-prevention-and-controlrecommendations.html. Accessed on: August 28, 2014.
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Laboratory test support for Ebola patients within a high-containment facility
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
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Publication
A peer reviewed publication.
URL
https://www.ncbi.nlm.nih.gov/pubmed/25184220
Read Online
Online location of the resource.
https://academic.oup.com/labmed/article/45/3/e109/2657899
Citation
Citation information for the publication itself.
Hill, C. E., E. M. Burd, C. S. Kraft, E. L. Ryan, A. Duncan, A. M. Winkler, J. C. Cardella, J. C. Ritchie and T. G. Parslow (2014). "Laboratory test support for Ebola patients within a high-containment facility." Lab Med 45(3): e109-111.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
free online - Oxford Academic
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Title
A name given to the resource
Laboratory test support for Ebola patients within a high-containment facility
Creator
An entity primarily responsible for making the resource
Hill, C. E., E. M. Burd, C. S. Kraft, E. L. Ryan, A. Duncan, A. M. Winkler, J. C. Cardella, J. C. Ritchie and T. G. Parslow
Subject
The topic of the resource
Laboratory
Description
An account of the resource
Two adult United States (US) nationals contracted the Ebola virus while on a humanitarian mission in Africa amidst a large Ebola outbreak there.
Date
A point or period of time associated with an event in the lifecycle of the resource
2014-08-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Diagnosis
Ebola
Infection Prevention and Control
Lab
Laboratory
Laboratory Testing
Malaria
Personal Protective Equipment (PPE)
R-Lab
R-PPE
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
URL
https://www.ncbi.nlm.nih.gov/pubmed/25811520
Citation
Citation information for the publication itself.
Beam, E., S. G. Gibbs, A. L. Hewlett, P. C. Iwen, S. L. Nuss and P. W. Smith (2015). "Clinical challenges in isolation care." Am J Nurs 115(4): 44-49.
Abstract
OVERVIEW: In 2014, the authors published the results of a study investigating nurses' use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions. The 24 participants were video-recorded as they donned and doffed PPE. Variations in practices that had the potential to cause contamination were noted. In this article, the authors comment on those variations, analyzing each element of proper PPE protocols and examining why the behaviors are a safety concern for the nurse and a potential risk for disease transmission in the hospital or other clinical area. The authors note that making use of reflective practice for complicated care situations such as infection control may help nurses improve decision making in isolation care.
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pay online - or through ovid subscription
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Title
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Clinical challenges in isolation care.
Creator
An entity primarily responsible for making the resource
Beam, E., S. G. Gibbs, A. L. Hewlett, P. C. Iwen, S. L. Nuss and P. W. Smith
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
In 2014, the authors published the results of a study investigating nurses' use of personal protective equipment (PPE) in the care of a live simulated patient requiring contact and airborne precautions.
Date
A point or period of time associated with an event in the lifecycle of the resource
2015-04-01
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-01-10 by PPE group Shawn Gibbs (both 3 years)
Clinical Care Guidelines
Critical Care
Infection Prevention and Control
Nursing
Patient Care
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
R-T&C
-
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f4a4f48ef9e079fa45404c12852ebe1d
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Hyperlink
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URL
http://emorymedicinemagazine.emory.edu/issues/2018/winter/briefs/after_ebola_outbreak_ppe/index.html
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Title
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After the Ebola Outbreak: Lessons Learned
Creator
An entity primarily responsible for making the resource
Loftus, Mary (editor), Emory Medicine
Subject
The topic of the resource
General
Description
An account of the resource
In the wake of caring for four patients with active Ebola virus in 2014, Emory clinicians have taken stock of lessons learned in infectious disease prevention, therapeutic care, and health aftereffects and are sharing that information broadly with other health care professionals and first responders.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-02-20
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Critical Care
Ebola
Experimental Drugs
Follow up
Infection Prevention and Control
Nursing
Patient Care
Personal Protective Equipment (PPE)
Prophylaxis
R-PPE
Survivors
Therapeutics
Training
Translational Research
-
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Develop
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
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Publication
A peer reviewed publication.
URL
https://www.ncbi.nlm.nih.gov/pubmed/26003001
Citation
Citation information for the publication itself.
Wadman, M. C., S. S. Schwedhelm, S. Watson, J. Swanhorst, S. G. Gibbs, J. J. Lowe, P. C. Iwen, A. K. Hayes, S. Needham, D. W. Johnson, D. J. Kalin, W. G. Zeger and R. L. Muelleman (2015). "Emergency Department Processes for the Evaluation and Management of Persons Under Investigation for Ebola Virus Disease." Ann Emerg Med 66(3): 306-314.
Abstract
INTRODUCTION: Due to the recent Ebola virus outbreak in West Africa, patients with epidemiologic risk for Ebola virus disease and symptoms consistent with Ebola virus disease are presenting to emergency departments (EDs) and clinics in the United States. These individuals, identified as a person under investigation for Ebola virus disease, are initially screened using a molecular assay for Ebola virus. If this initial test is negative and the person under investigation has been symptomatic for < 3 days, a repeat test is required after 3 days of symptoms to verify the negative result. In the time interval before the second test result is available, manifestations of the underlying disease process for the person under investigation, whether due to Ebola virus disease or some other etiology, may require further investigation to direct appropriate therapy. MATERIALS AND METHODS: ED administrators, physicians, and nurses proposed processes to provide care that is consistent with other ED patients. Biocontainment unit administrators, industrial hygienists, laboratory directors, physicians, and other medical personnel examined the ED processes and offered biocontainment unit personal protective equipment and process strategies designed to ensure safety for providers and patients. CONCLUSION: ED processes for the safe and timely evaluation and management of the person under investigation for Ebola virus disease are presented with the ultimate goals of protecting providers and ensuring a consistent level of care while confirmatory testing is pending.
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pay online - or through clinicalkey, or elsevier subscription
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Title
A name given to the resource
Emergency Department Processes for the Evaluation and Management of Persons Under Investigation for Ebola Virus Disease
Creator
An entity primarily responsible for making the resource
Wadman, M. C., S. S. Schwedhelm, S. Watson, J. Swanhorst, S. G. Gibbs, J. J. Lowe, P. C. Iwen, A. K. Hayes, S. Needham, D. W. Johnson, D. J. Kalin, W. G. Zeger and R. L. Muelleman
Subject
The topic of the resource
Intake and Internal Transport
Description
An account of the resource
Due to the recent Ebola virus outbreak in West Africa, patients with epidemiologic risk for Ebola virus disease and symptoms consistent with Ebola virus disease are presenting to emergency departments (EDs) and clinics in the United States.
Date
A point or period of time associated with an event in the lifecycle of the resource
2015-09-01
Type
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Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Clinical Care Guidelines
Diagnosis
Ebola
Emergency Department
Identify
Infection Prevention and Control
Inform
Isolate
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
R-IIT
R-PPE
R-Res&Pub
Travel Screening
Viral Hemorrhagic Fever
-
https://repository.netecweb.org/files/original/7946b4a9d7253b996b7b691654a6538b.pdf
93f57a9f76b1fce5f52a44b65d7be936
PDF Text
Text
HHS Public Access
Author manuscript
Author Manuscript
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
Published in final edited form as:
N Engl J Med. 2015 June 18; 372(25): 2423–2427. doi:10.1056/NEJMoa1500306.
Persistence of Ebola Virus in Ocular Fluid during Convalescence
Author Manuscript
Jay B. Varkey, M.D., Jessica G. Shantha, M.D., Ian Crozier, M.D., Colleen S. Kraft, M.D., G.
Marshall Lyon, M.D., Aneesh K. Mehta, M.D., Gokul Kumar, M.D., Justine R. Smith, M.B.,
B.S., Ph.D., Markus H. Kainulainen, Ph.D., Shannon Whitmer, Ph.D., Ute Ströher, Ph.D.,
Timothy M. Uyeki, M.D., M.P.H., M.P.P., Bruce S. Ribner, M.D., M.P.H., and Steven Yeh, M.D.
Department of Medicine, Division of Infectious Diseases (J.B.V., C.S.K., G.M.L., A.K.M., B.S.R.),
the Department of Ophthalmology (J.G.S., G.K., S.Y.), and the Department of Pathology and
Laboratory Medicine (C.S.K.), Emory University School of Medicine, and the Centers for Disease
Control and Prevention (M.H.K., S.W., U.S., T.M.U.) — both in Atlanta; the Infectious Diseases
Institute, Mulago Hospital Complex, Kampala, Uganda (I.C.); and Flinders University, Adelaide,
SA, Australia (J.R.S.)
SUMMARY
Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop
during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are
unknown. We describe a patient who recovered from EVD and was subsequently found to have
severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in
aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.
Author Manuscript
The current outbreak of EVD is believed to have begun in December 2013.1 As of April 26,
2015, a total of 26,312 cases of EVD (including 10,899 deaths) had been reported in six
countries in West Africa (i.e., Sierra Leone, Liberia, Guinea, Mali, Nigeria, and Senegal),
the United States, the United Kingdom, and Spain.2 The outbreak has also resulted in the
largest number of EVD survivors in history.
Author Manuscript
Among survivors of EVD, late complications that include ocular disease can develop during
convalescence.3,4 However, few systematic studies have been conducted on post-EVD
sequelae, so the incidence and clinical manifestations of post-EVD ocular complications are
unclear. Here, we report the clinical course of a man in whom severe, acute, unilateral
uveitis developed during the convalescent phase of EVD. We also report the detection of
viable EBOV in aqueous humor obtained from the inflamed eye 14 weeks after the onset of
the initial symptoms of EVD and 9 weeks after the clearance of viremia.
CASE REPORT
A previously healthy 43-year-old male physician received a diagnosis of EVD on September
6, 2014, while he was working in an Ebola treatment unit in Kenema, Sierra Leone. He was
Address reprint requests to Dr. Yeh at the Department of Ophthalmology, Emory University School of Medicine, 1365B Clifton Rd.
NE, Atlanta, GA 30322, or at steven.yeh@emory.edu.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
�Varkey et al.
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transferred to Emory University Hospital in Atlanta and arrived 4 days after the onset of
symptoms. He was treated with an experimental small interfering RNA antiviral agent
(TKM-100802, Tekmira Pharmaceuticals), convalescent plasma, and aggressive supportive
care.5
Author Manuscript
The hospital course was complicated by multiorgan system failure requiring mechanical
ventilation for 12 days and hemodialysis for 24 days.6 After extubation, the patient had
altered mental status, difficulty walking related to severe proximal weakness and
deconditioning, and extreme fatigue. On day 44 of the illness, hemodialysis was no longer
required and his mental status had markedly improved, with some residual mild wordfinding difficulty. Ambulation was limited to short distances because of exertional fatigue.
Blood and urine tested negative for EBOV on quantitative reverse-transcriptase–
polymerasechain-reaction (RT-PCR) assay on serial specimens, and he was discharged
home. A semen sample obtained on the day of discharge was positive for EBOV RNA on
quantitative RT-PCR assay, and EBOV was isolated from semen by means of culture at the
Centers for Disease Control and Prevention (CDC).7 The patient was advised to abstain
from sex or to use condoms for at least 3 months.8 Longitudinal monitoring of semen
specimens for EBOV is ongoing.
Author Manuscript
After discharge, 10 weeks after the onset of EVD symptoms, the patient’s word-finding
difficulty and exercise tolerance were markedly improved, but he had new symptoms,
including low back pain involving the right lumbar and sacroiliac region, bilateral enthesitis
of the Achilles’ tendon, and paresthesias involving the distal lower limbs. Ophthalmic
symptoms, which began shortly after discharge from the hospital, included occasional
bilateral ocular burning, foreign-body sensation, and photophobia. He required an
adjustment in his prescription for reading glasses, which suggested an accommodative
change. His ocular history was clinically significant only for myopia. He was referred to the
Emory Eye Center for further evaluation.
On initial evaluation in November 2014, the patient’s visual acuity was 20/15 bilaterally
while wearing eyeglasses. Intraocular pressure, pupils, ocular motility, and confrontational
visual fields were normal. The examination of the anterior eye by means of slit lamp was
normal. The examination of the dilated posterior eye revealed previously undocumented
multiple, peripheral chorioretinal scars with hypopigmented halos in both eyes and a small
intraretinal hemorrhage adjacent to one scar in the left eye (Fig. 1). He received the
diagnosis of posterior uveitis (i.e., chorioretinitis), a likely sequela of EVD. Close clinical
follow-up was planned.
Author Manuscript
One month later, 14 weeks after the diagnosis of EVD, he presented with an acute onset of
redness, blurred vision with halos, pain, and photophobia in the left eye. Visual acuity was
measured at 20/15 in the right eye and 20/20 in the left eye. The left intraocular pressure was
highly elevated at 44 mm Hg (normal value, 10 to 21). Slit-lamp examination of the left eye
showed conjunctival injection, mild corneal edema, rare nongranulomatous keratic
precipitates, and grade 1+ leukocytes and protein (flare) in the anterior chamber (Fig. 2).
Examination of the anterior chamber with gonioscopy indicated no signs of angle closure.
Dilated funduscopic examination showed stable chorioretinal scars in both eyes with no
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
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other signs of ocular inflammation. He received a diagnosis of anterior uveitis and ocular
hypertension in the left eye. Treatment was started with eyedrops containing 1%
prednisolone acetate four times daily and with ocular hypotensive agents including
acetazolamide (at a dose of 500 mg orally twice daily), eyedrops containing 0.2%
brimonidine twice daily, and eyedrops containing 2% dorzolamide and 0.5% timolol twice
daily. Results of laboratory testing, including measurement of the erythrocyte sedimentation
rate and C-reactive protein, were normal; rapid plasma reagin testing and serologic analysis
for Toxoplasma gondii were negative.
Author Manuscript
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Because of escalating anterior-chamber inflammation and worsening symptoms during the
subsequent 48 hours, the frequency of administration of prednisolone acetate was increased
to every 2 hours, and eyedrops containing 1% atropine twice daily were added. After
another 24 hours of increasing inflammation and concern about an infectious cause,
paracentesis of the anterior chamber was performed, with aspiration of 170 µl of aqueous
humor through a sterile 30-gauge needle while the practitioner was wearing gloves and a
surgical mask. The specimen was double-bagged and delivered to a dedicated laboratory at
Emory University Hospital for testing samples from patients with EVD. Testing was
performed by clinical laboratory technologists who were trained in the safe handling of
infectious pathogens and with the use of the standard institutional operating protocols.9 The
aqueous humor tested positive for EBOV RNA on quantitative RT-PCR assay, with a cycle
threshold value of 18.7. EBOV was isolated from this specimen by means of a viral culture
performed at the CDC.7 A conjunctival swab obtained before the procedure and tear-film
specimens collected before the procedure and 24 hours after the procedure tested negative
for EBOV RNA on quantitative RT-PCR assay. In addition, a specimen of peripheral blood
tested negative for EBOV RNA on quantitative RT-PCR assay. Preliminary analyses of
EBOV sequenced from blood during the patient’s hospitalization for symptomatic EVD, as
compared with EBOV sequenced from ocular fluid, identified a single nonsynonymous
mutation, as well as two silent mutations and two mutations in noncoding regions. The
significance of these mutations is unknown. However, these findings are in contrast to
results that showed no changes in viral consensus sequences acquired over several days from
a single patient.10 All personal protective equipment and materials that were used during
paracentesis and laboratory testing were sterilized by means of autoclaving before
disposal.11
Author Manuscript
The uveitis continued to progress; by 5 days after the onset of symptoms, visual acuity in the
left eye was decreased to 20/60. Anterior-segment examination revealed scleritis and
persistent anterior uveitis. Intermediate uveitis (i.e., vitritis, with grade 0.5+ haze) was noted
on examination of the dilated posterior segment. Oral prednisone (at a dose of 1 mg per
kilogram of body weight per day) was started. Ophthalmic drops of 1% prednisolone acetate
every 2 hours, 0.5% timolol twice daily, and 1% atropine twice daily were continued in the
left eye.
During the subsequent 72 hours, the patient’s condition improved, with resolution of the
scleritis and a decrease in the anterior uveitis. Despite this improvement in the anteriorsegment inflammation, the vitritis worsened, resulting in a decrease in visual acuity to
20/400 in the left eye at 1 week (Fig. 3). Continued clinical deterioration of the patient’s left
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
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eye prompted the initiation of treatment with topical difluprednate (Alcon Laboratories), a
21-day course of oral favipiravir (MediVector), a periocular injection of oral prednisone. On
examination 3 months after presentation with uveitis, the vitritis was resolving and left
visual acuity had recovered to 20/15. Follow-up ophthalmic evaluations are ongoing.
DISCUSSION
Author Manuscript
We describe the detection of viable EBOV in the aqueous humor of the eye in a patient in
recovery from EVD with acute panuveitis (a combination of anterior, intermediate, and
posterior uveitis). In a previous EVD outbreak, EBOV RNA was detected on RT-PCR assay
in a conjunctival sample obtained from a 25-year-old patient 22 days after the onset of
symptoms and 10 days after viremia had cleared. In that patient, 45 days after the onset of
EVD symptoms, posterior uveitis developed; the patient did not undergo any additional
testing of ocular tissue.4 Marburg virus, a filovirus like EBOV, has also been associated
with uveitis during convalescence. In 1975, Marburg virus was cultured from the aqueous
humor of a patient with acute anterior uveitis that developed nearly 3 months after the onset
of acute illness.12 Viral culture of the patient’s aqueous humor that was sampled 2 weeks
later was negative.13
Author Manuscript
Although the pathogenesis of EVD-associated uveitis is unknown, we believe that the
severe, acute panuveitis that developed in our patient was a direct cytopathic effect of active
replication of EBOV persisting in an immune-privileged organ. The acute onset of
symptoms, unilateral location, and extreme elevation of intraocular pressure that were seen
in our patient are clinical findings similar to infectious uveitis syndromes caused by
herpesviruses, in which the pathogenesis is known to be a direct consequence of active viral
replication.14,15 Although the relative contribution of lytic viral infection, as compared with
immunologic reaction to EBOV, in the pathogenesis of our patient’s aggressive panuveitis is
unclear, the low cycle threshold on quantitative RT-PCR assay shows that a high burden of
viable EBOV was present at the time that the patient’s ocular symptoms were worsening.
Further studies to investigate the mechanisms responsible for the ocular persistence of
EBOV and the possible presence of the virus in other immune-privileged sites (e.g., in the
central nervous system, gonads, and articular cartilage) are warranted.
Author Manuscript
Few systematic studies have examined post-EVD sequelae, so the incidence and clinical
manifestations of post-EVD ocular complications are uncertain. Of 71 EVD survivors from
the 1995 Ebola outbreak in the Democratic Republic of Congo, 20 were enrolled in a small,
retrospective study.4 Three of the 20 survivors in this limited sample were found to have
evidence of uveitis (anterior, posterior, or panuveitis) that occurred 42 to 72 days after the
onset of EVD. Data on the incidence of ocular complications among survivors of the current
West African EVD outbreak are also limited. Although 40% of participants in a recent
survey of 85 EVD survivors in Sierra Leone reported having “eye problems,” the incidence
of uveitis in this cohort is unknown.16
In conclusion, our patient’s recovery from EVD was complicated by acute anterior uveitis,
which rapidly evolved into a sight-threatening panuveitis with detection of persistent EBOV
within the eye. This case highlights an important complication of EVD with major
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implications for both individual and public health that are immediately relevant to the
ongoing West African outbreak. It is reassuring that samples of conjunctivae and tears tested
negative for EBOV, a finding that supports previous studies suggesting that patients who
recover from EVD pose no risk of spreading the infection through casual contact.3,17 Further
studies are needed to assess the persistence of EBOV during convalescence, to elucidate the
mechanisms underlying this persistence in ocular and other immune-privileged tissue sites,
and to identify effective treatment strategies for the clinical management of EVD
complications.
Acknowledgments
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the CDC.
Author Manuscript
Supported by a grant from the National Center for Advancing Translational Sciences of the National Institutes of
Health (UL1TR000454, to the Atlanta Clinical and Translational Science Institute), an unrestricted grant from
Research to Prevent Blindness and a grant from the National Eye Institute (P30-EY06360, to the Department of
Ophthalmology, Emory University School of Medicine), and a fellowship grant from the Australian Research
Council (FT130101648, to Dr. Smith). Favipiravir was provided by the Department of Defense Joint Project
Manager Medical Countermeasure Systems.
We thank Alison Boess and the family of Dr. Ian Crozier; staff members at the Biotechnology Core Facility Branch
of the CDC for their assistance in generating viral sequences; Dr. William Bornstein, Dr. Bryce Gartland, Crystal
Evans, Maureen Lindsey, Brian Frislie, Emily Beck, Connie Wilbanks, Paula DesRoches, and all the investigators
at the Emory Serious Communicable Diseases Unit; Kimberly Lovitt, Rhonda Waldron, Debora Jordan, Jannah
Dobbs, Matthew Raeber, and the staff at the Department of Ophthalmology at Emory University; Dr. Monica
Farley and the staff at the Division of Infectious Diseases at Emory University; and MediVector.
References
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1. Global alert and response: Ebola virus disease. Geneva: World Health Organization; 2014. (http://
www.who.int/csr/don/archive/disease/ebola/en).
2. Ebola situation report - 29 April 2015. Geneva: World Health Organization; 2015. (http://
www.who.int/csr/disease/ebola/situation-reports/en/?m=20141231).
3. Kibadi K, Mupapa K, Kuvula K, et al. Late ophthalmologic manifestations in survivors of the 1995
Ebola virus epidemic in Kikwit, Democratic Republic of the Congo. J Infect Dis. 1999; 179(Suppl
1):S13–S14. [PubMed: 9988158]
4. Sierra Leone: helping the Ebola survivors turn the page. Geneva: World Health Organization; 2014.
(http://www.who.int/features/2014/post-ebola-syndrome/en).
5. Kraft CS, Hewlett AL, Koepsell S, et al. The use of TKM-100802 and convalescent plasma in 2
patients with Ebola virus disease in the United States. Clin Infect Dis. 2015 Apr 22. (Epub ahead of
print).
6. Connor MJ Jr, Kraft C, Mehta AK, et al. Successful delivery of RRT in Ebola virus disease. J Am
Soc Nephrol. 2015; 26:31–37. [PubMed: 25398785]
7. Rodriguez LL, De Roo A, Guimard Y, et al. Persistence and genetic stability of Ebola virus during
the outbreak in Kikwit, Democratic Republic of the Congo, 1995. J Infect Dis. 1999; 179(Suppl
1):S170–S176. [PubMed: 9988181]
8. Ebola (Ebola virus disease): Q&As on transmission. Atlanta: Centers for Disease Control and
Prevention; 2015. (http://www.cdc.gov/vhf/ebola/transmission/qas.html).
9. Hill CE, Burd EM, Kraft CS, et al. Laboratory test support for Ebola patients within a highcontainment facility. Lab Med. 2014; 45(3):e109–e111. [PubMed: 25184220]
10. Gire SK, Goba A, Anderson KG, et al. Genomic surveillance elucidates Ebola virus origin and
transmission during the 2014 outbreak. Science. 2014; 345:1369–1372. [PubMed: 25214632]
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
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11. Ebola (Ebola virus disease): Ebola-associated waste management. Atlanta: Centers for Disease
Control and Prevention; 2015. (http://www.cdc.gov/vhf/ebola/hcp/medical-wastemanagement.html).
12. Gear JS, Cassel GA, Gear AJ, et al. Outbreake of Marburg virus disease in Johannesburg. Br Med
J. 1975; 4:489–493. [PubMed: 811315]
13. Kuming BS, Kokoris N. Uveal involvement in Marburg virus disease. Br J Ophthalmol. 1977;
61:265–266. [PubMed: 557985]
14. Amano S, Oshika T, Kaji Y, Numaga J, Matsubara M, Araie M. Herpes simplex virus in the
trabeculum of an eye with corneal endotheliitis. Am J Ophthalmol. 1999; 127:721–722. [PubMed:
10372885]
15. Chee SP, Bacsal K, Jap A, Se-Thoe SY, Cheng CL, Tan BH. Clinical features of cytomegalovirus
anterior uveitis in immunocompetent patients. Am J Ophthalmol. 2008; 145:834–840. [PubMed:
18255045]
16. Trenchard T. Survivors cope with new Ebola after-effects. Al-Jazeera. 2014 (http://
www.aljazeera.com/news/africa/2014/12/survivors-cope-with-new-ebola-aftereffects-2014121573521561384.html).
17. Rowe AK, Bertolli J, Khan AS, et al. Clinical, virologic, and immunologic follow- up of
convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic
Republic of the Congo: Commission de Lutte contre les Epidémies à Kikwit. J Infect Dis. 1999;
179(Suppl 1):S28–S35. [PubMed: 9988162]
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Figure 1. Montage Fundus Photographs 10 Weeks after the Onset of Ebola Virus Disease
Multiple peripheral chorioretinal scars with hypopigmented haloes are visible in the right
eye (Panel A) and left eye (Panel B) (white arrows). A small intraretinal hemorrhage (black
arrow) is adjacent to a chorioretinal scar in the left eye.
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Figure 2. Slit-Lamp Photograph of the Left Eye 14 Weeks after the Onset of Ebola Virus Disease
Mild corneal edema, rare keratic precipitates (arrows), and inflammatory cells and protein in
the anterior chamber are consistent with acute anterior uveitis.
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N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�Varkey et al.
Page 9
Author Manuscript
Author Manuscript
Author Manuscript
Figure 3. Fundus Photograph of the Left Eye 14 Weeks after the Onset of Ebola Virus Disease
Severe vitritis is indicated by the obscuration of the optic nerve and blood vessels.
Author Manuscript
N Engl J Med. Author manuscript; available in PMC 2015 December 18.
�
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Persistence of Ebola Virus in Ocular Fluid during Convalescence
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Varkey, J. B., J. G. Shantha, I. Crozier, C. S. Kraft, G. M. Lyon, A. K. Mehta, G. Kumar, J. R. Smith, M. H. Kainulainen, S. Whitmer, U. Stroher, T. M. Uyeki, B. S. Ribner and S. Yeh (2015). "Persistence of Ebola Virus in Ocular Fluid during Convalescence." N Engl J Med 372(25): 2423-2427.
Abstract
Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown. We describe a patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.
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Persistence of Ebola Virus in Ocular Fluid during Convalescence
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Varkey, J. B., J. G. Shantha, I. Crozier, C. S. Kraft, G. M. Lyon, A. K. Mehta, G. Kumar, J. R. Smith, M. H. Kainulainen, S. Whitmer, U. Stroher, T. M. Uyeki, B. S. Ribner and S. Yeh
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Among the survivors of Ebola virus disease (EVD), complications that include uveitis can develop during convalescence, although the incidence and pathogenesis of EVD-associated uveitis are unknown.<br /><br />This article was corrected in volume 372 on page 2469.
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2022-01-10 by PPE group Shawn Gibbs
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2025-01-10
Ebola
Eye/Ocular Health
Follow up
Infection Prevention and Control
Laboratory Testing
Patient Care
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
Specimen Collection
Specimen Handling
Survivors
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Johnson, D. W., J. N. Sullivan, C. A. Piquette, A. L. Hewlett, K. L. Bailey, P. W. Smith, A. C. Kalil and S. J. Lisco (2015). "Lessons learned: critical care management of patients with Ebola in the United States." Crit Care Med 43(6): 1157-1164.
Abstract
OBJECTIVE: This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. DATA SOURCES: Patient medical records. STUDY SELECTION: Not applicable. DATA EXTRACTION: Not applicable. DATA SYNTHESIS: Not applicable. CONCLUSIONS: Safe and effective care of patients with Ebola virus disease requires significant communication and planning. Adherence to a predetermined isolation protocol is essential, including proper donning and doffing of personal protective equipment. Location of the patient care area and the logistics of laboratory testing, diagnostic imaging, and the removal of waste must be considered. Patients with Ebola virus disease are often dehydrated and need adequate vascular access for fluid resuscitation, nutrition, and phlebotomy for laboratory sampling. Advanced planning for acute life-threatening events and code status must be considered. Intensivist scheduling should account for the significant amount of time required for the care of patients with Ebola virus disease. With appropriate precautions and resources, designated hospitals in the United States can safely provide care for patients with Ebola virus disease.
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Lessons learned: critical care management of patients with Ebola in the United States
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Johnson, D. W., J. N. Sullivan, C. A. Piquette, A. L. Hewlett, K. L. Bailey, P. W. Smith, A. C. Kalil and S. J. Lisco
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Treatment & Care
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This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center.
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2015-06-01
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2025-09-27
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2022-09-27 - general asset review - Treatment & Care group
2022-01-10 by PPE group Shawn Gibbs (both 3 years)
Clinical Care Guidelines
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AJCP / Editorial
Safety Considerations in the Laboratory Testing of
Specimens Suspected or Known to Contain Ebola Virus
Peter C. Iwen, PhD, D(ABMM),1,2 Philip W. Smith, MD,3 Angela L. Hewlett, MD,3
Christopher J. Kratochvil, MD,4 Steven J. Lisco, MD,5 James N. Sullivan, MD,5 Shawn G. Gibbs,
PhD, CIH,6 John J. Lowe, PhD,6 Paul D. Fey, PhD, D(ABMM),1 Vicki L. Herrera, MS,2
Anthony R. Sambol, MA,2 James L. Wisecarver, MD,1 and Steven H. Hinrichs, MD1
From the 1Department of Pathology and Microbiology, College of Medicine, University of Nebraska Medical Center, Omaha; 2Nebraska Public Health
Laboratory, Omaha; 3Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha; 4Department of
Psychiatry, College of Medicine, University of Nebraska Medical Center, Omaha; 5Department of Anesthesiology, Division of Critical Care, University
of Nebraska Medical Center, Omaha; and 6Department of Environmental, Agricultural, and Occupational Health, College of Public Health, University of
Nebraska Medical Center, Omaha.
Am J Clin Pathol January 2015;143:4-5
DOI: 10.1309/AJCP26MIFUIETBPL
Reference to the Ebola virus causes concern among all
individuals, whether from the public or within the medical
community. Realization that patients with Ebola virus disease
(EVD) have now been recognized in the United States in
response to the major outbreak occurring in West Africa has
heightened this fear. Recently, the World Health Organization
declared the Ebola epidemic to be a Public Health Emergency
of International Concern to provide containment of this
major international health threat. In response to this threat
to public health, the United States has stepped up efforts to
provide care for infected patients, which include bringing
individuals with EVD into the United States for treatment.
These activities, along with the increased possibility of having
more individuals recognized with EVD in the United States,
have caused hospitals to evaluate how to contain and care for
patients suspecting of having EVD. As a part of this response,
laboratorians have been asked to be prepared to test specimens
from persons under investigation (PUIs) for EVD or patients
known to have EVD.
Recently, the Centers for Disease Control and
Prevention (CDC) provided an interim guideline followed
by a supplemental document for how US laboratories could
safely manage specimens from PUIs for EVD.1,2 In these
documents, the CDC recommended that risk assessments
be conducted by each laboratory to determine the potential
for sprays, splashes, or aerosols generated from laboratory
procedures when handling these specimens and to adjust
work practices, safety equipment controls, and personal
protective equipment (PPE) requirements as needed to
provide a safe environment in the laboratory. Recently, we
described an integrated approach on how laboratory tests
could be conducted on specimens from Ebola-infected
4
Am J Clin Pathol 2015;143:4-5
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on 09 February 2018
patients.3 In our risk assessment, we determined that the
core laboratories where chemistry and hematologic testing
takes place do not have facilities that can safely handle
specimens suspected of containing or known to contain
Ebola virus. For example, the processing of open tubes
without the availability of a biosafety cabinet and the
centrifugation of specimens without safety cups or sealed
rotors are common practices within the core laboratory.
In addition, clinical laboratories that do have the facilities
to perform biosafety level 3 (BSL-3) practices (to include
processing within a biosafety cabinet, centrifugation using
safety cups or sealed rotors, and enhanced PPE to include
respiratory protection) are generally available only to the
clinical microbiology laboratory and specific to the testing
of specimens potentially containing the causative agents
for tuberculosis or for endemic fungi such as Coccidioides
immitis and Histoplasma capsulatum.
Subsequently, a risk assessment within our laboratories
was done that focused on the potential for microdroplet or
aerosol generation. Although Ebola virus is not thought to
be spread through human-generated aerosols, automated
instruments that include centrifuges are capable of generating
microdroplets of blood. Ebola virus has an infectious dose
of fewer than 10 organisms and a blood virus concentration
in excess of 10E8 viral particles per milliliter, and a blood
droplet theoretically would be sufficient to cause infection.
The primary risk was considered the mucous membranes
and eyes of laboratorians. As a result of this assessment, we
determined that only closed manual or automated chemistry and hematology analyzers were considered safe for the
testing of blood containing specimens with potential Ebola
virus present outside the BSL-3 containment laboratory. We
© American Society for Clinical Pathology
�AJCP / Editorial
❚Table 1❚
Essential and Supplemental Tests Used for the Support of a
Patient Infected With Ebola Virusa
Test
Essential
CBC count with automated
differential
Basic metabolic panel
Magnesium
Comprehensive metabolic panel
Ionized calciume
Standard calcium
Phosphorus
Cortisol
Troponin
Blood gasese
Lactate
Prothrombin timee
Partial thromboplastin timee
Platelet count
Blood typingf,g
Culture proceduresh
Molecular assayj
Supplemental
Manual differential
Lipase
Amylase
Creatine kinase total
Malaria smeark
HIV screen
Laboratory
Locationb
Centrifugation
Requiredc
Core
No
Core
Core
Core
BCU
Core
Core
Core
Core
BCU
Core
BCU
BCU
Core
BCU
NPHLi
NPHLi
Yesd
Yes
Yesd
No
Yesd
Yes
Yes
Yes
No
Yesd
No
No
No
No
No
No
Core
Core
Core
Core
Core
Core
No
Yes
Yes
Yes
No
No
BCU, biocontainment unit; HIV, human immunodeficiency virus; NPHL, Nebraska
Public Health Laboratory.
a All open-tube testing and centrifugation were performed within the biosafety level
3 (BSL-3) laboratory environment. The lists of tests were determined from a risk
assessment for safety in consultation with infectious diseases and critical care
physicians. This list will not necessarily represent capabilities and needs for all
clinical laboratory applications.
b Laboratory locations were determined following a risk assessment.
c Centrifugation was performed in the BCU laboratory and transferred to the core
laboratory as noted.
d Testing also available on point-of-care testing instrument.
e Utilization of point-of-care testing instrument.
f Using slide agglutination method.
g Type O, Rh- and Kell-negative blood were recommended where appropriate.
h All cultures were performed in the BSL-3 laboratory using culture media contained
in plastic containers.
i Provides for a BSL-3 containment facility.
j Using an emergency use authorization kit assay approved by the Food and Drug
Administration.
k Smear prepared and fixed in the BCU laboratory.
subsequently met with the clinical team, including infectious
diseases and critical care physicians, to define an expanded
list of assays that could be done safely to help provide optimal
patient care. The goal was to determine which assays could
be performed in the patient care biocontainment unit using
point-of-care (POC) instruments, the Nebraska Public Health
Laboratory BSL-3 laboratory, or the core laboratory. ❚Table 1❚
lists both the essential and supplemental tests that we identified could be done safely to manage our patients infected
with Ebola virus along with the laboratory locations where
the tests were performed. As expected, other tests could be
anticipated following an evaluation of the safety to perform
the test as needed. In some cases in the evaluation, testing was
© American Society for Clinical Pathology
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considered not safe (ie, fibrinogen levels, procalcitonin levels,
and cross-matching of blood), requiring consultation between
the requesting physicians and the laboratory personnel to
determine what alternative tests might be considered.
Since the clinical management of patients with EVD is
heavily focused on cardiopulmonary function and electrolyte
balance, we found that this expanded menu of laboratory tests
was necessary to support optimal patient management. In
addition, although the original plan was to use our standard
policy for transfusion of type O, Rh-negative blood, it became
necessary to perform reverse typing when consideration was
given for use of apheresis plasma from a patient who had
been infected with and recovered from the Ebola virus.
Kell-negative units were held in reserve in case a hemolytic
episode was encountered under this circumstance.
A general understanding among our laboratory staff
was that no room existed for error when handling specimens
that contained Ebola virus. A laboratory-based transmission
would not only cause human distress but also have detrimental
consequences for the laboratory operation with a subsequent
limit to the ability of the entire hospital to function optimally.
Our described plan may have general applicability to tertiary
medical centers where closed-system automated instruments
are commonly used and where a BSL-3 facility (such
as a mycobacteria testing laboratory) is available where
appropriate BSL-3 practices are done. Using this combination
of capabilities, laboratories could provide for the initial
processing of specimens (eg, centrifugation and subsequent
testing in locations that are appropriate for either POC assays
or closed automated platforms). The approach described here
is offered to provide a baseline for further discussion of the
processing and testing of specimens with the potential to
contain the Ebola virus or other high-consequence pathogens.
Acknowledgments: We thank Michelle Schwedhelm, RN, and all
the dedicated staff of the Nebraska Medicine and the Nebraska
Public Health Laboratory for their expert service and care.
References
1. Centers for Disease Control and Prevention (CDC). Interim
guidance for specimen collection, transport, testing, and
submission for persons under investigation for Ebola virus disease
in the United States. 2014. http://www.cdc.gov/vhf/ebola/hcp/
interim-guidance-specimen-collection-submission-patientssuspected-infection-ebola.html. Accessed November 10, 2014.
2. Centers for Disease Control and Prevention (CDC). How
U.S. clinical laboratories can safely manage specimens
from persons under investigation for Ebola virus disease.
2014. http://www.cdc.gov/vhf/ebola/hcp/safe-specimenmanagement.html. Accessed November 10, 2014.
3. Iwen PC, Garrett JL, Gibbs SG, et al. An integrated approach
to laboratory testing for patients with Ebola virus disease. Lab
Med. 2014;45:e146-e150.
Am J Clin Pathol 2015;143:4-5 5
DOI: 10.1309/AJCP26MIFUIETBPL
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Safety considerations in the laboratory testing of specimens suspected or known to contain Ebola virus
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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https://www.ncbi.nlm.nih.gov/pubmed/25511134
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https://academic.oup.com/ajcp/article/143/1/4/1760657
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Iwen, P. C., P. W. Smith, A. L. Hewlett, C. J. Kratochvil, S. J. Lisco, J. N. Sullivan, S. G. Gibbs, J. J. Lowe, P. D. Fey, V. L. Herrera, A. R. Sambol, J. L. Wisecarver and S. H. Hinrichs (2015). "Safety considerations in the laboratory testing of specimens suspected or known to contain Ebola virus." Am J Clin Pathol 143(1): 4-5.
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Safety considerations in the laboratory testing of specimens suspected or known to contain Ebola virus
Creator
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Iwen, P. C., P. W. Smith, A. L. Hewlett, C. J. Kratochvil, S. J. Lisco, J. N. Sullivan, S. G. Gibbs, J. J. Lowe, P. D. Fey, V. L. Herrera, A. R. Sambol, J. L. Wisecarver and S. H. Hinrichs
Subject
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Laboratory
Date
A point or period of time associated with an event in the lifecycle of the resource
2015-01-01
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Publication
Description
An account of the resource
Reference to the Ebola virus causes concern among all individuals, whether from the public or within the medical community.
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Biosafety
Ebola
Infection Prevention and Control
Lab
Laboratory
Laboratory Testing
Personal Protective Equipment (PPE)
R-Lab
R-PPE
R-Res&Pub
Specimen Handling
-
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19a9cbcce4d3a8a41ca6f97448a33bae
PDF Text
Text
Q&A
Clinical Chemistry 63:4
807–811 (2017)
Are We There Yet? Laboratory Preparedness for
Emerging Infectious Diseases
Moderators: Carey-Ann D. Burnham1* and Jennie H. Kwon2
Experts: Eileen M. Burd,3 Sheldon Campbell,4,5 Peter C. Iwen,6 and Melissa B. Miller7
The West African Ebola virus epidemic of 2013–2016
was the most widespread epidemic of this disease in history; it is estimated that this occurrence contributed to
more than 11000 deaths. During the epidemic, healthcare workers (HCW)8 (including laboratorians) were
mobilized to care for individuals with suspected or confirmed Ebola virus disease (EVD). However, at the
height of the epidemic, guidance on appropriate safety
measures for laboratory workers manipulating specimens
from EVD patients was sparse. This highlighted the need
for data and guidelines for laboratories testing specimens
not only for patients with EVD, but for any emerging
infectious disease. During the Ebola epidemic, questions
were raised about the roles and responsibilities of laboratories in responding to highly infectious diseases, and the burden of ongoing readiness for rare events. As the outbreak
decelerates, laboratorians must regroup, gather data, and
prepare for future outbreaks. We have asked 4 experts in this
field to share their thoughts on contemporary challenges in
laboratory preparedness for emerging infectious diseases.
During the recent Ebola epidemic, what laboratory
testing did your hospital offer for patients with suspected EVD? Who performed this testing and where
was the testing performed? Did you have dedicated
equipment for laboratory testing or did you utilize
existing core laboratory equipment?
Eileen Burd: Patients with clinical symptoms and appropriate epidemiologic risk factors for EVD were stratified
as high, intermediate, or low risk by the provider seeing
the patient. If evaluation revealed low risk or no identifiable risk, standard tests were generally ordered that included tests for diagnoses other than EVD including
Departments of 1 Pathology & Immunology and 2 Medicine, Washington University
School of Medicine, St. Louis, MO; 3 Department of Pathology and Laboratory Medicine,
Emory University School of Medicine, Atlanta, GA; 4 Department of Laboratory Medicine,
Yale School of Medicine, New Haven, CT; 5 Pathology and Laboratory Medicine; VA Connecticut Health Care, West Haven, CT; 6 Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE; 7 Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
* Address correspondence to this author at: Department of Pathology & Immunology,
Washington University School of Medicine, 660 S Euclid Ave., Campus Box 8118, St.
Louis, MO 63110. Fax 314-362-1461; e-mail cburnham@path.wustl.edu.
Received October 15, 2016; accepted November 10, 2016.
complete blood count
(CBC) with differential,
complete metabolic profile (CMP), and malaria
testing. Other tests that
were ordered as indicated
by the patient’s symptoms
included blood cultures,
respiratory virus testing,
urinalysis, urine culture,
and molecular gastrointestinal panels. Blood and
other specimens were collected and placed in specimen
transport bags in the patient’s exam room and transported
to the main hospital laboratories per standard protocol.
If evaluation revealed that Ebola testing was indicated, the Emory Serious Communicable Disease Unit
(SCDU) physician on call was contacted. If the SCDU
physician agreed, the SCDU laboratory director on call
was notified and the SCDU laboratory was activated. All
specimens were packaged and transported under Category A precautions to the SCDU laboratory. Testing was
limited to the tests available in the SCDU laboratory and
no specimens were sent to the main laboratories in the
hospital until EVD was ruled by PCR. Ebola virus PCR
results were available in about 1.5 h after receipt of the
specimen in the SCDU laboratory. Other tests available
in the SCDU laboratory included CBC, CMP, magnesium,
lactate dehydrogenase, ␥-glutamyl transferase, amylase, lactate, phosphorous, venous/arterial blood gases, urinalysis,
FilmArray® gastrointestinal panel, FilmArray® respiratory
panel, BinaxNOW® malaria assay, and Alere Determine™
HIV-1/2 Ag/Ab Combo test.
Testing in the SCDU laboratory is performed by
staff medical technologists who volunteer on a rotating
© 2016 American Association for Clinical Chemistry
8
Nonstandard abbreviations: HCW, healthcare workers; EVD, Ebola virus disease; CBC,
complete blood count; CMP, complete metabolic profile; SCDU, Serious Communicable
Disease Unit; PCR, polymerase chain reaction; PUI, person(s) under investigation; SLPH,
State Laboratory of Public Health; BSL2+, biosafety level 2+; PPE, personal protective
equipment; POC, point of care; BSC, biological safety cabinet; ICU, intensive care unit; FDA,
Food and Drug Administration; BBP, bloodborne pathogen; SARS-CoV, severe acute respiratory syndrome coronavirus; LDT, laboratory-developed tests; pdmH1N1, pandemic H1N1;
EUA, Emergency Use Authorization; MERS-CoV, Middle East respiratory syndrome coronavirus; ASM, American Society for Microbiology; PHL, public health laboratory.
807
�Q&A
on-call schedule so that laboratory services can be provided around the clock. The equipment in our SCDU
laboratory is dedicated for use only in that laboratory.
The major drawback of using dedicated equipment is the
expense, including the initial purchase and the cost of
maintaining equipment and space that is rarely used. In
addition, backup instruments are not available if an instrument becomes disabled.
a biological safety cabinet (BSC) adjacent to an isolation
room in an intensive care unit (ICU). Laboratory personnel were trained and on call to staff the POC laboratory, as
needed. Until this laboratory was ready, our plan specified
that specimens be transported to Microbiology for centrifugation and processing, as needed, before delivery to the
Core Laboratory for essential testing on designated devices
that would then be decontaminated using routine protocols.
Melissa Miller: Our initial plans focused on a person under investigation
(PUI) likely presenting to
our emergency department
or an outpatient clinic with
the assumption that either
the laboratory would be notified by the clinical team,
or in the laboratory’s travel
history review for malaria
testing, we would identify
a potential PUI. We developed plans for the appropriate
collection and transport of specimens to the clinical microbiology laboratory for Ebola testing performed by our
State Laboratory of Public Health (SLPH) and the CDC,
as well as the essential tests to support patient care without undue risk to laboratorians. The on-site microbiologic testing offered for PUI was limited to blood cultures
(collected in plastic bottles) and malaria smears (thin
smear only), as indicated. All specimen processing performed before inactivation procedures was performed in our
mycobacteriology suite [biosafety level 2ϩ (BSL2ϩ)] by
personnel trained in donning and doffing personal protective equipment (PPE). Laboratory personnel were on call
24/7 to provide this service.
Inherently problematic was the assumption that the
laboratory would be notified of these cases. Extensive
education, signage, and computer alerts (i.e., hard stop
for required travel history and symptom review) were
developed in an attempt to mitigate this risk. Unlike
many past infectious disease epidemics, the impact to
the clinical laboratory extended beyond microbiology.
Core laboratory services, including chemistry and hematology, were also challenged. Due to the concerns of contamination of laboratory equipment and potential exposure of laboratorians in a high-throughput laboratory,
our institution elected to develop dedicated point of care
(POC) services for PUI. We worked with local experts
who had treated EVD patients in Africa and our infectious disease and critical care colleagues to determine the
“minimal necessary testing” for a critically ill PUI until
they had been ruled out for EVD by the SLPH/CDC.
Based on this list, POC instruments were reallocated
and/or acquired for the sole purpose of testing PUIs.
These instruments were placed in a dedicated room with
What is the current status of your emerging pathogens
laboratory?
808
Clinical Chemistry 63:4 (2017)
Melissa Miller: The POC laboratory used during the
EVD epidemic has been decommissioned. However, we
have maintained procedures for ready deployment of the
laboratory should the need arise. The EVD epidemic and
risk to laboratorians was unique in that it impacted multiple areas of the clinical laboratory, including anatomic
pathology. Most of our epidemics and emerging pathogen concerns to date have relied primarily on the readiness of the clinical microbiology laboratory. Our microbiology laboratory maintains a secure, camera-monitored
“Emerging Pathogens Room” with a BSC and small incubators and supplies. This dedicated room, along with
our mycobacteriology suite, provides continuous readiness and security for most emerging pathogens.
Eileen Burd: The Emory SCDU Laboratory is at “ready
state.” An on-call schedule is generated each month with
2 medical technologists (1 testing technologist, 1 safety
technologist) and 1 laboratory director on call each 24-h
day, separate from their routine laboratory duties. The instruments in the laboratory are maintained by the technologists who are trained to run tests in the SCDU laboratory.
Quality control, calibration, and proficiency testing are performed as appropriate for each assay or instrument.
What are some of the challenges that clinical laboratories encounter that hinder preparedness for emerging infectious diseases?
Sheldon Campbell: The
biggest challenge is the unknown, intermittent, and
dynamic nature of the risk.
Emerging infections come
in different types—viral,
bacterial, fungal, parasitic;
by definition they appear
unexpectedly, and the outbreaks vary from a dozen
cases to global pandemics.
Routes of transmission, duration of risk before, during, and after symptoms, specificity of the clinical syndrome, quantitative risk of a given
�Q&A
source-patient actually being infected, and level of infectious risk in a given specimen type vary between outbreaks, and our understanding of them evolves within the
span of a new outbreak. Secondly, clinical laboratories,
like all parts of the healthcare system, are under continuous pressure to reduce costs and improve outcomes in
documentable ways. The efforts we make to prepare for
the latest outbreak tend to erode and be gone by the time
the next thing happens.
Peter Iwen: Major challenges for clinical laboratories include inadequate
facilities for handling
specimens that might contain a high-risk pathogen,
outdated or lack of appropriate equipment, and
insufficient number of
trained laboratorians. The
high cost to validate new
testing platforms that
might only be used rarely to assess specimens from a
highly infectious patient must be considered. Finally, the
need to provide for a proficiency and quality management program over the long term along with the availability of staffing that can meet competency assessments
for this specialty laboratory will be an ongoing financial
challenge for hospital and laboratory administrators.
How can laboratories ensure that personnel maintain
competency with enhanced PPE and/or special equipment or procedures outside of an epidemic setting?
Eileen Burd: All of the HCWs in the Emory SCDU are
required to demonstrate competency in using PPE each
quarter during routine periods when the SCDU is not
activated. Any changes in PPE equipment or procedures are
reviewed during the competency sessions. In addition to
quarterly competency, annual no-notice drills are held that
involve only the SCDU personnel on call that day. Annual
drills are organized and observed by the SCDU Medical
Director and Program Coordinator. These are “real-life”
exercises in which the SCDU is activated and a volunteer
“patient” is transferred by ambulance. The volunteer patient
is admitted to the SCDU and evaluated. Specimens are
taken and laboratory tests are performed as ordered. As in a
real event, a conference call is held in the afternoon to discuss
patient status, review expectations, schedules, and Just-inTime Training. All members of the SCDU team, even if
they are not participating in the drill, are encouraged to join
the conference call or appoint a designee.
Sheldon Campbell: The only possible approach is to
practice and drill the procedures. This is very difficult to
sustain in the absence of an imminent threat; there’s always something more urgent to do. It might make more
sense for the rest of us to create skeletal procedures and
mechanisms that we build on when an event occurs, then
activate our training and procedures when an emerging
infection hits some threshold. But then, what’s the
threshold to activate the planning and start training?
What if you’re the first place hit?
In the setting of an outbreak of an emerging infectious
disease, how do clinical laboratories balance the risks
to patients and the risk to laboratory workers?
Eileen Burd: Outbreak situations generate a certain
amount of fear among hospital and laboratory staff. Having emerging infectious disease protocols in place helps
lessen that fear. Individuals caring for, or testing, specimens from known or suspected infected patients are under additional stress and using the greatest protective
methods available is justified. Because initial symptoms
of emerging infectious disease may be nonspecific, as is
the case with EVD, it is not always possible to identify
infected patients early. It is crucial that standard precautions are used consistently by all HCWs at all times.
Patients suspected or known to be infected with certain epidemiologically important pathogens such as
Ebola virus require additional control measures to protect HCWs and other patients. The goal is to provide care
as needed, but to minimize unnecessary contact with patients and avoid procedures that increase the risk of exposure to infectious material. Some of the recommended
measures include limiting the number of people exposed
to the patient, isolating the patient in a room with the
door closed, implementing standard, contact, and droplet precautions, limiting invasive procedures to those essential for patient care, using PPE, and appropriately decontaminating surfaces and equipment, etc.
The laboratory should provide a minimum menu of
tests for the diagnosis and evaluation of the patient, with
results available as quickly as possible. Risk of exposure
from spills or aerosols generated when testing patient
specimens can be minimized by limiting the number of
staff performing the tests and use of appropriate PPE.
Consideration should be given to segregating equipment
used for testing and performing laboratory tests in a dedicated space.
Sheldon Campbell: There’s no “right” answer to this.
Ideally, the impact on mortality of delayed or absent
laboratory testing could be balanced against the risk to
laboratory personnel and some greatest-good-for-thegreatest-number calculation applied; in practice there’s
no way to make that calculation. I think the “abundance
of caution” formulation used in Ebola was unhelpful;
“abundance of caution” for whom, the laboratory or the
Clinical Chemistry 63:4 (2017) 809
�Q&A
patient? Laboratorians frequently mention what a large
fraction of medical decisions involve laboratory results;
with that in mind, we cannot consistently argue that “the
laboratory results don’t matter that much in this case.”
There needs to be a more robust dialogue, both within
the laboratory community, and between laboratories and
clinicians, about what levels of risk are acceptable, and
what impact delaying or restricting laboratory testing will
have on patients. Ideally this would be an evidencedriven discussion; that may be another part of the research agenda.
How do laboratories decontaminate laboratory equipment used for testing clinical samples from patients with
highly virulent infections?
Melissa Miller: To my knowledge, this is still largely an
unanswered question. The CDC has provided guidance
for surface decontamination, but defer to the manufacturers’ operator’s manuals for decontaminating internal
components of equipment. The CDC states they are in
consultation with the Food and Drug Administration
(FDA) and manufacturers to address these unanswered
issues. Since there is no recommended method(s) for decontamination, or a validated method for assessing effectiveness of any method, an instrument may have to be
decommissioned if it becomes contaminated. These issues, in part, led to our decision to implement POC
testing devices for the essential laboratory tests needed to
support the care of a critically ill PUI.
Peter Iwen: A wide range of methods have been described by manufacturers to decontaminate equipment
used to test specimens containing Ebola virus, ranging
from minimal processes such as bleach wiping, to incineration of the instrument after utilization. In many instances where laboratories are being developed for the
patient care biocontainment units, equipment is being
dedicated to an in-unit or remote laboratory location that
will be devoted to this unit. Scientifically validated standardized protocols for environmental disinfection have
shown that fresh 10% bleach at a minimal contact time of
5 min is highly effective to inactivate Ebola virus and
most likely the other high consequence viral pathogens.
To reemphasize, laboratory safety practices are not new
concepts for the laboratory with blood-borne pathogen
(BBP) safety standards that are already a standard of practice in the laboratory, which include barrier protection,
gloves, gowns, and goggles.
What evidence, guidance, and diagnostic tools are
needed for future outbreaks with emerging infections?
Melissa Miller: Each outbreak is unique in terms of the
type of guidance needed, data available to inform recom810
Clinical Chemistry 63:4 (2017)
mendations, and the diagnostic tools desired. Nonetheless, with each new outbreak, we improve our readiness
on both a national and local scale for the next emerging
infectious disease. For example, the severe acute respiratory syndrome coronavirus (SARS-CoV) epidemic took
months to identify the infectious agent and make its viral
sequence publicly available. At the time, this seemed
astoundingly rapid compared to previous emerging infectious agents (e.g., HIV). The rapid availability of sequence data facilitated development of laboratorydeveloped tests (LDTs) and epidemiologic studies that
informed an appropriate public health response. The laboratory protocols that many of our institutions developed
for SARS were readily adapted in 2009 when we were
faced with the influenza pandemic. The pandemic
H1N1 (pdmH1N1) viral sequences were publicly available in weeks, which allowed for in silico analysis of FDAcleared laboratory tests, development of LDTs, and submission and approval of Emergency Use Authorization
(EUA) tests. Likewise, we drew upon the lessons learned
from SARS and pandemic influenza to guide our preparedness for the Middle East respiratory syndrome coronavirus (MERS-CoV), and outbreaks with multidrugresistant Acinetobacter helped informed our preparedness
for carbapenem-resistant Enterobacteriaceae outbreaks.
However, the EVD outbreak was more challenging
because most US laboratories did not have previous experience managing a highly virulent, BBP outbreak. But
we do have extensive experience in working with BBPs
and relied on our knowledge of transmission to guide our
laboratory practices. Nonetheless, the highly virulent nature of the Ebola virus led to more fear and enhanced
precautions since the risk associated with improper procedures or simple mistakes was increased. The laboratory
needs associated with the next outbreak are unpredictable, but unifying needs for every outbreak are (a) rapid,
consistent communication from public health and federal entities, (b) data-driven recommendations, and (c)
adequate, sustainable funding to quickly mobilize local,
regional, and national responses.
Sheldon Campbell: We need templates for risk assessment, reviewed and vetted by authoritative bodies. Guidance during evolving events tends to be fragmented and
inconsistent, coming from multiple sources with different recommendations. I’m not sure there’s a cure for that;
bright people working with limited data will arrive at
disparate conclusions, but it’s rough on the folks trying to
decide what to do. Regulatory support for ongoing preparedness is necessary. In particular, the Joint Commission has tremendous power to drive the agenda of healthcare systems. Nothing happens without administrative
support and resources, and absent financial incentives;
regulatory support is essential. We also need a research
agenda which includes laboratories. There are a tremen-
�Q&A
dous number of unique unanswered questions out there,
particularly with regard to risks associated with laboratory systems and instrumentation.
What is the most important lesson for clinical laboratories from the recent Ebola epidemic?
Melissa Miller: One important lesson I learned both as a
laboratory director and as a member of the American
Society for Microbiology (ASM) Committee on Laboratory Practices is the need for timely, effective communication. Communication was critical in every aspect of
EVD readiness planning. Reciprocal communication
with public health colleagues, coordination of efforts
among sections of the clinical laboratory, and discussions
with a wide variety of services (including infection control, emergency preparedness, waste management, critical care, transport services, and shipping companies,
among others) required clear, effective communication
to organize a cohesive readiness plan.
Peter Iwen: Many important lessons were learned during
the recent Ebola epidemic that were not originally anticipated. One lesson learned while caring for patients with
EVD in the US was the critical requirement to have safety
protocols in place to process and test specimens that potentially might have a high-risk pathogen. In addition,
open lines of communication between in-house medical
staff and external collaborators to include those at the
jurisdictional public health laboratory (PHL) were essential. Individuals in the PHL can provide guidance on the
screen assays available, provide for transportation of specimens from the medical facility to the PHL, and interact
directly with the CDC laboratories when additional testing is required. Finally, although many laboratories have
a program for the deposition of clinical specimens that
might include decontamination or the archiving of excess
clinical material, the “cradle to grave” concept of specimen tracking was recognized as an important issue that
all laboratories needed to consider. The ability to determine where high-risk specimens have been handled in
the laboratory, and to recognize individuals who may
have come in contact with the specimen, was important
to determine who may be at risk for a laboratory-acquired
infection and the potential for community exposure. Ultimately, the lesson learned from the recent Ebola outbreak is that all laboratorians need to be prepared to
handle any specimen that could potentially harbor a
high-risk pathogen, that administrators need to be flexible and provide appropriate protocols to make sure that a
safe environment exists for the laboratorians, and that the
laboratory be able to provide support for optimal management in the care of the patient.
Sheldon Campbell: That it’s just one blasted thing after
another; we can never be certain what’s in that tube, so
continuous, minute-to-minute and day-to-day and
month-to-month attention to standard precautions and
continuous safety improvement is essential, not just
when there’s a high-profile outbreak, but all the time.
Like a sports team, we have to drill the fundamentals,
whether or not we’re going to get to the Big Game.
Eileen Burd: EVD is extremely hazardous because of the
high mortality, lack of proven therapeutics, and potential
for transmission. Very early after our first patient arrived,
it became obvious that in situations like this you have to
be flexible. The course of EVD is remarkably varied and
testing needs to be varied accordingly. Extra effort was
focused on communication between the care providers
and the laboratory. Our most severely ill patient required
many of the features of intensive care and the dynamics
and testing needs shifted, sometimes by the hour. Treating 2 patients at a time is different from treating only 1,
and laboratory personnel had to plan to spend longer
periods of time in the containment laboratory to accommodate the larger number of specimens. Throughout the
care of each patient every team member needed to be able
to respond to change and adapt quickly. Flexibility allowed our teams to adapt to the difficult task of caring for
these patients more adeptly.
Author Contributions: All authors confirmed they have contributed to
the intellectual content of this paper and have met the following 3 requirements: (a) significant contributions to the conception and design, acquisition of data, or analysis and interpretation of data; (b) drafting or revising
the article for intellectual content; and (c) final approval of the published
article.
Authors’ Disclosures or Potential Conflicts of Interest: Upon manuscript submission, all authors completed the author disclosure form. Disclosures and/or potential conflicts of interest:
Employment or Leadership: M. Miller, American Society for
Microbiology.
Consultant or Advisory Role: C.-A.D. Burnham, Monsanto and
Thermo Fisher Scientific; M. Miller, Cepheid.
Stock Ownership: None declared.
Honoraria: None declared.
Research Funding: C.-A.D. Burnham, Cepheid, Accelerate Diagnostics, bioMe´rieux, and Theravance; M. Miller, Hologic and Luminex
Molecular Diagnostics.
Expert Testimony: None declared.
Patents: None declared.
Previously published online at DOI: 10.1373/clinchem.2016.265850
Clinical Chemistry 63:4 (2017) 811
�
Dublin Core
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Title
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Are We There Yet? Laboratory Preparedness for Emerging Infectious Diseases.
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
URL
http://clinchem.aaccjnls.org/content/clinchem/63/4/807.full.pdf
Citation
Citation information for the publication itself.
Burnham, C. D., J. H. Kwon, E. M. Burd, S. Campbell, P. C. Iwen and M. B. Miller (2017). "Are We There Yet? Laboratory Preparedness for Emerging Infectious Diseases." Clin Chem 63(4): 807-811.
Abstract
The West African Ebola virus epidemic of 2013–2016 was the most widespread epidemic of this disease in his- tory; it is estimated that this occurrence contributed to more than 11000 deaths. During the epidemic, health- care workers (HCW)8 (including laboratorians) were mobilized to care for individuals with suspected or con- firmed Ebola virus disease (EVD). However, at the height of the epidemic, guidance on appropriate safety measures for laboratory workers manipulating specimens from EVD patients was sparse. This highlighted the need for data and guidelines for laboratories testing specimens not only for patients with EVD, but for any emerging infectious disease. During the Ebola epidemic, questions were raised about the roles and responsibilities of laborato- ries in responding to highly infectious diseases, and the bur- den of ongoing readiness for rare events. As the outbreak decelerates, laboratorians must regroup, gather data, and prepare for future outbreaks. We have asked 4 experts in this field to share their thoughts on contemporary challenges in laboratory preparedness for emerging infectious diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
free online
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Are We There Yet? Laboratory Preparedness for Emerging Infectious Diseases.
Creator
An entity primarily responsible for making the resource
Burnham, C. D., J. H. Kwon, E. M. Burd, S. Campbell, P. C. Iwen and M. B. Miller
Subject
The topic of the resource
Laboratory
Description
An account of the resource
We have asked 4 experts in this field to share their thoughts on contemporary challenges in laboratory preparedness for emerging infectious diseases.
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-11-10
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-10
Diagnosis
Infection Prevention and Control
Lab
Laboratory
Personal Protective Equipment (PPE)
R-Lab
R-PPE
R-Res&Pub
Special Pathogens
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Publication
A peer reviewed publication.
URL
https://www.ncbi.nlm.nih.gov/pubmed/26559735
Citation
Citation information for the publication itself.
Beam, E. L., S. Schwedhelm, K. Boulter, C. Kratochvil, J. Lowe, A. Hewlett, S. G. Gibbs and P. W. Smith (2016). "Personal protective equipment processes and rationale for the Nebraska Biocontainment Unit during the 2014 activations for Ebola virus disease." Am J Infect Control 44(3): 340-342.
Abstract
In response to the Ebola virus disease outbreak of 2014, specific procedures for personal protective equipment use were developed in the Nebraska Biocontainment Unit for the isolation care of patients with the illness. This brief report describes the 2 different levels used for patient care and presents the rationales for the specialized processes.
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pay online - or through clinicalkey, or elsevier subscription
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Personal protective equipment processes and rationale for the Nebraska Biocontainment Unit during the 2014 activations for Ebola virus disease.
Creator
An entity primarily responsible for making the resource
Beam, E. L., S. Schwedhelm, K. Boulter, C. Kratochvil, J. Lowe, A. Hewlett, S. G. Gibbs and P. W. Smith
Subject
The topic of the resource
Infection Control
Description
An account of the resource
In response to the Ebola virus disease outbreak of 2014, specific procedures for personal protective equipment use were developed in the Nebraska Biocontainment Unit for the isolation care of patients with the illness.
Date
A point or period of time associated with an event in the lifecycle of the resource
2016-03-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-01-10 by PPE group Shawn Gibbs
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-10
Contact Transmission
Donning and Doffing
Droplet Transmission
Ebola
Infection Prevention and Control
Patient Care
Personal Protective Equipment (PPE)
R-PPE
R-Res&Pub
-
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
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Develop
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<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
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URL
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Emory University Coursera Course – Ebola Virus Disease: An Evolving Epidemic
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Emory
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General
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Ebola Virus Disease: An Evolving Epidemic - Emory University | Coursera
Date
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2018-01-08
Contributor
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2022-03-29 by Josia Mamora
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2024-01-01
Communications
Diagnosis
Donning and Doffing
Ebola
Epidemic
Epidemiology
Ethics
Example
Immunology
Infection Prevention and Control
Lab
Laboratory
Laboratory Testing
Nursing
Outbreaks
Outcomes
Patient Care
Personal Protective Equipment (PPE)
Prophylaxis
Public Health
Public Relations
Quarantine
R-PPE
Therapeutics
Virology
-
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225a70b426ff74c1fdcb3bd7e3b60813
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1d0fd78fe48d5b3fd94b0b1644f4997d
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Discover
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<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
http://www.cdc.gov/vhf/ebola/index.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Centers for Disease Control and Prevention (CDC): CDC's Response to the West African Ebola Epidemic
Creator
An entity primarily responsible for making the resource
CDC
Subject
The topic of the resource
General
Description
An account of the resource
U.S. Healthcare Workers and Settings | Ebola Hemorrhagic Fever | CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-01-19
Autoclave
Communications
CONOPS
Decontamination
Donning and Doffing
Ebola
Emergency Department
Emergency Management
EMS
Federal
Identify
Infection Prevention and Control
Inform
Isolate
Isolation/Biocontainment
Occupational Health
Patient Care
Patient Transport
Person Under Investigation (PUI)
Personal Protective Equipment (PPE)
Physical Infrastructure
Pre-hospital Transport
Public Health
R-PPE
Special Pathogens
Staffing
Staffing Model
Training
Waste
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Webinar
Portal access to a webinar
URL
https://www.nebraskamed.com/biocontainment/ebola
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Nebraska Biocontainment Unit Webinars
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine
Subject
The topic of the resource
General
Description
An account of the resource
Resources - National Ebola Training and Education Center
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Format
The file format, physical medium, or dimensions of the resource
Under Construction
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (BH)
2023-03-30 by PPE group - Jill Morgan - General Asset Review - Kate B. confirmed
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-03-30
Communications
Diagnosis
Donning and Doffing
Ebola
Emergency Department
Emergency Management
Epidemic
Epidemiology
Ethics
Example
Immunology
Infection Prevention and Control
Lab
Laboratory
Laboratory Testing
Nursing
Outbreaks
Outcomes
Patient Care
Patient Transport
Personal Protective Equipment (PPE)
Prophylaxis
Public Health
Public Relations
Quarantine
R-PPE
Specimen Handling
Specimen Transport
Therapeutics
Virology
Waste
-
https://repository.netecweb.org/files/original/abbaa723ded5b55c7aa69f67242c291e.png
2306fbffa4985416452ef408b1aeb71b
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<iframe width="560" height="315" src="https://www.youtube.com/embed/4MuxjW0ZK4o" frameborder="0" title="PAPR Assembly and Testing Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PAPR Assembly and Testing – Level C: ILC Dover Sentinel XL
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine / Heroes
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The Nebraska Biocontainment Unit Videos - National Ebola Training and Education Center (NETEC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2012-03-03
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (JC)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-08-22 ** Specific Review Date
Aerosols
Airborne Transmission
Example
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/706da07956c9e1fdb2ba27eb95064f43.png
6bab230d7b10f8978163efac6c8ee030
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<iframe width="560" height="315" src="https://www.youtube.com/embed/hnFcZmWutZI" frameborder="0" title="ISOPOD TVI Model Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
ISOPOD Basics: TVI Model
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine / Heroes
Subject
The topic of the resource
Pre-Hospital
Description
An account of the resource
The Nebraska Biocontainment Unit Videos - National Ebola Training and Education Center (NETEC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2013-02-19
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (JC, BH)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-08-22 ** Specific Review Date
EMS
Example
Intake
Isopod
Patient Transport
Personal Protective Equipment (PPE)
Portable Isolation Unit
Pre-hospital Transport
R-EMS
R-IIT
R-PPE
R-PreH
-
https://repository.netecweb.org/files/original/fc471999030600150990c225411ac029.png
eab199ca2e6be266d0d611fd4a5376a6
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<iframe width="560" height="315" src="https://www.youtube.com/embed/OMClvii_rs8" frameborder="0" title="ISOPOD IRT Model Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
ISOPOD Basics: IRT Model
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine / Heroes
Subject
The topic of the resource
Pre-Hospital
Description
An account of the resource
The Nebraska Biocontainment Unit Videos - National Ebola Training and Education Center (NETEC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2013-02-28
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (JC, BH)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-08-22 ** Specific Review Date
EMS
Example
Intake
Isopod
Patient Transport
Personal Protective Equipment (PPE)
Portable Isolation Unit
Pre-hospital Transport
R-EMS
R-IIT
R-PPE
R-PreH
-
https://repository.netecweb.org/files/original/eb6c8c11d942dfbf847fda2453ad9528.png
a9438be1b2b151d14ab417fd6cb4870d
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<iframe width="560" height="315" src="https://www.youtube.com/embed/6HCjYLcbLMY" frameborder="0" title="ISOPOD Patient Care Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
ISOPOD Basics: Patient Care
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine / Heroes
Subject
The topic of the resource
Pre-Hospital
Description
An account of the resource
The Nebraska Biocontainment Unit Videos - National Ebola Training and Education Center (NETEC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2013-03-06
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (JC, BH)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-08-22 ** Specific Review Date
EMS
Example
Intake
Isopod
Patient Care
Patient Transport
Personal Protective Equipment (PPE)
Portable Isolation Unit
Pre-hospital Transport
R-EMS
R-IIT
R-PPE
R-PreH
-
https://repository.netecweb.org/files/original/7ec63b43f98bd8d3539f26f449d8cf63.png
9f489981be327e4f00e689cf79d8dc82
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<iframe width="560" height="315" src="https://www.youtube.com/embed/8KwjSZjrvg4" frameborder="0" title="Doffing PAPR PPE Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Doffing PAPR Level PPE
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine / Heroes
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The Nebraska Biocontainment Unit Videos - National Ebola Training and Education Center (NETEC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2015-10-31
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (JC)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-08-22 ** Specific Review Date
Doffing
Emergency Management
Infection Prevention and Control
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
https://repository.netecweb.org/files/original/52c87b179cd89b020289130a7e759f88.png
41fa76536b980dc0a4b13632c0983439
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Video
A video iframed into the item.
Player
Field for the html for a video player.
<iframe width="560" height="315" src="https://www.youtube.com/embed/O04BuVFbhfE" frameborder="0" title="Donning PAPR PPE Video"></iframe>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Donning PAPR Level PPE
Creator
An entity primarily responsible for making the resource
University of Nebraska Medical Center / Nebraska Medicine / Heroes
Subject
The topic of the resource
Infection Control
Description
An account of the resource
The Nebraska Biocontainment Unit Videos - National Ebola Training and Education Center (NETEC)
Date
A point or period of time associated with an event in the lifecycle of the resource
2015-10-31
Contributor
An entity responsible for making contributions to the resource
2022-03-08 by PPE group UNMC (JC)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2023-08-22 ** Specific Review Date
Donning
Emergency Management
Infection Prevention and Control
Personal Protective Equipment (PPE)
Powered Air Purifying Respirator (PAPR)
R-PPE
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Protocol
Protocol documentation
URL
http://www.emoryhealthcare.org/ebola-protocol/ehc-message.html
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Must provide contact info and sign user agreement. Lots of clicking to get to end protocols.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Emory University Protocols
Creator
An entity primarily responsible for making the resource
Emory
Subject
The topic of the resource
General
Description
An account of the resource
Resources - National Ebola Training and Education Center
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Contributor
An entity responsible for making contributions to the resource
2022-03-29 by Josia Mamora
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-01-01
Autoclave
Donning and Doffing
Ebola
Emergency Department
Emergency Management
EMS
Example
Identify
Infection Prevention and Control
Inform
Isolate
Isolation/Biocontainment
Occupational Health
Patient Care
Personal Protective Equipment (PPE)
Physical Infrastructure
R-PPE
Regional Treatment Center
Special Pathogens
Staffing
Staffing Model
Waste
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https://repository.netecweb.org/files/original/a6782cf618e22d25290b255edbe8fbcf.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
http://www.cdc.gov/vhf/ebola/healthcare-us/ppe/calculator.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
PPE Calculator
Creator
An entity primarily responsible for making the resource
CDC
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Estimated Personal Protective Equipment (PPE) Needed for Healthcare Facilities | Ebola Hemorrhagic Fever | CDC Go to the PPE Calculator at the URL below.<br /><br />Directly download from <a href="https://www.cdc.gov/vhf/ebola/csv/PPE-calculator-for-hopitals.XLSX">the CDC here</a>.
Date
A point or period of time associated with an event in the lifecycle of the resource
2018-01-08
Relation
A related resource
Y - PPE pos 86 qualtrics 307
Y - D0.1PPE/D0.2PPE Qualtrics # 307
Contributor
An entity responsible for making contributions to the resource
2023-07-13 by Christa Arguinchona and Caroline Croyle (PM)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-07-14
Ebola
Example
Federal
Personal Protective Equipment (PPE)
R-PM
R-PPE
Staffing
Staffing Model