Understanding respiratory protection options in Healthcare: The Overlooked Elastomeric

assigned protection factor n95

In the healthcare industry, the importance of respiratory protection is often overlooked. Choosing the correct respirator for the exposure level and work task is a critical component of a respiratory protection program.  Most healthcare workers are aware of the N95 respirator but may not be aware that the re-formable, reusable elastomeric respirators are a viable option for respiratory protection. (Peterson et al., 2015).  Elastomeric respirators with N95 cartridges have been used during aerosol transmissible disease outbreak emergencies like SARS as a reusable N95 respirator option. (CDC-NIOSH January 20, 2012) They are a cost-efficient and sustainable alternative when the demand for disposable respirators is excessive.  This blog aims to educate healthcare workers and administrators about elastomeric respirators.  A summary of various types of respiratory protection for the healthcare setting, including elastomeric respirators, is included below.  It is important to understand the most suitable respiratory protection option given the potential hazards of a situation.

assigned protection factor n95

Surgical Masks

Surgical masks are not respirators. They are disposable coverings designed to be loose-fitting over the user’s nose and mouth. These loose-fitting masks leave gaps between the mask and the wearer’s face through which harmful particles may pass. Since the Food and Drug Administration (FDA) does not address the fit function of masks and surgical masks are not NIOSH approved, the mask may not be used in situations covered by Occupational Safety and Health Administration (OSHA) within areas requiring the use of respiratory protection. Therefore surgical masks should never be used for protection against infectious aerosolized particles.

N95 Respirator and Surgical N95

assigned protection factor n95

Both the N95 respirator and the surgical N95 are filtering facepiece respirators (FFRs) with an assigned protection factor (APF) of 10. The level of protection is the major difference between surgical masks and FFRs; the APF of 10 means the N95 reduces the aerosol concentration to 1/10 of that in the room and this equates to blocking 90% of airborne particles from being inhaled. (CDC-NIOSH, May 23, 2017). Both types of N95 respirators protect the user from aerosolized particles, whereas the surgical mask does not.

Standard N95 : NIOSH-approved device (not FDA cleared). Used to reduce inhalation of aerosolized particles. Fit testing is required.

Surgical N95 : NIOSH-approved and cleared by the FDA as a medical device. Meaning the protection characteristics are the same as the standard N95, except that the surgical N95 protects the sterile field, while protecting the worker with spray and splash resistance as well as flame resistance. Fit testing is required.

The most common type of N95 respirator is disposable and not designed for extended use. However, healthcare workers may be directed to re-wear these respirators, with specific directions, during emergency shortages (CDC-NIOSH March 13, 2014). For a true reusable respirator, an elastomeric or powered air purifying respirator should be considered.

Elastomeric Respirator

assigned protection factor n95

An elastomeric respirator is a reusable device with exchangeable cartridge filters that also has an APF of 10. The facepiece is made of synthetic or rubber materials that form a seal against the user’s face, with properties that allow the original shape to be repeatedly reestablished if it is temporarily deformed. As the facepiece of the elastomeric respirator should form a tight seal against the user’s face, just like the disposable FFRs, fit testing is still required. A particular challenge and potential benefit of an elastomeric air purifying respirator (APR) is that it may be disinfected through a process using a bleach water mixture. The ideal way to disinfect these respirators is with bleach and water. However, the use of bleach and water use is not practical between patients. Therefore, alcohol may be used for disinfection by wiping the exterior surface. The attached filtering cartridge(s) is replaceable and can be easily changed (Bessesen et al., 2015). This makes the device valuable during times of high demand, such as during a pandemic. Unfortunately procedures for disinfection and decontamination within healthcare environments are not routine and must be established for the environment where elastomerics may be used. Further complicating its common use, many healthcare workers have never heard of the elastomeric respirator, which indicates that there is a great need for education about the option of this type of respiratory protection. Although OSHA considers the protective factor for the elastomeric FFR to be the same as the disposable standard N95 FFR, some health facilities use the elastomeric exclusively due to employee’s perceptions of better fit. The elastomeric FFR may potentially cost less over time and may not create as much hospital waste as the N95 FFR due to the extended wear time. The elastomeric respirator offers a viable protection option that hospital administrators and healthcare workers may consider when updating respiratory protection programs.

Powered Air Purifying Respirator (PAPR)

assigned protection factor n95

The Powered Air Purifying Respirator (PAPR) is an additional option for consideration. These battery-powered respirators may have an OSHA APF of 25 for the loose-fitting PAPR facepiece, an APF of 50 for the tight-fitting half-mask PAPR, and an APF of 1000 for the full facepiece PAPR. The PAPR provides superior respiratory protection compared to FFRs and elastomeric respirators, but healthcare workers complaints have been associated with the physiologic and ergonomic impact of wearing the apparatus including restricting peripheral vision. Loose-fitting PAPRs may be used when fit testing fails or when facial hair is present. PAPRs also have higher initial costs and additional proprietary ancillary supplies (batteries, hoods) adding additional logistical challenges for product management.

What are your thoughts?

None of these devices provide absolute respiratory protection (NAS, 2006). Correct donning and doffing procedures are important to achieve suitable protection. Understanding the available types of respiratory protective devices and their correct use are important to the promotion of healthy working environments. Elastomeric respirator use is a practical option that may be considered for respiratory protection within healthcare institutions. Further discussion is needed to evaluate the pros and cons of instituting a strategy for the use of this type of respirator within the healthcare industry. Please use the comment section below to add your thoughts to the conversation. Does your institution have a strategy for adoption of elastomeric use? Do you see benefits? Drawbacks? Should elastomerics be considered as part of an overall strategy during a pandemic when demand for N95’s exceeds available supply? Should elastomerics be part of hospital and public health stockpiles?

Michael Bach PhD, RN, is an American Association of Colleges of Nursing (AACN) Fellow with NIOSH

Mention of any company, product, or service is for informational purposes only and does not constitute endorsement by the National Institute for Occupational Safety and Health (NIOSH), the Centers for Disease Control and Prevention (CDC), or the U.S. Department of Health and Human Services (HHS), or imply that any company or its products or services are preferred over any other.

Bessesen, M. T., Adams, J. C., Radonovich, L., & Anderson, J. (2015). Disinfection of reusable elastomeric respirators by health care workers: A feasibility study and development of standard operating procedures. American journal of infection control, 43(6), 629-634.

CDC-NIOSH January 20, 2012. Retrieved from: https://www.cdc.gov/niosh/npptl/topics/respirators /factsheets/respsars.html

CDC-NIOSH March 13, 2014. Retrieved from: https://www.cdc.gov/niosh/topics/hcwcontrols/ recommendedguidanceextuse.html

CDC-NIOSH May 23, 2017. Retrieved from https://www.cdc.gov/niosh/npptl/topics/respirators/disp _part/n95list1.html

National Academy of Sciences (NAS), (2006). Reusability of facemasks during an influenza pandemic: Facing the flu. Committee on the development of reusable facemasks for use during influenza pandemic. National Academies Press: Washington, DC.

Peterson, K., Novak, D., Stradtman, L., Wilson, D., & Couzens, L. (2015). Hospital respiratory protection practices in 6 US states: A public health evaluation study. American journal of infection control , 43 (1), 63-71.

Additional Resources

https://www.cdc.gov/niosh/docs/2015-117/default.html

  • https://www.cdc.gov/niosh/docs/wp-solutions/2016-109/default.html
  • https://blogs.cdc.gov/niosh-science-blog/2009/10/14/n95/
  • https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/RespSource.html

The Centers for Disease Control and Prevention is addressing questions related to the Coronavirus Disease 2019 through CDC-INFO and on their webpage. As such, this blog has been closed to comments. Please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html . You can find the most up-to-date information on the outbreak and get the latest answers to frequently asked questions. If you have specific inquiries, please contact CDC-INFO at https://wwwn.cdc.gov/dcs/contactus/form or by calling 800-232-4636. If you have questions about PPE that are not related to Coronavirus Disease 2019, please contact us at [email protected] .

22 comments on “Understanding respiratory protection options in Healthcare: The Overlooked Elastomeric”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy » .

interesting, as a health care provider I had not heard of these and had little training in them. thank you

As a small woman with a small face, most respirators of whatever type are simply too big to fit well, no matter how adjusted. Currently available respiratory protection generally does not serve its purpose for those of us for whom it was not designed well enough to fit. Only greater consideration of variability of wearers’ sizes and a greater range of size options will address this shortcoming.

The elastomeric respirator in the picture has chemical cartridges. These cartridges do not provide any protection against particulates unless they have particulate prefilters. A picture of an elastomeric respirator with filters might be more appropriate for your otherwise excellent article.

Good Catch. Chemical cartridges are typically not used by healthcare workers. We changed the photo to represent an elastomeric that may be used within the hospital.

Thanks for your reply!

Actually, those are not chemical cartridges pictured. Those are P100 filters, equivalent to a HEPA filter, with a “shower cap” to protect the filter from water or bodily fluid splashes. This particular elastomeric facepiece, with accompanying P100 filter, is ideal for healthcare workers due to available scrub colors, exhalation diverter valve, and the aforementioned shower caps. It is less obtrusive to the patient than industrial elastomeric facepieces as it is available in hospital-friendly colors, diverts wearer’s exhaled air away from patient’s face, and it also clarifies voice communication with the built in speech diaphragm.

Thank you for drawing this to our attention. We have inserted a new photo in the elastomeric section.

I believe the elastometric respirators would be a valuable option for pre-hospital application such as EMS, EMA, fire, rescue etc as well as hospital based departments such as the ER, OR, and any unit that deals with airborne precautions. As a healthcare provider I would feel most comfortable using a elastometric respirator and it is my belief that with proper training, fittings, and upkeep a majority of healthcare workers would feel the same way. Well written article, thank you.

Does anyone know where I can find the NIOSH requirements for PAPR annual Training? Is hands on training a Requirement for PAPRs or can it be online education?

Hello Jon, PAPR training is typically part of an institution’s Respiratory Protection Program. The RPP is an annual training initiative to keep healthcare workers current on the facilities policies and procedures for respirator use. The PAPR is an air purifying respirator that is used for a specific purpose when other respirator choices do not suit the user or situation for proper respiratory protection. If possible please consult with your Education Department or Infection Control Manager about PAPR training in your facility. Also you may find the 2 links below helpful, specifically the “Hospital Respiratory Protection Program Toolkit”: page 32 (Training), and the “Implementing Hospital Respiratory Protection Programs: Strategies from the Field” publication: page 29 (Chapter 3: Training and Fit Testing Challenges and Strategies).

https://www.jointcommission.org/assets/1/18/Implementing_Hospital_RPP_2-19-15.pdf

Thank you for your question.

I’ve considered the option of using the elastomeric’s but wonder what the life of the filters would be. You’d need to have a plan for changing them out and enough on hand.

Elastomeric respirators typically have an exhalation valve. Thus they should not be worn in a sterile field or other patient treatment areas where a surgical mask or surgical N95 (as described in this post) is necessary to provide patient protection.

As mentioned in the blog post and reiterated in your comment, only respirators cleared by the FDA should be used when a sterile environment is required. The elastomeric is a potential replacement for an N95 filtering facepiece respirator, not a surgical N95 filtering facepiece respirator.

OSHA guidance states “Surgical respirators (without exhalation valves) should be selected for use in environments where a sterile field must be maintained.” (OSHA, 2015, page 25)

Please visit the following for more information on respirator use with exhaust valves: Occupational Safety and Health Administration. (2015). Hospital respiratory protection program toolkit. OSHA publication, (3767-05). Retrieved from: https://www.osha.gov/Publications/OSHA3767.pdf (page 25) CDC-NIOSH August 19, 2016 Retrieved from: https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/respsource3healthcare.html , and National Academy of Sciences (NAS), (2006). Reusability of facemasks during an influenza pandemic: Facing the flu. Committee on the development of reusable facemasks for use during influenza pandemic. National Academies Press: Washington, DC. (Page 31)

Thank you for your comment.

Hi, As some Asian ladies with very slim face ( too samll) for fitting the common Surgical N95. Question 1 : Can they wear N95 ( without FDA cleared) one with wearing Face-shield for nursign patient with Airborne precaution and Blood / body fluid spalsh is anticipated ? Question 2 : same HCWs as Question 1, if they need to do the operation in an Airborne precaution case, whcih type of respirator can be worn? Thanks

The following response comes from experts within the National Personal Protective Technology Laboratory.

You should consult the appropriate governmental agencies that regulate the use of PPE in your country for specific guidance (for example the State Administration of Work Safety). There are NIOSH-approved N95 respirators that would provide adequate respiratory protection, but not the splash protection of a surgical N95 filtering facepiece respirator. The use of a faceshield would compensate for the difference in respirators and actually add more splash protection than a surgical N95 filtering facepiece respirator because the faceshield also covers other mucous membranes (eyes, nose) and more facial skin. For an overall review of faceshield use and related issues, we have a recent publication: http://www.tandfonline.com/doi/abs/10.1080/15459624.2015.1095302 .

In the United States, the Occupational Safety and Health Administration (OSHA) which is the U.S. government agency which sets and enforces occupational health and safety standards has a Bloodborne Pathogens standard. It states: “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 potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated.” (Occupational Health and Safety Administration (OSHA) Blood Borne Pathogens Standard (Title 29 Code of Federal Regulations, Part 1910:1030 subpart (d)(3)(i)). [accessed July 14, 2015]; Available at https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10051 ). Again, check with the governmental agencies in your country if they have a comparable standard.

in my opinion, it is necessary to use elastomers in the hospital. but back again to hospital policy and also how big a hospital or hospital standard itself. but does a hospital like this have to use elastomers?

Has anyone seen the latest N95 respirators on the market? I haven’t seen in stores but I understand that several members of Children’s Hospital raved about the respirators ability to transform a depressing ambiance and overpoweringly melancholy environment like a sick kids room in to one of laughter and suspended reality. My buddy said the company is called ugly mug respirators. I haven’t had time to look them up, but be my guest. Jim, my friend, even mentioned that they are in the process of creating a line of N95 masks in a smaller size…which might work great for someone like you, Gloria

All respirators used in the workplace with a respiratory protection program must be NIOSH-approved. NIOSH is not familiar with the product or company mentioned. The appropriate markings of a NIOSH-approved filtering facepiece are illustrated in NIOSH document 2013-138 . At this time, NIOSH has not approved any filtering facepiece respirators by “ugly mug.” Verification of whether or not a respirator is NIOSH-approved can be answered by looking at the NIOSH Certified Equipment List .

If the N95 Surgical Mask does not have an exhalation valve and protects the Sterile Field where does the exhalation breath of the wearer go? I am not that familiar with surgical FFR’s. Another question: I am not clear about this statement (quoted below) in the explanation above:

“The level of protection is the major difference between surgical masks and FFRs; the APF of 10 means the N95 reduces the aerosol concentration to 1/10 of that in the room and this equates to blocking 90% of airborne particles from being inhaled.”

Does an APF refer to level of protection meaning that the 10 will protect the wearer up to 10 times the PEL of the contaminant and If the concentration is more than 10 times the PEL a half-mask cannot be used. Also does the 95 refer to efficiency, meaning that a N95 is 95% efficient in it’s filtering capacity? (what does the stated blocking of 90% refer to)? Please Clarify, Thank you

With the Coronavirus being the most severe threat to public health in the world and there is a shortage of the disposable N95 masks, would you recommend using Elastomeric Respirator coupled with with P100/P95/N100/N95 filters as a protection for the general public? Thanks!

At this time, CDC is not recommending the use of face masks among general public for the novel coronavirus. For the general American public, who are unlikely to be exposed to this virus, the immediate health risk from 2019-nCoV is considered low at this time. While an elastomeric respirator provides the same level of protection as an N95 respirator, additional considerations should be made when selecting a respirator for non-occupational use. Please take a look at our blogs on non-occupational respirator use and selection. These blogs will provide you information on how to select the best respirator for you and links to NIOSH certified respirators: http://blogs.cdc.gov/niosh-science-blog/2018/01/04/respirators-public-use/ and https://blogs.cdc.gov/publichealthmatters/2019/06/picking-a-respirator/ . You can also find a breakdown of the differences between surgical masks, N95 respirators and elastomeric respirators here: https://www.cdc.gov/niosh/npptl/pdfs/UnderstandingDifference3-508.pdf .

If you use an elastomeric half face respirator (EHFR) with removable filters* while treating covid-19 patients, how long can you use the same filter – one day only, or days to months ? Can the filters be removed daily, the face mask cleaned, and the filters carefully reattached (without a high risk of self inoculation)? Or can the filters be rotated after use, stored for 10 days (or however long it takes virus to become inactive), then reused? How many days is long enough to store the filters for the virus to inactivate? It has been suggested that in a crisis when disposable N95 and PAPR are not available, health care workers may need to consider alteernate strategies.** Is there any guidance on what is most safe and effective for use of EHFR with regards to filter changes?

*for example, the widely available P100 3M pink disc filters model 2091 or 2097, with a model 7502 mask **for example, CDC has already released limited guidance on extended use and reuse of N95 disposable masks during a severe shortage

A respirator used in the care of an infectious patient should be considered potentially contaminated with infectious material on the outside and a source of contact transmission for healthcare personnel or patients. Therefore, PAPR filters should be removed with minimal handling, and disposed of properly. Hand hygiene should always be performed after removing a respirator. (NIOSH. Pittsburgh, PA: 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. 2015-117, 2015 May; :1-82 https://www.cdc.gov/niosh/docs/2015-117/ ). Please consult the manufacturer’s instructions to determine if your PAPR filter can be reused. Unless the manufacturer identifies a specified duration of use, the service life of all powered air-purifying respirator (PAPR) filters is limited by unacceptable contamination/soiling or physical damage. All PAPR filters should be replaced whenever they are damaged, soiled, or causing noticeably increased resistance which results in decreased airflow. Follow manufacturer’s recommendations for specific information on the model you are using. For information on coronavirus disease 2019, please visit https://www.cdc.gov/coronavirus/2019-ncov/index.html .

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COVID-19 Fact Sheet: Workers Need Respirators

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COVID-19: Workers Need Respirators

Click here to download printable PDF.

Click here for Additional Resources & References.

Click here for full list of COVID-19 Resources.

Anyone can be a source. Anyone can be a receiver.

assigned protection factor n95

With an N95 filtering facepiece respirator (FFR)…

…he has 1-10% inward leakage and outward leakage.

Workers need a fit-tested* respirator to prevent inhalation of infectious particles. Better respirators with higher protection factors should be used for high particle concentrations.

assigned protection factor n95

With a surgical mask…

…he has 50% inward leakage and outward leakage

A surgical mask may be appropriate for patients to wear as source control. It does not provide adequate protection for workers from inhalable infectious particles.

assigned protection factor n95

With a cloth face covering (Cloth FC)…

…he has 75% inward leakage and outward leakage.

A cloth face covering may be appropriate for the public to wear as source control, but they should limit proximity to others and time spent in an indoor space.

*N95 FFRs have an assigned protection factor of 10 (10% inward leakage) but must receive a fit factor of 100 (1% inward leakage) on an individual worker.

A FACE COVERING GIVES MINUTES. A RESPIRATOR GIVES HOURS.

According to CDC, an uninfected person with no face covering can be infected if within 6 feet of an infected person for 15 minutes. The time increases to 27 minutes if both are wearing a cloth FC, and to 2,500 hours if both are wearing a fit-tested N95 FFR. The table below indicates time to infection for other combinations.

Time to Infectious Dose for Someone Not Infected with COVID-19

assigned protection factor n95

INWARD LEAKAGE = Percentage of particles entering the facepiece to be inhaled by a receiver

Outward leakage = percentage of particles exhaled by a source exiting the facepiece.

assigned protection factor n95

WARNING: If respirators are required for other workplace hazards, do not stop their use. Treat COVID-19 as a new hazard that may require additional protection.

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What Does APF for Respirators Mean?

A Respirator’s protectiveness is ranked according to specific factors. The respirator’s ability to protect the wearer from airborne particles is judged by assigning it an Assigned Protection Factor or APF. But what does it mean? Find out below.

What is a respirator APF?

The APF is the multiple of the outside concentration of a hazardous substance that would be present without respiratory protection. To put it another way, The Assigned Protection Factor (APF) is the degree of respiratory protection that a respirator or class of respirators is intended to offer to employees when the employer conducts a continuous, effective respiratory protection program.

What does an APF of 1000 mean?

In order to get an APF of 1,000, the respirator manufacturer must present the employer with proof that their products have been tested to a level of protection of at least 1,000. The easiest way to show this level of performance is to conduct a WPF or SWPF study or a comparable exam.

What is the APF of an N95 respirator?

Both the surgical N95 and the N95 respirator have an assigned protection factor (APF) of 10 and are filtering facepiece respirators.

What does APF 50 mean?

Full-face masks with an APF of 50 would decrease exposure to 0.4 ug/m3 when correctly fitted.

Is an APF of 10 good?

Only 10% of the pollutants that the worker is exposed to are allowed to flow into the mask, which has a protection factor of 10.

Related Questions and Answers

Which respirator has the highest protection factor.

In terms of air-purifying respirators, PAPRs with a tight-fitting headpiece and class TM3 provide maximum protection.

What does the protection factor indicate?

A respirator’s assigned protection factor (APF) measures the degree of protection it can give if used appropriately and by the intended recipient.

What is the highest efficiency particulate air filter cartridge per NIOSH?

95, 99, and 99.97 percent filter efficiency are the three degrees of filter efficiency. Regarding filter efficiency deterioration, N, R, and P are the three kinds of resistance.

What is the protection factor for a full-face respirator?

At 50 mm, the APF is equivalent to using a 100-class filter. To avoid using APF of 25, the manufacturer must show an APF of 1000. For asbestos exposure, use a four-piece full-face PAPR with HE filters.

Is N95 dust mask APF 10?

A correctly utilized N95 respirator has an APF of 10, which means it may be used safely in an environment with a dangerous concentration up to 10 times the Permissible Exposure Limit (PEL).

What is better FFP1 or FFP3?

When it comes to overall protection, an FFP3 is superior to the other two options. All three FFPs have an Assigned Protection Factor (APF) between 4 and 20.

How do I choose between full-face and half-face respirators?

This video should help clarify:

What are the factors that can affect the seal of a respirator?

Factors that alter the seal between the respirator and the facepiece include a mustache, bone structure of the face, dentures, scars on the face, eyeglasses, or over-the-top cosmetics.

Make sure the APF of the respirator you wear matches the circumstances present in your workplace. Do not wear a respirator that does not meet the safety threats you may face.

NEXT UP: What Are CBRN Threat Vectors?

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Rebecca Ross

About Rebecca Ross

Rebecca Ross an Environmental, Health and Safety (EHS) consultant who runs her own occupational safety consultancy. She focuses on hazardous materials, warehouse safety, fire safety, lab safety, fall protection, head protection and other workplace safety topics. Learn more about Rebecca here or connect with her on Twitter | LinkedIn | Medium

  

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N95 Respirator Alternatives and Conservation Strategies

Becky j. wong.

Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, ude.drofnats@wjbwjb

Branden D. Tarlow

Lucy s. tompkins, amanda chawla, ronald g. pearl, samuel h. wald, to the editor.

We read with great interest the article, 1 Utility of Substandard Facemask Options for Health Care Workers During the COVID-19 Pandemic, which highlights an important issue facing all health care workers (HCW). Anesthesia providers are especially vulnerable to shortages of personal protective equipment (PPE) as the American Society of Anesthesiologists (ASA) recommends appropriate PPE during all aerosol-generating procedures when working near the airway, such as endotracheal intubation. 2 To use optimal equipment, 1 the HCW must have knowledge of the advantages and disadvantages of the available options. We provide a summary for the conservation of N95 respirators and their alternatives (Figure).

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Object name is ane-publish-ahead-of-print-10.1213.ane.0000000000005134-g001.jpg

N95 respirator conservation and alternatives. APF indicates assigned protection factor; FFR, filtering facepiece respirator; MRI, XXX; PAPR, powered air purifying respirator.

FILTERING FACEPIECE RESPIRATORS

Surgical n95.

Conventionally known as medical N95s, these respirators require fit testing and are fluid resistant and rated in the removal of particulate matter. Historically, filtering facepiece respirators (FFRs) were considered single use, but in the pandemic context, the FDA issued Emergency Use Authorizations (EUAs) for the decontamination of respirators. New N95 respirators remain the first choice before a decontaminated respirator. 3

Industrial N95

Although industrial N95 respirators require fit testing and are not fluid resistant rated, HCWs are now turning to industrial N95s as a PPE option with the surgical N95 shortage. A full face shield can be worn over the industrial N95 to prevent fluid penetration.

Elastomeric Respirator

Elastomeric respirators are designed to be reusable and require fit testing. They have disposable and replaceable filters, inhalation/exhalation valves, and come in half facepiece and full facepiece masks. These elastomeric respirators are certified to provide protection equivalent or greater than N95 FFRs. Elastomeric respirators do not filter exhaled breaths. Elastomeric respirators are required to be cleaned and disinfected between users. Cleaning refers to the removal of soil from surfaces (eg, cosmetics and skin oils) using water and detergent. Disinfection eliminates all pathogenic microorganisms with liquid chemicals. 4 Filters need to be replaced based on the biological agent to be filtered, the manufacturer guidelines, and theinfection control policies of the hospital. In the era of universal masking, a procedure mask may be worn over the exhalation valve.

POWERED AIR PURIFYING RESPIRATOR

Powered air purifying respirators (PAPRs) provide filtered, positive airflow to the wearer. PAPRs have the motor and blower unit on a belt with a large hose connecting to the head piece. This can be cumbersome and potentially dangerous for a disconnect. MAXAIR Controlled Air Purifying Respirators (CAPRs) are a proprietary form of PAPRs which rearranges the blower and motor unit to the head piece with only a thin cord connecting the headpiece to the belt with the battery pack. The Occupational Safety and Health Administration (OSHA) gives an assigned protection factor (APF) to respirators. PAPRs have the benefit of higher APF than N95 respirators, but they are limited by availability, contraindication to MRI suite due to ferromagnetic parts, and present debatable concerns for exhaust air flow around sterile fields. 5

RESPIRATOR CONSERVATION AND ALTERNATIVES STRATEGIES

N95 extended use versus limited reuse.

Extended use of an N95 respirator is defined as wearing the same N95 respirator for repeated encounters with several patients, without removing the respirator between encounters. Per the CDC, the maximum recommended period of use when practicing extended use is 8–12 hours. 3

Limited reuse of an N95 respirator is defined as wearing the same N95 respirator for multiple encounters with patients and donning and doffing it in between encounters. The CDC suggests up to 5 uses to ensure an adequate safety margin. 6 Furthermore, the HCW should check the respirator for tears, strap breakage, and nosepiece fractures. HCWs should perform their own seal test with each donning and evaluate for increased breathing difficulties. Any of these signs may prompt the user to discard the respirator. A potential model for reuse is a 4- to 5-day cycle of 4–5 respirators in which the HCW wears a different respirator each day. Individual respirators are stored separately in their own paper bag at the end of the day. The HCW should don the next respirator in order of least recently used.

Reprocessed Surgical N95

Reprocessed N95s have been through a decontamination process. Under the FDA EUA, Battelle Critical Care Decontamination System was 1 process approved to decontaminate N95 respirators. 2 Approved N95 respirators are delivered to the decontamination site for a 4- to 8-hour process: respirators are hung in a closed space, gased with hydrogen peroxide (H 2 O 2 ) vapor, and left for a clearance phase during which H 2 O 2 is converted to oxygen and water vapor. The decontaminated N95 respirators can be returned to the individual person “index user” or to a general pool of reprocessed respirators. Respirators should be marked after each decontamination cycle and disposed of after the maximum reprocessed number has been reached. The maximum number of cycles is a function of the specific decontamination protocol and type of respirator. An important distinction is that N95s are not cleaned. Cosmetic stains, blood contamination, and soiling on the respirator necessitate disposal, not decontamination. The respirators are quality checked and discarded for any visual markings.

Cleaning and Disinfecting Elastomeric Respirators

Little guidance exists regarding the frequency of cleaning and disinfecting and whether these tasks should be centralized or performed by the individual user. OSHA guidelines for cleaning elastomeric respirators involve removing filters, disassembling facepieces, immersing in detergent, scrubbing, submerging in chlorine or iodine disinfectant agent, rinsing, drying, and reassembling. 4 This process would place a high time burden on individual HCWs. The alternative is to have the hospital batch clean and disinfect all elastomeric respirators. This poses an additional workload to sterile processing and incurs extra cost to purchase enough elastomeric respirators to be in circulation.

Hospitals may need to utilize a multipronged strategy to ensure an adequate PPE supply. The options presented here may have varying levels of success based on the hospital size, resources, and capacity for testing patients. However, one thing is universal: the utmost importance for HCWs to be protected.

ACKNOWLEDGMENTS

The authors would like to acknowledge the members of the Stanford N95 Conservation Taskforce, staff, and health care workers from Stanford Health Care for their contributions.

Workplace protection factors for an N95 filtering facepiece respirator

Affiliation.

  • 1 3M Company, Occupational Health and Environmental Safety Division, 3M Center Bldg. 235-2E-91, St. Paul, Minnesota 55144-1000, USA. [email protected]
  • PMID: 17654225
  • DOI: 10.1080/15459620701517764

This study evaluated the workplace performance of an N95 filtering facepiece, air-purifying respirator in a steel foundry. Air samples were collected inside and outside respirators worn by workers who were properly trained and qualitatively fit tested. For most workers, three or four pairs of air samples were collected on each of 2 days. The 49 valid sample sets were analyzed for iron, silicon, and zirconium. Only iron was present in sufficient concentrations to perform workplace protection factor (WPF) calculations. Individual WPF measurements ranged from 5 to 753. The geometric mean of the distribution was 119 with a lower 5th percentile value of 19. Time-weighted average WPFs (WPF(TWA)) were also calculated for each day for each worker as an estimate of the protection an individual might receive with daily respirator use. The WPF(TWA) values ranged from 15 for the worker with the single WPF value of 5, to a high of 684. The distribution of WPF(TWA) had a geometric mean of 120 and a lower 5th percentile of 22. Both data treatments indicate this respirator's performance was consistent with the assigned protection factor of 10 typically used for half facepiece respirators. The respirator provided adequate protection as used in this study. All contaminant concentrations inside the respirator were well below the relevant occupational exposure limits. Data collected also illustrate the dynamic nature of faceseal leakage in the workplace.

Publication types

  • Evaluation Study
  • Air Pollutants, Occupational / analysis*
  • Inhalation Exposure / analysis*
  • Inhalation Exposure / prevention & control
  • Metallurgy*
  • Occupational Exposure / analysis*
  • Occupational Exposure / prevention & control
  • Particle Size
  • Particulate Matter / analysis
  • Respiratory Protective Devices*
  • Air Pollutants, Occupational
  • Particulate Matter

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IMAGES

  1. Proper N95 Respirator Use for Respiratory Protection Preparedness

    assigned protection factor n95

  2. Respirators Assigned Protection Factor Explained

    assigned protection factor n95

  3. Respirator assigned protection factors

    assigned protection factor n95

  4. Protection Factor for N95 Filtering Face Mask with Clipping Path Stock

    assigned protection factor n95

  5. (PDF) COVID-19 pandemic: choosing a loose- fitting PAPR for better

    assigned protection factor n95

  6. Respirator Assigned Protection Factors

    assigned protection factor n95

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  6. Putting on an N95

COMMENTS

  1. PDF AssignedProtectionFactors

    ASSIGNED PROTECTION FACTORS FOR THE REVISED RESPIRATORY PROTECTION STANDARD 7. Definitions Termsprecededbyanasterisk(*)refertodefinitions thatcanbefoundinparagraph(b)("Definitions")of OSHA'sRespiratoryProtectionstandard(29CFR 1910.134). *Air-purifyingrespirator: Arespiratorwithanair-pu-

  2. NIOSH Guide to the Selection and Use of Particulate Respirators

    For example, a filter marked N95 would mean an N-series filter that is at least 95% efficient. Chemical cartridges that include particulate filter elements will carry a similar marking that pertains only to the particulate filter element.

  3. PDF Assigned Protection Factors (APF) for Select 3M Respirators

    Assigned Protection Factors (APF) for Select 3M Respirators APF of 10 if Qualitative fit test (QLFT), if Quantitative fit test (QNFT) APF per table above APF of 10 with full facepiece with 95/99 class filters. APF of 50 with full facepiece with 100 class filters. Manufacturer must demonstrate APF of 1000, otherwise use APF of 25.

  4. Types of Respiratory Protection

    Additionally, each type of respirator has an assigned protection factor (APF). This indicates the level of protection you can expect to receive from that respirator. Table 1 of the OSHA Respiratory Protection standardpresents the APFs for each type of respirator.

  5. Respirator assigned protection factors

    Protection Factor (PF) = (the concentration of harmful substances on the outside of the mask) / (concentration under mask) = 1 / Penetration. The term "Protection Factor PF" has been used in the U.S., and the term "Penetration" was used in the soviet literature from the 1960s.

  6. Understanding respiratory protection options in Healthcare: The ...

    (CDC-NIOSH, May 23, 2017). Both types of N95 respirators protect the user from aerosolized particles, whereas the surgical mask does not. Standard N95: NIOSH-approved device (not FDA cleared). Used to reduce inhalation of aerosolized particles. Fit testing is required. Surgical N95: NIOSH-approved and cleared by the FDA as a medical device.

  7. 1910.134

    Assigned protection factor (APF) means 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 this section.

  8. eTool : Respiratory Protection

    The assigned protection factor (APF) of a respirator reflects the level of protection that a properly functioning respirator would be expected to provide to a population of properly fitted and trained users. For example, an APF of 10 for a respirator means that a user could expect to inhale no more than one tenth of the airborne contaminant ...

  9. PDF A Guide to Air-Purifying Respirators

    Another way to express this is that the OSHA Assigned Protection Factor (APF) is 10. For proper don-ning (putting on) and dofing (taking of) techniques of this type of respiratory protection, refer to the manufac-turer's instructions. Elastomeric Half Facepiece Respirators

  10. COVID-19 pandemic: choosing a loose-fitting PAPR for better protection

    PAPR systems have Assigned Protection Factor (APF) of at least 25 (may up to 1000) while N95 Filtering Facepiece Respirator (FFR) have an APF of 10 (Centre for Disease Control 2020 ).

  11. COVID-19 and cardiopulmonary resuscitation: an N95 respirator mask may

    PAPRs provide 2.5-100 times greater protection than N95 masks as indicated by their respective assigned protection factors. 2 The latter denotes the factor by ... (which provides a high level of droplet protection but low airborne reduction factors) with an N95 mask, 13 to elastomeric respirators. 2 Mechanical chest compression devices may ...

  12. Protection Factor for N95 Filtering Facepiece Respirators Exposed to

    Protection Factor for N95 Filtering Facepiece Respirators Exposed to Laboratory Aerosols Containing Different Concentrations of Nanoparticles - PMC Journal List HHS Author Manuscripts PMC4589166 As a library, NLM provides access to scientific literature.

  13. COVID-19 Fact Sheet: Workers Need Respirators

    *N95 FFRs have an assigned protection factor of 10 (10% inward leakage) but must receive a fit factor of 100 (1% inward leakage) on an individual worker. A FACE COVERING GIVES MINUTES. A RESPIRATOR GIVES HOURS. According to CDC, an uninfected person with no face covering can be infected if within 6 feet of an infected person for 15 minutes.

  14. What Does APF for Respirators Mean?

    Both the surgical N95 and the N95 respirator have an assigned protection factor (APF) of 10 and are filtering facepiece respirators. What does APF 50 mean? Full-face masks with an APF of 50 would decrease exposure to 0.4 ug/m3 when correctly fitted. Is an APF of 10 good?

  15. Respirator Fit Testing, Assigned Protection Factors and Maximum Use

    OSHA developed the assigned protection factors (APFs) to assist you with the determination of maximum protection for different respirators. The APFs are listed in Table 1 of 29 CFR 1910.134.

  16. Cal/OSHA

    When the current AQI is greater than 535, a respirator with an assigned protection factor greater than 10 (not a disposable dust mask) is required. Q: Can an employer distribute N95 masks to workers? A: Where respirator use is voluntary, the employer may provide respirators at the workers' request, or permit workers to use their own respirators.

  17. Respiratory Protection

    Assigned Protection Factors for the Revised Respiratory Protection Standard. OSHA Guidebook (Publication 3352), (2009). Provides employers with information for selecting respirators for workers, using Assigned Protection Factors (APFs) and Maximum Use Concentrations (MUCs). ... (NIOSH Publication No. 87-108), and includes information on N95 ...

  18. PAPR vs. N95 Masks

    These terms are the Assigned Protection Factor (APF) and the Maximum Use Concentration (MUC). The APF is defined as "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…"

  19. Assigned Protection Factors

    The assigned protection factor (APF) of a respirator reflects the level of protection that a properly functioning respirator would be expected to provide to a population of properly fitted and trained users. For example, an APF of 10 for a respirator means that a user could expect to inhale no more than one tenth of the airborne contaminant ...

  20. N95 Respirator Alternatives and Conservation Strategies

    APF indicates assigned protection factor; FFR, filtering facepiece respirator; MRI, XXX; PAPR, powered air purifying respirator. Go to: FILTERING FACEPIECE RESPIRATORS Surgical N95 Conventionally known as medical N95s, these respirators require fit testing and are fluid resistant and rated in the removal of particulate matter.

  21. Workplace protection factors for an N95 filtering facepiece respirator

    Workplace protection factors for an N95 filtering facepiece respirator This study evaluated the workplace performance of an N95 filtering facepiece, air-purifying respirator in a steel foundry. Air samples were collected inside and outside respirators worn by workers who were properly trained and qualitatively fit tested.

  22. N95 Respirator Alternatives and Conservation Strategies

    N95 respirator conservation and alternatives. APF indicates assigned protection factor; FFR, filtering facepiece respirator; MRI, magnetic resonance imaging; PAPR, powered air purifying respirator. We read with great interest the article by Abd-Elsayed and Karri, 1 which highlights an important issue facing all health care workers (HCW).

  23. Fit testing and fit factors for the N-95 respirators for protection

    Fit testing and fit factors for the N-95 respirators for protection against TB exposure. Standard Number: 1910.134 OSHA requirements are set by statute, standards and regulations. Our interpretation letters explain these requirements and how they apply to particular circumstances, but they cannot create additional employer obligations.