Understanding respiratory protection options in Healthcare: The Overlooked Elastomeric

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

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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.cdc.gov/niosh/docs/2015-117/default.html

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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