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Coronavirus Illness 2019 (COVID-19)


Contingency Capability Methods Throughout Surge Demand Conditions

Who this steerage is for: These chargeable for creating and implementing insurance policies and procedures for stopping pathogen transmission in healthcare settings. This contains federal, state, and native public well being officers, respiratory safety program managers, occupational well being service leaders, and an infection prevention and management program leaders.

Goal: This webpage describes choices for deploying air-purifying reusable elastomeric particulate respirators to supply respiratory safety to healthcare practitioners (HCP) when provides of N95 filtering facepiece respirators (FFRs), together with surgical N95s, are restricted or not out there.

Methods for reusable elastomeric respirator use in healthcare settings in typical, non-surge demand conditions, are mentioned in Typical Methods. Typical use ought to adhere to OSHA necessities and manufacturer-specific really useful directions.

Contingency capability methods are for emergency conditions wherein every elastomeric respirator is issued for the unique use of a person worker. The respirators are cleaned and disinfected as usually as vital to stay unsoiled and sanitary. Their description and use needs to be a part of a written OSHA respiratory safety program (RPP). If there’s deviation from the usual RPP, it needs to be approved and documented by this system’s administrator.

Disaster capability methods are for emergency use, restricted respirator and/or respirator element provides resembling filters, cartridges, or canisters, and valves, and conditions wherein it’s not possible for particular person HCP to have a devoted elastomeric respirator, for instance when the identical respirator have to be utilized by a number of HCP. When utilized by multiple HCP, respirators have to be cleaned and disinfected earlier than being worn by completely different people. Using elastomeric respirators needs to be a part of a written OSHA RPP. If there’s any deviation from the traditional RPP, it needs to be approved and documented by this system’s administrator.

Elastomeric Respirators as an alternative choice to NIOSH-approved N95 respirators

NIOSH-certified reusable elastomeric particulate respirators present a minimum of the identical degree of safety as N95 FFRs, and a few varieties of elastomeric respirators can supply increased assigned safety components than N95 FFRs.

Essentially the most vital distinction between reusable elastomeric respirators and disposable FFRs is that reusable respirators have to be maintained and inspected after every use, together with cleansing and disinfection of the elastomeric parts resembling facepiece valves, valve covers, and straps. When utilized in typical office situations, the filter, cartridge, or canister of a reusable elastomeric respirator isn’t cleaned or disinfected; it’s discarded as soon as broken, dirty, or clogged. Elastomeric respirators are geared up with replaceable filters. Some replaceable filters are cartridge model wherein the filtration media is housed within a cartridge. Others include versatile, disc or pancake-style filters, wherein the filter media aren’t housed inside a cartridge physique.

This doc gives concerns for disinfecting the skin of a filter cartridge throughout contingency and disaster situations to extend the provision of respirators for cover throughout the Coronavirus Illness 2019 (COVID-19) pandemic. Nevertheless, there’s an elevated threat of contact transmission or injury to the filter cartridge that have to be thought of.

Normal Reusable Elastomeric Respirator Issues

Reusable respirators described on this doc embody tight-fitting half-facepiece or full-facepiece elastomeric respirators that use replaceable filters, cartridges, or canisters and have facepieces manufactured from artificial or pure rubber materials allowing repeated cleansing, disinfection, storage, and reuse. They comprise an exhalation valve and shouldn’t be utilized in surgical settings when there’s concern that unfiltered air popping out of the exhalation valve could contaminate the surgical subject. As with N95 FFRs, reusable respirators require an RPP together with, however not restricted to, preliminary and annual match testing, and a consumer seal verify every time the respirator is used. Nevertheless, on March 14, 2020 OSHA issued Non permanent Enforcement Steerageexterior icon allowing OSHA subject places of work to train enforcement discretion concerning the annual match testing necessities till additional discover.7

NIOSH-approved, elastomeric respirators present another respiratory safety choice able to reducing the full variety of respirators required as a result of they could be cleaned, disinfected, and reused quite a few occasions, which ought to scale back the variety of respirators wanted when provides are restricted.8 Nevertheless, a provide of elastomeric respirator facepiece parts needs to be held in reserve to interchange broken or deteriorated components, and provides of alternative filters, cartridges, or canisters are additionally wanted. The filters of those respirators are a minimum of as protecting because the N95 FFRs and surgical N95 FFRs sometimes utilized in healthcare settings. They aren’t cleared by FDA for fluid resistance and require upkeep together with cleansing, disinfection, and inspection.

There are a number of varieties of filter media to be used with NIOSH-approved reusable, half -facepiece elastomeric respirators. All are adequate at eradicating droplet and viral dimension particles when worn accurately at some stage in the publicity. Filters can be found in three effectivity ranges – 95, 99, 100. Thus, a big selection is doubtlessly out there to be used to reinforce the general provide of respirators in healthcare settings.

  • On an emergency foundation throughout contingency and disaster emergency use,
    • Filters (aside from unprotected disc kind, i.e., pancake model) could also be used for an prolonged interval, if the filter housing of cartridge sorts is disinfected after every affected person interplay offered the disinfectant or cleansing agent doesn’t are available contact with the filter media.
    • Filters, even cartridge sorts, should not be dipped or immersed in a cleansing or disinfection resolution as a result of this will likely injury or render the filter materials ineffective. When utilizing a cleansing or disinfectant wipe on the exterior floor of a filter cartridge, customers ought to keep away from contact with the filter media on the within of the cartridge.
  • The particular cautions, limitations, and restrictions of use needs to be understood when figuring out whether or not to make use of these respirators in healthcare amenities.
    • Respirators with full facepieces have the identical filter concerns however present better safety due to higher sealing traits and fewer face seal leakage and in addition present safety to extra of the face and really importantly, the eyes.
    • Elastomeric respirators with exhalation valves shouldn’t be utilized in surgical settings attributable to considerations that unfiltered air popping out of the exhalation valve could contaminate the surgical subject.

Half-facepiece or half masks (APF = 10)1 and full facepiece (APF = 50) elastomeric respirators have particular cautions, limitations, and restrictions of use that must be understood when figuring out whether or not to make use of these respirators in a healthcare facility. Respirators with full facepieces have the identical filter concerns however present better safety due to higher sealing traits and fewer face seal leakage and in addition present safety to extra of the face and really importantly, the eyes.

Efficient Elastomeric Respirator Use

Throughout contingency and disaster capability methods, when shortages are predicted, however provides are nonetheless out there, every elastomeric respirator is issued for the unique use of a person worker. Elastomeric respirators have to be cleaned as usually as vital to stay unsoiled and sanitary.

  • As with N95 FFRs, attaining an enough seal to the face is crucial. OSHA laws require a written respiratory safety program requiring staff to bear an preliminary and annual match take a look at and conduct a consumer seal verify every time the respirator is donned (placed on). Staff should move an preliminary and annual match take a look at to substantiate a correct seal earlier than utilizing a tight-fitting respirator within the office. Any exception to this system throughout emergency use needs to be approved and documented by this system administrator. On March 14, 2020 OSHA issued Non permanent Enforcement Steerageexterior icon allowing OSHA subject places of work to train enforcement discretion concerning the annual match testing necessities till additional discover.7
  • When correctly fitted and worn, minimal leakage happens across the edges of the tight-fitting respirator the place it seals to the consumer’s face when the consumer inhales. This implies nearly all of the air is directed by means of the filter media.
  • A respirator with an exhalation valve gives the identical degree of safety to the wearer as one that doesn’t have a valve. The presence of an exhalation valve reduces exhalation resistance, which makes it simpler to breathe (exhale). Some customers really feel {that a} respirator with an exhalation valve retains the face cooler and reduces moisture construct up contained in the facepiece. Nevertheless, respirators with exhalation valves are typically not be utilized in conditions when a sterile subject have to be maintained, resembling throughout an invasive process in a surgical or procedural setting, as a result of the exhalation valve permits unfiltered air exhaled by the wearer, doubtlessly contaminated with microbes, to flee and presumably contaminate the sterile subject. There could also be different healthcare actions the place respirators with exhalation valves are applicable.
  • Throughout contingency or disaster situations, HCPs could obtain elastomeric respirators they aren’t accustomed to utilizing. The JETFIT Research gives details about how shortly the healthcare staff could be skilled on utilizing elastomeric respirators when switching from N95 FFRs to elastomerics.9
  • The Bessesen et al. protocol describes a easy strategy to cleansing and disinfecting elastomeric respirators in healthcare settings.10 The CDC webinar on Elastomeric Respirators for U.S. Healthcare Supply describes the Bessesen protocol and extra details about using elastomeric respirators in healthcare settings.11

Normal Cleansing and Disinfection Info

Viruses and micro organism that trigger acute respiratory infections can survive on respirator parts for variable durations of time, from hours to weeks. Consequently, contaminated elastomeric respirators have to be dealt with, cleaned, and disinfected correctly to scale back the potential of the system carrying infectious particles and contributing to illness transmission.2

Every respirator producer identifies the suitable cleansing procedures, which generally includes 1) utilizing cleaning soap and heat water or chemical disinfectants approved to be used with their particular elastomeric facepiece parts and a pair of) discarding the filter cartridge.

For typical use: Employers should seek the advice of with the producer regarding the effectiveness and uncertainties of other cleansing and disinfectant options and procedures used for reuse of the facepiece, straps, and filter parts.

  • The options and procedures have to be efficient for disinfection however 1) not injury the respirator, together with inflicting injury to the filter media, which conventionally is discarded and a pair of) not trigger hurt resembling pores and skin irritation to the wearer.
  • Extended or repeated use of disinfectants could injury or degrade respirator elastomeric parts (facepiece, valves, valve covers, straps), inflicting parts to discolor, swell, harden, and crack.

For contingency and disaster use: Due to necessity, elastomeric facepiece parts and filter cartridges could also be handled otherwise for his or her cleansing and disinfection. Whereas typical observe is to discard the filter element, contingency practices could necessitate cleansing and disinfecting the filter housing, however care have to be taken to not uncovered the filter media to any cleansing options. The efficiency of filter media could be degraded by contact with the disinfectant.

  • Throughout surge conditions, when producer directions aren’t out there, and provide shortages exist, interim cleansing and disinfection procedures could also be vital and efficient to reuse scarce or unavailable alternative parts. Nevertheless, interim procedures may improve the chance of contact transmission or injury to the filter media if not achieved correctly. Alternate procedures and dangers have to be thought of to guard HCP and meet healthcare wants.
  • First clear the floor of every element aside from the filter media after every use. Eradicating natural and inorganic supplies from the element surfaces will assist obtain maximally efficient disinfection.12
  • Some disinfectants are highly effective germicides, so their use requires particular precautions resembling enough air flow, use of unpolluted non-sterile gloves, robes, and face shields. As such, cleansing and disinfection have to be achieved by competent, skilled people.
  • Further pointers for cleansing and disinfecting elastomeric respirators can be found from the CDC/NIOSH-sponsored JETFIT research, performed in 2019-2020 at two educational medical facilities to raised perceive the feasibility of quickly match testing and coaching HCP to make use of elastomeric respirators.9
  • Care must be taken throughout cleansing and disinfection to make sure the skilled respirator cleansing employees doesn’t contaminate or injure themselves. Centralizing this exercise could be useful for making certain that it’s being correctly executed. Latest research display that some elastomeric respirators proceed to perform and carry out as anticipated after 150 cleansing and disinfection cycles.13

Primary Steps to Clear and Disinfect an Elastomeric Respirator

There are a number of primary steps to wash and disinfect an elastomeric respirator – take away, clear, disinfect, rinse and dry, examine and restore or change, and retailer. Bessesen et al. present helpful pointers for cleansing and disinfecting elastomeric respirators in healthcare environments.10 These strategies have been used efficiently in a number of healthcare settings in the US. The order and particulars of every step are necessary.

If out there and applicable, the respirator facepiece parts needs to be cleaned utilizing OSHA or producer protocols.7 1415 Filter cartridge parts would conventionally be discarded. Nevertheless, during times of surge capability, a cautious wipe of the filter cartridge, avoiding contact with the filter media, and utilizing a standard hospital disinfectant wipe has low threat of damaging the filter. The filter cartridge ought to by no means be dipped or submerged in disinfectant or excessively wetted with disinfectant.

Typically, it is suggested that respirators be cleaned and disinfected instantly after doffing (i.e., eradicating). To keep away from contact transmission, precautions needs to be taken throughout doffing and use. Coaching on applicable donning and doffing procedures needs to be offered to all workers anticipated to put on respirators. Each CDC and OSHA have movies illustrating correct donning and doffing of the respirator.16 Elastomeric parts fluctuate amongst producers and react otherwise to cleansing and disinfection options and procedures. The respirator facepiece parts resembling facepiece, valves, and straps require upkeep together with cleansing, disinfection and inspection previous to reuse. OSHA solely requires changing filters “the place vital,” for instance, when dirty, contaminated, or clogged. The alternate cleansing and disinfection methodology, described by Bessesen et al. to be used in healthcare when typical practices aren’t sensible, has been used efficiently.10

Cleansing

  • When eradicating natural and inorganic matter from the respirator, skilled personnel ought to put on nitrile gloves to guard their fingers and restrict the potential for self-infection. Further protecting tools resembling robes and face shields, in addition to air flow, could also be required throughout cleansing and disinfection procedures. Cleansing resolution contact with the filter media have to be prevented.
  • A detergent or cleaning soap and heat water could possibly be used to wash the floor of the filter cartridge previous to disinfection. Fastidiously keep away from contact with the filter media. Cleansing could be achieved utilizing a clear, delicate fabric dampened with heat water roughly 49°C (120°F) containing a gentle pH impartial (pH 6-8) detergent and utilizing a mechanical wiping motion. Different elastomeric facepiece parts could also be cleaned utilizing the producer’s really useful procedures.

Disinfecting

The effectiveness of an alternate filter cartridge disinfection resolution and process could also be unsure:

  • All crevices of many filter cartridge housings might not be reached with adequate disinfection resolution or be contacted for the time period required to be efficient.
  • The filter media could also be degraded from contact with the disinfectant.

Some elastomeric respirators have filter cartridges that forestall disinfectant contact with the filter media. If out there, these filter cartridges needs to be used within the contingency capability methods strategy. These filter cartridges present added assurance that the filter media is not going to be contacted with the cleansing and disinfectant options. These cartridges could also be wiped down repeatedly.

NOTE: P-series filters can typically be re-used till they’re dirty, broken, or troublesome to breathe by means of. Warning needs to be used when utilizing the filter for a stay virus, and thorough disinfection of the filter cartridge needs to be accomplished.

Practices not authorised by the producer can improve the chance and uncertainty of re-using broken or degraded parts. This have to be balanced in opposition to different out there HCP safety choices to maintain efficient HCP safety and affected person care.

Modified procedures used throughout emergencies needs to be assessed and documented within the written RPP, together with alternate cleansing and disinfection practices.

For disinfection, diluted family bleach options, alcohol options with a minimum of 70% ethyl alcohol, and EPA-registered family disinfectants needs to be efficient in opposition to coronaviruses.

To be used of diluted family bleach options, observe disinfectant producer’s directions for correct disinfectant utility, PPE, and air flow.

  • Test to make sure the bleach isn’t previous its expiration date.
  • By no means combine family bleach with ammonia or some other cleanser. Unexpired family bleach might be efficient in opposition to coronaviruses when correctly diluted.
  • Most Family bleach options fluctuate in focus from 5.25% sodium hypochlorite (~50,000 ppm out there chlorine) to as much as 12.5% sodium hypochlorite (~125,000 ppm). It is very important verify the product label and observe the disinfection instructions to be used, dilution, and call time. Alter the ratio of bleach to water as wanted to realize applicable focus of sodium hypochlorite.
    • Based mostly on the EPA Checklist N: Disinfectants for Use In opposition to SARS-CoV-2 merchandise, 2500 ppm (0.25%) for five minutes is efficient. Most available bleach is roughly 6% so 2/3 cup of bleach per gallon of chilly faucet water (1:24 dilution) for five minutes is acceptable.
    • For bleach preparations containing 5.25% sodium hypochlorite, use ¾ cup of bleach per 1 gallon of chilly faucet water for five minutes.
    • If a decrease focus of bleach is desired, the EPA customary disinfection fee for hypochlorite merchandise is 600 ppm for 10 minutes. That’s, use 3 tablespoons of bleach per 1 gallon of chilly faucet water for 10 minutes.
  • Put together a contemporary bleach resolution every day in a well-ventilated space. At all times add bleach to chilly water, not water to bleach.

CAUTION: The next could degrade or injury the respirator parts.

  • Sturdy options resembling hypochlorite, iodine, and excessive concentrations of alcohol could degrade, deteriorate or extract chemical components from sure respirator supplies.
  • Healthcare sterilization processes together with ethylene oxide shouldn’t be used until approved by the respirator producer, as they could degrade and alter the form of the facepiece.
  • Steam sterilization tools shouldn’t be used until approved by the respirator producer.

 

Some EPA-approved disinfectants are additionally out there as prepared to make use of at 2700 ppm for 1 minute; nevertheless, these sturdy options may affect the integrity of the respirator parts. Merchandise with EPA-approved rising viral pathogens claims exterior iconare anticipated to be efficient in opposition to SARS-CoV-2. Comply with the producer’s directions for all cleansing and disinfection merchandise (e.g., focus, utility methodology and call time, and many others.).

Disinfectants listed on the EPA’s Registered Antimicrobial Merchandise for Use In opposition to Novel Coronavirus SARS-CoV-2, the virus that causes COVID-19, could possibly be used to inactivate the virus.18 These meant to be used with delicate surfaces could also be most well-liked.

Inspection

All respirators utilized in routine conditions have to be inspected by correctly skilled people earlier than every use and through cleansing. This features a verify of respirator perform, tightness of connections, and the situation of the varied components, such because the facepiece, head straps, valves, cartridges, and canisters or filters.

Examine elastomeric components for pliability and indicators of decay. Respirators that fail an inspection or are in any other case discovered to be faulty needs to be faraway from service and discarded, repaired, or adjusted in accordance with the next procedures:

  • Repairs or changes to respirators have to be made solely by individuals appropriately skilled to carry out such operations, and solely utilizing the respirator producer’s NIOSH-approved components designed for the respirator.
  • Repairs have to be made in keeping with the producer’s suggestions and specs for the kind and extent of repairs to be carried out.
  • Lowering and admission valves, regulators, and alarms have to be adjusted or repaired solely by the producer or a technician skilled by the producer.

Particulate Filter Alternative

Discard filter cartridges in the event that they develop into visibly dirty or moist, if they’re visibly broken, or if the respirator turns into notably tougher to breathe by means of. In any other case, change out the filters periodically. Offered the cartridge integrity and filter haven’t been compromised, present observe exhibits that conservatively, the filters could possibly be used for a minimum of one yr.18

Coaching

Staff have to be educated and skilled on the right way to safely use their elastomeric respirator. Employers ought to observe the respirator producer’s directions and OSHA steerage to the best extent doable; and think about coaching suggestions described within the Bessesen protocol. The NIOSH JETFIT research gives wonderful coaching for contingency conditions.

To make sure respirator upkeep is performed correctly, employers ought to set up disinfection and cleansing procedures and prepare employees to carry out the required upkeep together with storage, inspection, distribution, restore or alternative, cleansing, disinfection, and disposal. Employers could establish a central location for disinfection or prepare particular person customers to wash and disinfect their respirators. Preliminary floor cleansing needs to be achieved at level of use earlier than transferring to a central location for disinfection. 19, 20, 21

Respirator storage

Respirators have to be saved in a clear, non-contaminated location in a fashion that doesn’t distort the facepiece or straps. Respirators must be completely air dried previous to storage.

Disaster Capability Methods Throughout Surge Demand Conditions

In periods of disaster surge capability, a number of methods along with the contingency methods could also be adopted.

Sharing elastomeric respirators

Whether it is not possible for particular person HCP to have devoted elastomeric respirators, the identical elastomeric respirator could also be utilized by a number of HCP. Elastomeric respirators issued to multiple worker needs to be cleaned, disinfected, and inspected earlier than being worn by completely different people. One choice is to label the respirator, conduct floor cleansing on the level of use, and return to a central location to be disinfected by central employees earlier than reissuing the respirator to a distinct consumer.

Machines could also be used to expedite the cleansing, sanitizing, rinsing, and drying of enormous numbers of elastomeric respirators. Usually, the respirator’s elastomeric parts shouldn’t be cleaned with solvents (e.g., acetone, ethanol) or uncovered to temperatures better than 50°C (122°F).  Put up-cleaning inspection by personnel skilled within the vital upkeep duties ought to nonetheless be performed to guarantee respirator performance has not been degraded.

Excessive care needs to be taken to restrict tumbling, agitation, or publicity to temperatures above these really useful by the producer, as these situations could end in injury to the respirators.

Ultrasonic cleaners, garments washing machines, dishwashers, and garments dryers have been specifically tailored and efficiently used for cleansing and drying elastomeric respirators. 22

Waiving the match testing necessities

OSHA has issued non permanent enforcement steerage about switching from quantitative to qualitative match testing, and OSHA is waiving the annual match testing necessities as described above.7 If match testing isn’t doable, leakage on the face seal may happen and the safety offered to the wearer could also be considerably lowered. For any tight-fitting respirator, resembling FFRs and elastomeric respirators, a profitable consumer seal verify have to be carried out with every donning.

Below severe outbreak situations wherein respirator provides are severely restricted, HCP could not have the chance to ever be match examined on a respirator earlier than needing to make use of it. Whereas this isn’t preferrred, on this situation, HCP ought to work with their employers to decide on the respirator that matches them finest, as, even with out match testing, a respirator will present higher safety than utilizing no respirator in any respect or utilizing a surgical masks.

If doable, the HCP ought to begin with the dimensions used beforehand for match testing, however as dimension can fluctuate by producer and mannequin, a distinct dimension could also be wanted to realize a very good match.

If match testing has by no means been achieved, the next suggestions are nonetheless helpful.

  • If utilizing a half facepiece respirator, it ought to match over the nostril and underneath the chin. If a very good face seal can’t be achieved when performing a consumer seal verify, strive a distinct mannequin or dimension.
  • OSHA has developed movies in English and Spanish to help customers with donning, doffing, and consumer seal checks.23,24
  • If respirators are acquired throughout a disaster, they usually must be used immediately with out match testing, ask the employer for added product coaching movies and literature on correct donning (placing on) and doffing (taking off), and content material on the right way to conduct a consumer seal verifyexterior icon.25
  • Apply placing on the respirator and doing a consumer seal verify a minimum of a number of occasions.
  • Test the slot in a mirror or ask a colleague to look to make sure the respirator is touching your face and seems to be on correctly.

Match testing is critical to substantiate if a respirator does or doesn’t match. Throughout a disaster, nevertheless, when typical necessities can’t be carried out, healthcare professionals ought to be capable to decide if they’ve obtained an affordable match if they’ve had coaching they usually carry out a profitable consumer seal verify prior to every use of the respirator.

Issues for Customers of Corrective Lenses

  • Conventionally, staff who put on a full facepiece respirator and wish corrective lenses would have prescription inserts. In a surge scenario, the place a number of workers share respirators, using prescription inserts may not be possible.
  • Staff who use glasses may put on half facepiece respirators, with glasses worn over the respirator to keep away from a scenario the place the arms of the glasses intrude with the respirator seal.
  • The dangers of contamination by solvent vapors don’t apply in most healthcare settings. Subsequently, people who put on contact lenses ought to be capable to put on both full facepiece or half facepiece respirators.  Nevertheless, using contact lenses basically may current extra dangers the place SARS-CoV-2 exposures are identified or suspected.

Footnotes

1 An Assigned Safety Issue (APF) is the office degree of respiratory safety {that a} respirator is predicted to supply to workers when used along side an efficient RPP.

References

1OSHA (Requirements – 29 CFR). Occupational Security and Well being Requirements. Obtainable from: https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=12716&p_table=requirementsexterior icon

2WHO [2014]. An infection prevention and management of epidemic-and pandemic inclined acute respiratory infections in well being care. Obtainable from: https://www.who.int/csr/bioriskreduction/infection_control/publication/en/exterior icon

3CDC [2020]. Coronavirus Illness 2019 (COVID-19): FAQ about PPE. Obtainable from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirator-use-faq.html

4CDC [2020]. Coronavirus Illness 2019 (COVID-19): Optimize PPE Provide. Obtainable from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/index.html

53M [2020]. Respiratory Safety for Airborne Exposures to Biohazards. Obtainable from: https://multimedia.3m.com/mws/media/409903O/respiratory-protection-against-biohazards.pdfpdf icon

6Moldex. 7000 Sequence Reusable Half Masks Respirator. Obtainable from: https://www.moldex.com/product/7000-series-half-mask-respirator/exterior icon

7OSHA [2020]. Non permanent Enforcement Steerage – Healthcare Respiratory Safety Annual Match-Testing for N95 Filtering Facepieces In the course of the COVID-19 Outbreak. Obtainable at: https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fitexterior icon

8NIOSH [1996]. NIOSH Information to the Choice and Use of Particulate Respirators (Licensed Below 42 CFR 84). U.S. Division of Well being and Human Companies, Facilities for Illness Management and Prevention, DHHS (NIOSH) Publication 96-101, https://www.cdc.gov/niosh/docs/96-101/default.html

9Pompei LA, Kraft CS, Brownsword EA [2020]. Coaching and Match Testing of Well being Care Personnel for Reusable Elastomeric Half-Masks Respirators In contrast with Disposable N95 Respirators. JAMA. doi:10.1001/jama.2020.4806

10Bessesen M, Adams JC, Radonovich L, Anderson J [2015]. Disinfection of Reusable Elastomeric Respirators by Well being Care Staff: A Feasibility Research and Improvement of Normal Working Procedures. American Journal of An infection Management 43(6):629-634.

11CDC [2020]. Coronoavirus Illness 2019 (COVID-19): Decontamination and Reuse of Filtering Facepiece Respirators. Obtainable at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html

12Rutala WA, Weber DJ [2019]. Healthcare An infection Management Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Services, 2008.

13Lawrence C, Harnish DA, Sandoval-Powers M, Mills D, Bergman M, Heimbuch BK [2017]. Evaluation of half-mask elastomeric respirator and powered air-purifying respirator reprocessing for an influenza pandemic. Am J Infect Management, 45(12):1324-1330.

14OSHA 29CFR1910.134. Obtainable from: https://www.osha.gov/laws-regs/laws/standardnumber/1910/1910.134exterior icon

15OSHA 1910.134 App B-2 Respirator Cleansing Procedures (Obligatory). Obtainable from: https://www.osha.gov/laws-regs/laws/standardnumber/1910/1910.134AppB2exterior icon

16CDC. Sequence for Placing On Private Protecting Tools (PPE). Obtainable at: https://www.cdc.gov/niosh/npptl/pdfs/PPE-Sequence-508.pdfpdf icon

17EPA [2020]. Checklist N: disinfectants to be used in opposition to SARS-CoV-2. Obtainable from: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2exterior icon

18Private communications with College of Maryland Faculty of Medication, March 18, 2020.

19College of Nebraska Medical Heart [2012]. Half Masks Respirator II: Gross Decon, Reassembly, and Storage. Obtainable at: https://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=73&src=ytexterior icon

20College of Nebraska Medical Heart [2011] Half Masks Respirator III: Gentle Decon and Storage. Obtainable at: https://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=72&src=ytexterior icon

21CDC [2020].  Elastomeric Respirators for U.S. Healthcare Supply. Obtainable from: https://www.youtube.com/watch?v=8wd5Bx2fVDI

22ATSM Worldwide F3387-19, Normal for Respiratory Safety.

23OSHA [2009]. Respiratory Security (video). Obtainable at: https://www.youtube.com/watch?v=Tzpz5fko-fg

24OSHA [2009]. Seguridad de Máscaras de Respiración. Obtainable at: https://www.youtube.com/watch?v=jgRKuRcTGeE

25College of Nebraska Medical Heart [2011]. Half Masks Respirator I: Donning, Doffing and Match Test. Obtainable at: https://app1.unmc.edu/nursing/heroes/mpv.cfm?updateindex=71&src=ytexternal iconexterior icon



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