PE RSONAL PROT ECT IVE EQUIPMENT
Requirement
Assigned Protection factor (APF) Filter efficiency
Test agent used
Total inward leakage (TIL) Inhalation resistance Exhalation resistance
Rebreathed CO2 Figure 1
the source or at more distant locations, is most effectively interrupted by a respiratory protection device, such as an N95 filtering face-piece respirator.7
Respiratory Protective Equipment The Health and Safety Executive has undertaken a very useful piece of work looking at the merits and test standards for the different types of masks available and their comparison. The N95 has not been tested to the European standards and is not CE Marked. It is, however, widely accepted by industry that the N95 (available in the US) and the FFP2 are comparable, for filtering non-oil-based particles including bioaerosols (eg viruses). The research report states in the introduction, ‘HSE’s current stance is that, where there is a respiratory risk of infection, use of FFP3 devices represents best practice and, where these are not available, then FFP2 may be an acceptable, pragmatic compromise.’8
What has changed in the new guidance? To ensure maximum workplace risk mitigation, organisations should undertake local risk assessments based on the measures, as prioritised in the hierarchy of controls. If an unacceptable risk of transmission remains, following this risk assessment, it may be necessary to consider
the extended use of Respiratory Protective Equipment for patient care in specific situations. The risk assessment should include evaluation of the ventilation in the area and prevalence of infection/new variants of concern in the local area.9
The main
amendments to this version of the guidelines is the inclusion of the hierarchy of controls, as these apply to COVID-19. Also included is further advice on the use of valved respirators with examples of sterile procedures in the clinical setting. There is also additional advice on minimising sessional or extended use of gowns where cohorts of COVID-19 patients are managed and there is a lack of single rooms/ isolation rooms. The list of aerosol- generating procedures has been amended to state ‘upper gastro-intestinal endoscopy where open suction of the upper respiratory tract occurs beyond the oro-pharynx’. Finally, it is re-iterated that individuals who are extremely vulnerable from COVID-19 will require protective IPC measures (depending on their medical condition and treatment) while receiving healthcare – for example, priority of single room isolation. The guidance states that maintaining services requires a continuous review of ways of working to respond to the pandemic and guidance for working in a changing environment requires continual and ongoing development – based upon emerging evidence, experience and expert opinion. It also highlights that each of
the devolved nations may have differences in their advice, so local country-specific guidance is necessary to check. It specifically states that guidance for social care has already been provided and continues to be relevant.
Personal Protective Equipment In the view of the author, the guidance while remaining similar to previous versions, is clearer here. Protective solutions, approved by the Health and Safety Executive or the Medicines and Healthcare products Regulatory Agency, are identified below in the detailed advice. All PPE should be: l Located close to the point of use (where this does not compromise patient safety, for example, mental health/learning disabilities). In domiciliary care, PPE must be transported in a clean receptacle.
l Stored safely and in a clean, dry area to prevent contamination.
l Within expiry date (or had the quality assurance checks prior to releasing stock outside this date)
l Single use unless specified by the manufacturer or as agreed for extended/ sessional use including surgical facemasks.
l Changed immediately after each patient and/or after completing a procedure or task (unless sessional use has been agreed and local risk assessment undertaken).
l Disposed into the correct waste stream depending on setting, for example
Requirement N95 (NIOSH 42CFR84)
10 ≥95% (85 l/min)
NaCl N/A
≤343 Pa (85 l/min) ≤245 Pa (85 l/min) N/A
Requirement FFP2
(EN149:2001+A1:2009) 20
≥94% (95 l/min)
NaCl and Paraffin oil ≤8%
≤240 Pa (95 l/min) ≤300 Pa (160 l/min) ≤1%
Requirement FFP3
(EN149:2001+A1:2009) 20
≥99% (95 l/min)
NaCl and Paraffin oil ≤2%
≤300 Pa (95 l/min) ≤300 Pa (160 l/min ≤1%
AUGUST 2021
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