November 3rd, 2009
Personal Protective Equipment (PPE) and H1N1 Influenza
Personal Protective Equipment (PPE) is defined as “specialized clothing or equipment worn by an employee for protection against infectious materials”.
Presently statics show that of the total number of cases of influenza-like illness (ILI) 99.9% have been confirmed as H1N1. During the H1N1 Influenza pandemic any nurse who is in contact within 2 meters (6 feet) of a patient with ILI should don the following PPE.
Gloves Disposable non-latex (nitrile) gloves should be worn at all times. If non-latex gloves are not available then wear disposable latex gloves. Nurses should limit opportunities for “touch contamination” to protect yourself, your coworkers and your patients.
Gown Isolation gowns should fully cover the torso, fit comfortably over the body and have long sleeves that fit snuggly at the wrist. Cotton and synthetic isolation gowns vary in their degree of fluid resistance. If fluid penetration is likely then a fluid resistant gown or a fluid resistant apron should be worn over a standard isolation gown.
Eye Protection Goggles and face shields are considered to provide appropriate protection as long as they meet the following requirements.
Goggles should fit snuggly over and around the eyes or prescription lenses. An anti-fog feature will improve clarity for the user. Personal prescription lenses and safety glasses do not provide adequate eye protection and should not be used as a substitute for goggles.
Non-disposable goggles should be cleaned with cidex or virox (accel, percept) wipes. If the goggles are visibly soiled then use two wipes one to clean and one to disinfect. The goggles should be left to air-dry to achieve the required contact time for the disinfectant. Once the goggles are dry then they can be rinsed with water and dried with a clean soft cloth to prevent scratching.
Face shields should cover the forehead, extend below the chin and wrap around the sides of the face. If the face shield you are provided does not cover your face and/or does not curve or wrap around the side of your face then insist on being provided with appropriate goggles. Face shields are not a substitute for respiratory protection.
Respiratory Protection
N95 Respirator Under the Alberta Occupational Health and Safety Code (section 244) employers are required to ensure that workers are provided with respiratory protective equipment if a worker is or may be exposed to an airborne biohazardous material. Since there is no current data to confirm the route of transmission, it must be assumed that H1N1 is transmitted by all routes (contact, droplet and airborne). Therefore you must be provided with the appropriate respiratory protection when within 2 meters of a patient with ILI.
Surgical masks do not meet the requirements of providing respiratory protection. The Centre for Disease Control (CDC), the Canadian Federation of Nurses (CFNU) and Alberta Workplace Health and Safety agree that N95 respirators provide adequate protection from both droplet and airborne particles as long as the employee wears a NIOSH (National Institute for Occupational Safety and Health) approved fit-tested N95.
It is essential that there is an adequate seal between the respirator and the user's face otherwise know as the fit. Proper fit-testing is the major factor that determines how effective a respirator is. The size and shape of individuals' faces can vary greatly so N95 respirators come in different sizes and shapes. Respirators must be kept in a clean dry location as humidity, moisture, dirt and crushing reduces the effectiveness of the respirator.
Disposable N95 respirators should be only once. You should don a new mask when you enter the room of a patient with ILI and dispose of the mask when you leave the room. However, because the respirator filters out particles the pores of the filter will eventually become blocked if you are required to wear the respirator for an extended period. This blockage makes breathing more difficult for the user and can result in a break in the seal to the face. If you find that breathing while wearing the N95 for some time becomes much more difficult then you should properly dispose of the N95 and replace it with a new N95 respirator.
Powered Air Purifying Respirator (PAPR) The powered air purifying respirators (PAPR) should be available for use by the small percentage of employees who are unable achieve a proper seal with a N95 respirator or cannot wear a N95 due to medical reasons. A PAPR is battery operated and consists of a hood and full face shield. It uses a HEPA filter to supply purified air to the wearer. PAPRs should be cleaned and disinfected based on manufacturers recommendations.
What You Need to Know:
Get Fit Tested! - The Multi-Employer/UNA Joint Committee has reached an agreement regarding N95 Respirator Provision and Fit Testing, which requires the employer to provide N95 respirator fit-testing to all employees covered by the Multi-Employer/UNA Collective Agreement. Fit-Testing is mandatory as per Article 35.02 (a)
Ensure you have enough N95 respirators - The Joint Committee agreement obligates the Employer to ensure that an appropriate supply of N95 respirators is available.
You may be temporarily transferred - In the event of an emergency Article 44: Mobility (44.05 (e)) allows the Employer to reassign Employees from any site to perform work at any other site in emergency circumstances. An emergency is defined as “an unforeseen combination of circumstances or the resulting state that calls for immediate action”. Contact you Local representative or Labour Relations Office for additional information regarding emergency transfers.
Do not report to work if you are sick - Nurses should not be reporting to work if they have influenza like illness (fever and respiratory symptoms). Nurses who do report to work are putting patients and their co-workers at risk of infection and illness. The Alberta Government is asking that individuals with flu like symptoms stay home from work and avoid public places when ill.
You do not have to put your health at risk - The agreement between the parties states that employees who have not been fit-tested for an N95 respirator or are unable to achieve an effective facial seal shall not be expected to enter or provide services in an area where a suspected or confirmed case of swine influenza A has been identified. These Employees may be deployed to another area.
You need to assess whether you believe that you need to provided with N95 respirators (fit-tested), gown and eye protection. If your employer refuses then ask to be reassigned.
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