Aerosol Transmissible Disease and Respiratory Protection Program Power

Aerosol Transmissible Disease and Respiratory Protection Program

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Program Syllabus

Introduction Welcome to our “Aerosol Transmissible Disease and Respiratory Protection Program” education module. This module is for most Tulare Regional Medical Center personnel organization-wide performing their regular work for the organization and interfacing with patients. The purpose for this module is to provide a better understanding about aerosol transmissible diseases, what you can do to prevent the spread of A. T. D. , and what options are available to you as staff at Tulare Regional Medical Center to protect yourself and others.

Course Details Target Group: Employees who interface with patients Prepared by: Infection Prevention Team Structure: Review the Power. Point Program Take the post-test

Learning Objectives By completion of this module, the employee will: • Define A. T. D. • Recognize what protective respiratory equipment is available at Tulare Regional Medical Center. • Comply with required vaccinations for employment. • Identify engineering controls that limit A. T. D. • Examine unit specific requirements indicated within the A. T. D. plan.

What policies drive the A. T. D. Plan? A. T. D. Plan is implemented according to: Policy #20 -8037 Aerosol Transmissible Disease (A. T. D. ) Plan, with reference to: Policies #20 -8003, 20 -8016, 20 -8018, 20 -8024, 20 -8034, and 20 -8036.

History of the Aerosol Transmissible Disease Standard The Cal/OSHA Aerosol Transmissible Disease Standard was enacted May 21, 2009. The standard applies to several different institutions, not just hospitals. On September 1, 2010, employers were required to provide Powered-Air Purifying Respirators (P. A. P. R. s) in specific settings and conditions. The Aerosol Transmissible Disease standard is an “umbrella” standard encompassing multidisciplinary actions. The standard addresses aspects of infection control, employee health, maintenance/engineering, and lab biosafety, as well as adherence to a Respiratory Protection Program that addresses medical evaluation for fit testing, the fit testing process, and the option of a Powered Air-Purifying Respirator (P. A. P. R. ). Lack of compliance with the Cal/OSHA A. T. D. standard has resulted in hefty fines and infected employees. Breaches in infection control practice, notification delays, lack of worker exposure assessment and post-exposure treatment has contributed to secondary cases of infection related to respiratory transmission of disease.

Aerosol Transmissible Disease and Respiratory Protection Program A. T. D. stands for Aerosol Transmissible Disease: Disease causing microorganisms that can be spread through very small aerosolized droplets.

A. T. D. - Engineering Controls • Engineering and administrative controls such as patient triage and appropriate placement of patients using Isolation Precautions when indicated, and performing cleaning and disinfection procedures per policy are paramount! • When negative airflow is required for a patient with a suspected A. T. D. an electronic order must be entered in the computer for Engineering/Maintenance to set-up a high efficiency particulate air (HEPA) filter and apply negative airflow in the patient’s room. (see Policy 20 -8013, Section IV, Airborne Isolation) • This same electronic order will remind Engineering/ Maintenance to perform daily checks of the room to verify negative airflow is maintained. (see Policy 20 -8013, Section IV, Airborne Isolation)

A. T. D. Engineering Controls In order to assure negative airflow is being maintained the following methods of measurement should be performed: • • • (May be performed by anybody) Placing a small piece of tissue paper at the base of the closed door (entrance) to an airborne precautions room with HEPA-filter set-up on. The tissue should be drawn into the room demonstrating negative airflow is effective. Smoke tube test (may be performed by Maintenance) – use of a smoke generating kit that produces a cloud which usually consists of water and acid. Based on the air flow gradient the smoke will demonstrate whether flow is drawing negative in toward the airborne precautions room. Manometer (may be performed by Maintenance) – use of handheld pressure gauge that measures the pressure difference between two spaces.

Protect Yourself And Those We Serve • Ensure patients, visitors, and coworkers are aware of appropriate respiratory hygiene – cover a cough, use facial tissue, and/or masks.

A. T. D. - Vaccines Receive vaccine to protect yourself against certain types of aerosol transmissible diseases: • Measles (Rubeola) • Mumps (Parotitis) • Rubella (German Measles) • Varicella (Chickenpox) • Pertussis (Whooping Cough) • Influenza (Flu) (annually)

Respirator Fit Testing and P. A. P. R. s • If you grow facial hair, gain or lose a significant amount of weight, or undergo substantial changes to your face, you must be refitted for an N 95 respirator if your position requires you to be fit tested. • If you are unable to be fitted for an N 95 respirator because you cannot taste saccharine, or Bitrex ®, or do not respond to smoke irritant testing, or you have some contraindication to using an N 95 respirator, you will be offered a powered air-purifying respirator (P. A. P. R. ) if your position requires you to enter airborne isolation rooms.

About Facemasks and Respirators Facemasks and N 95 respirators are devices that may help prevent the spread of germs (viruses and bacteria) from one person to another. They are part of an infection prevention strategy that should also include frequent hand washing, respiratory/cough etiquette and social distancing. What is a facemask? Facemasks are loose-fitting, disposable masks; often labeled as a surgical or medical procedure masks. Facemasks help prevent the spread of germs by capturing the large droplets that may be expelled when a patient coughs, sneezes or speaks. Facemasks should be used once and then discarded in the trash. Facemasks should be worn by healthcare personnel when: • Providing care for patients on droplet precautions (meningitis, seasonal/H 1 N 1 influenza, pertussis) • When in close contact (6 feet) of an unmasked patient with a cough Facemasks should be worn by patients when: • Entering the hospital with symptoms of a respiratory illness (e. g. , cough, fever) • During transportation outside the patient’s room for procedures or treatment What is an N 95 respirator? An N 95 respirator is a respiratory protective device designed to achieve a very close facial fit and effectively filter at least 95% of airborne particulates. These respirators should be worn only once and then discarded in the trash. N 95 respirators should be worn by healthcare personnel when: • Providing routine care for patients on airborne precautions (TB, chickenpox, measles) • Performing an aerosol-generating procedure (e. g. bronchoscopy, sputum induction, open nasopharyngeal suctioning, administration of aerosolized pentamidine or other medication) on a patient known or suspected to have seasonal or H 1 N 1 influenza Visitors should wear an N 95 respirator when entering the room of patients on airborne precautions. Patients do not wear N 95 respirators. What is a PAPR? A PAPR is a powered air-purifying respirator that uses a blower to force ambient air through a highefficiency filter before entering the hood/head cover worn by the user and is designed to filter out at least 99% of airborne particulates. A PAPR should be worn by healthcare personnel when: • Unable to pass fit testing with an N 95 respirator due to an inadequate seal or the presence of facial hair • Performing a high-hazard, aerosol-generating procedure (e. g. , bronchoscopy, sputum induction, pulmonary function testing, open nasopharyngeal suctioning, administration of aerosolized pentamidine or other medication) on a patient known or suspected to have an airborne transmissible disease (ATD)

A. T. D. – Who Wears What? • Any time you are required to transport a patient with a suspected or confirmed A. T. D. , the patient must wear a regular surgical mask NOT an N 95 respirator. • Remember surgical masks are manufactured to restrict respiratory droplets from the wearer being dispersed into the environment. • Respirators are manufactured to filter particulate from outside air in order to protect the wearer.

ATD - Who Wears What? • Visitors entering an airborne isolation precautions room must be offered an N 95 respirator and instructed on how it works (in their own language). • Document any education provided in the medical record. • If a visitor declines to wear an N 95 respirator the response should be noted in the patient’s electronic medical record as a narrative.

Cleaning an Airborne Isolation Room • A room used for airborne isolation may still contain aerosolized transmissible disease producing organisms up to an hour after a patient with a suspected/ confirmed A. T. D. is discharged from the room. • Employees must wear an N 95 respirator prior to entering the room and the door should remain closed up to 1 hour post patient discharge.

When Not to Wear a P. A. P. R. or Respirator Note: P. A. P. R. units and N 95 respirators are not effective against Immediately Dangerous to Life and Health (IDLH) scenarios such as fires, explosions, or demolition activities – follow policies #21 -2001 Code Red and/or #21 -2010 Code Triage External (Disaster), #21 -2009 Code Triage Internal (Disaster) Don’t put yourself in harm’s way.

A. T. D. and the Emergency Department • ‘Fast path’ suspected A. T. D. patients into airborne isolation. • Communicate with the Nursing Supervisor to find an airborne isolation room. • The “ 5 hour rule” applies when airborne isolation rooms are unavailable and the patient suspected of having an A. T. D. is unable to be transferred to another facility with available airborne isolation. • Contact the local county health officer at the Tulare County Public Health 24 -hour hotline: (559) 733 -6441 (document contact) • Document there is no negative airflow rooms within the jurisdiction • Document the efforts that have been made to contact other establishments outside of the jurisdiction • Follow the local health officer’s recommendations

A. T. D. and the Operating Room • • • Perform only required surgical procedures on patients suspected/confirmed with an A. T. D. Place a surgical mask on suspected/confirmed A. T. D. patients and ‘Fast Path’ them into an O. R. suite O. R. Surgical Team wear N 95 respirators Perform procedure with O. R. suite doors closed throughout the procedure Post procedure, place a HEPA filter in the O. R. suite and allow the HEPA filter to run for at least 20 minutes to do air scrubbing of the environment (see Policy 20 -8013, Section IV, Operating Rooms) O. R. suite is safe for terminal clean when the HEPA filter is removed from the suite.

A. T. D. and Home Care/Rural Health Clinics • Community settings lack some of the environmental controls that the acute care setting has (i. e. ability to control air exchanges and create an airflow gradient – positive or negative airflow). • In order to reduce risk of A. T. D. exposure in Home Care and Rural Health Clinic settings the following actions should be implemented: ü Provide a patient/client who demonstrates a cough with facial tissue and/or surgical mask or have them cover their cough when you are in close proximity to them. ü Turn on a fan that blows toward the patient so that airborne microbes are unable to remain suspended in the air for long periods of time, thereby decreasing your risk for exposure. ü Open windows near the patient to allow outside air to mix with indoor air – this will dilute the concentration of A. T. D. microbes and reduce airborne suspension of microbes.

Senate Bill (SB) 432 • Effective January 1, 2018, SB 432 revises the notification procedure for situations when prehospital emergency medical care personnel may have been exposed to a reportable communicable disease or condition that could result in transmission. • SB 432 requires health facilities to notify the prehospital emergency care personnel, as well as the county health officer, upon determining that the person provided care by the prehospital personnel has been diagnosed with a reportable communicable disease or condition that may have been transmitted during the provision of care.

Aerosol Transmissible Disease and Respiratory Protection Program • Problem with a particular type of respirator or P. A. P. R. ? Report the problem to your Supervisor and to the Infection Prevention and Control Program. • Annual evaluation of the Aerosol Transmissible Disease Plan is required by Cal/OSHA. • Your input and feedback is needed to ensure an effective A. T. D. /Respiratory Protection Program.

Resources • California Code of Regulations, Title 8, Section 5144. Aerosol Transmissible Diseases Standard • California Code of Regulations, Title 8, Section 5144. Respiratory Protective Equipment • Centers for Disease Control and Prevention: Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings

Post Test • Thank you for viewing the program. We hope you have learned! • It is time to test your knowledge and take the Post test. • You may now exit this program and access the post test.