Wikisource:WikiProject Film/Drafts/TB Respiratory Protection - Administrator's Review
User: Randomstaplers
File: TB Respiratory Protection - Administrators Review.webm
Author: National Institute for Occupational Safety and Health
Publisher: National Institute for Occupational Safety and Health
Year: 2002
PD: PD-USGov-HHS-NIOSH
Note: Presented by Loretta Swit
Cat:
00:01
00:05
National Institute for
Occupational Safety and Health
00:07
Dramatic music begins.
00:07
00:13
Newscaster
Non-free text removed
00:19
Reporter
Non-free text removed
00:28
Newspaper clippings.
00:28
Loretta Swit
What you are seeing is not from a developing country. It is not from decades ago.
00:35
Reporter
Non-free text removed
00:42
Newspaper clippings.
00:42
Loretta Swit
This is the story of tuberculosis in the United States during the 1990s. A story that includes the emergence of multi-drug resistant strains, hospital outbreaks, and the infection of many healthcare workers. A small number of workers even lost their lives to the disease.
01:02
Newscaster
Non-free text removed
01:09
Newspaper clippings.
01:09
Loretta Swit
Thanks to aggressive nationwide response, the occurrence of TB appears to be decreasing at this time, but the threat remains very significant for health care workers.
01:21
Reporter
Non-free text removed
01:30
Newspaper clippings, with increasingly dramatic music.
01:30
Loretta Swit
And images like these remind us that this threat must be taken seriously.
01:39
Clock transitions between people wearing and not wearing N95 disposable respirators.
02:07
02:12
TB Respiratory
Protection
REVIEW
02:19
End of music. Begin hosting in artificial room.
02:19
Loretta Swit
02:19
Loretta Swit
Hello, I'm Loretta Swit for the National Institute for Occupational Safety and Health.
02:25
This program is intended to supplement the written NIOSH guide for respirator program administrators. The guide contains full details of NIOSH recommended procedures, as well as regulations set forth by OSHA, the Occupational Safety and Health Administration.What we're going to do here is provide an overview of each of your responsibilities as they are detailed in the guide, so that you have a clear understanding of how to establish a respiratory protection program. Goes without saying that workers exposed to patients with infectious tuberculosis need to be protected from the disease, because engineering controls, like negative pressure isolation rooms, may not control the TB hazard completely. The use of respirators is necessary.The OSHA Respiratory Protection Standard clearly states that a formal respiratory protection program must be in place at any facility where respirators are needed. There are many factors to consider when developing a program, but the administrator's guide divides this process into eight steps for you to follow. So now, let's take a look at where to begin.
03:32
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Risk Assessment
03:32
Loretta Swit
Step one: Conduct a TB risk assessment.
03:38
B-roll of a hospital.
03:38
Loretta Swit
Infection control measures should be based on careful assessment of the risk for TB transmission. A risk assessment must be performed for the entire facility as well as for specific areas. The primary goal of the assessment is to determine which employees must wear respirators and when they should be worn. Because the risk of transmission depends on many variables, it can vary greatly from one health care environment to another.
04:07
Loretta Swit
A constellation of factors such as
04:09
Patient Population
04:09
Loretta Swit
patient population,
04:11
of TB
04:11
Loretta Swit
prevalence of TB in the community,
04:14
of TBEffectiveness
of Controls
04:14
Loretta Swit
and the effectiveness of existing TB control measures, can impact risk levels.
04:20
Coughing patient being treated by a doctor wearing a disposable N95.
04:20
Loretta Swit
For example, the risk may be higher in an emergency room because patient care is initiated prior to diagnosis. If procedures that stimulate coughing routinely occur in these areas, the risk is compounded.
04:36
Four people in a hospital waiting area.
04:36
Loretta Swit
Or consider this hospital waiting area. At first, it may not seem like a place where you would have to assess the risk of TB transmission. But there could very well be factors present that increase the risk, like high prevalence of TB in the community the hospital serves.
Your initial assessment should take into account data from a variety of sources from within the facility, such as infection control and discharge records and from the community at large.
05:07
Person organizing the NIOSH publication: Protect Yourself Against Tuberculosis.
05:07
Loretta Swit
Follow-up assessments are required at least annually. The specific elements of a TB risk assessment are detailed in your administrator's guide. Once the assessment is complete, you will be ready for the next step:
05:19
Respirators
05:19
Loretta Swit
Select respirators.
05:24
Three people looking at various brands of respirators.
05:24
Loretta Swit
You should provide a variety of respirator models and sizes to all users. An adequate selection will ensure that workers can find a respirator with a comfortable and effective fit. Respirators that aren't comfortable will be less likely to be used as needed. Also, if respirators do not fit properly, they will not offer adequate protection.
05:47
NIOSH
Approval Label
05:47
Loretta Swit
Of course, all respirators must be NIOSH certified.
05:51
NIOSH
Approval Label
05:51
Loretta Swit
Respirators labeled N, R, or P, and that have a
05:55
95%
NIOSH
Approval Label
05:55
Loretta Swit
filter efficiency rating of at least 95 percent, will provide adequate protection.
06:02
N95
NIOSH
Approval Label
06:02
Loretta Swit
For example, a respirator labelled "N95" has a "N"-series filter, with a 95 percent efficiency rating.
06:14
This example is not shown in the video.
3D animation of a dummy wearing a disposable particulate respirator.
06:14
Disposable
Particulate
06:14
Loretta Swit
The disposable particulate respirator is by far the most common type used in health care and is adequate for most situations. These respirators are lightweight, relatively easy to wear, and do not require cleaning. They usually come in three sizes and can be obtained with or without an exhalation valve.
06:34
Loretta Swit
If respiratory protection is needed in a sterile environment, disposable particulate respirators should be used, provided they are not equipped with an exhalation valve.
06:46
.jpg)
This example is not shown in the video.
Close up of a respirator with an exhalation valve.
06:46
Loretta Swit
Workers should never use a respirator with an exhalation valve in a sterile environment. An exhalation valve exhaust air breathed by the user and may contaminate the field.
07:00
.jpg)
Not shown in the video.
A person wearing a face shield and N95 respirator.
07:00
Loretta Swit
All disposable models can be used with a face shield in case protection against body fluids is needed. Workers should take care to ensure the shield does not interfere with the respirator's fit. Otherwise, the respirator may not provide needed protection.
07:17
Poster not shown in the video.
A person wearing a surgical mask on one side, and another person wearing a disposable respirator on the other.
07:17
MaskRespirator
07:17
Loretta Swit
As you are probably aware, a typical surgical mask is not a respirator and does not adequately protect against TB. Because some disposable respirators resemble surgical masks, make sure that workers clearly understand the difference between them.
07:37
This example is not shown in the video.
3D animation of a dummy wearing a half-face elastomeric respirator.
07:37
Replaceable-Filter
Particulate
07:37
Loretta Swit
Other particulate respirators use replaceable N, R, or P filters. These filters are made of the same material as those found on disposable respirators that protect against TB.
07:37
This example is not shown in the video.
A person wearing a half-mask elastomeric respirator, and then a person wearing a full-face elastomeric respirator.
07:51
- Reusable
- Cleanable
- More Durable
07:51
Loretta Swit
Half mask and full facepiece models are available. Full facepieces offer a better seal in addition to eye protection. The need for such protection will of course depend on the overall level of risk.
08:15
This example is not shown in the video.
3D animation of a dummy wearing a full-facepiece powered air-purifying respirator.
08:15
Powered Air-
Purifying (PAPR)
08:15
Loretta Swit
The next type of respirator is the powered air purifying respirator or PAPR. These respirators use a motorized blower to pass contaminated air through a HEPA filter and are powered by a battery pack attached to the wearer. Purified air is then delivered to a half mask, full face piece, or hood. PAPRs are designed for higher risk situations where disposable or replaceable filter half mask respirators do not provide adequate protection.
08:50
Person wearing a PAPR with a beard.
08:50
Loretta Swit
Your risk assessment will indicate when the use of PAPRs may be necessary. Note that some types of facial hair can interfere with the function of tight-fitting respirators which compromises the protective seal. In such cases, hooded PAPRs can be used. Like other respirators we've discussed, PAPRs are not suitable for use in sterile environments.
09:15
This example is not shown in the video.
3D animation of a dummy wearing a full-facepiece supplied-air respirator.
09:15
Positive-Pressure
Supplied-Air
09:15
Loretta Swit
The final type of respirator you may need to consider is the positive pressure supplied air respirator. Unlike more common respirators which filter environmental air, supplied air respirators deliver compressed air from a stationary source to a half mask or full face piece.
These respirators offer an advanced level of respiratory protection and should be used in special circumstances, such as an autopsy, where greatest protection is needed.
Once you have selected respirators based on your risk assessment, it's time to put all aspects of the program in writing.
09:57
Operating
Procedures
09:57
Loretta Swit
Step three, write standard operating procedures.
10:02
Loretta Swit
You are required to establish standard operating procedures, or SOPs, governing the selection and use of respirators at your facility based on each user's need. A written SOP should describe a procedure so thoroughly that it cannot be misinterpreted. SOPs should contain all information necessary to maintain a successful respirator program. This information should be presented in an easy to follow manner, such that it is useful to all individuals directly involved in the program.
10:38
Loretta Swit
The following individuals should have a thorough understanding of your program's SOPs:
10:45
Program
Administrator
10:45
Loretta Swit
You, as the program administrator;