Why the need for disposable respirators and more importantly – why correct fitting is important?

When working in an environment where there is a risk of hazardous particles, it’s possible that if inhaled they would pose a risk to the employees’ health, putting them at risk of contracting diseases such as Covid-19, occupational asthma or industrial cancer.

All respirators provided for use in the working environment must be CE marked including the test house number. By 1 January 2022, respirators will be required to be marked with the UKCA – UK Conformity Assessed marking. The CE and the soon to be UKCA shows that the design has been tested to achieve the recognised standard in UK and Europe. They must meet the requirement of EN 149:2009 + A1:2009 and the masks must be marked with EN 149: 2001.

Additional markings, such as FFP1, FFP2 or FFP3, indicate the protection level that can be obtained if the respirator is a good fit and used correctly. The higher the number, the greater the protection. FFP1, FFP2 and FFP3 respirators can reduce the amount of air borne particles you breathe by factors of 4, 10 and 20 respectively. FFP3 respirators should be worn for aerosol-generating procedures (AGPs).

The surface area of an FFP mask, and layers of filter media enables the FFP mask to filter out the hazardous particles in the incoming air. The Filter media is electrostatically charged adding to the filtering ability of the FFP mask attracting even the very small particles; resulting in FFP’s filtering out the following percentage of airborne particles:

FFP = Filtering Face Piece – EN 149:2001 protects the wearer from particles. FFP3 will protect against aerosol generated particles including bacteria and viruses.

Surgical Masks – EN 14683 – Protects the patient and surrounding areas

Alpha Solway HX Series –Offers both EN 149:2001 and EN 14683

A disposable respirator must not be used where there is an oxygen-deficient atmosphere or harmful gases and vapours.

Non Reusable (NR) Disposable respirators should be discarded at the end of the shift or sooner if they are contaminated. They should not be hung up in a contaminated environment for later use. If used in an infection prevention and control risk area – ensure the mask is disposed of correctly eg; clinical waste bins prior to leaving a clinical area.

Detail on how to achieve a good fit and seal around the face is included in the instructions provided with Alpha Solway masks, and in the Globus NHS Hub https://nhshub.globusgroup.com...

Information is included within the manufacturer’s instructions. All tight fitting Respiratory Protective Equipment (RPE) will require a fit test to ensure that it fits without leaking around the seal.

A respirator that depends on a positive face fit is not going to seal if the wearer has facial hair around the seal of the mask.

The only way to know if the seal is good enough is by conducting respirator fit test. Tight fitting face masks can be fit tested using the Qualitative or the Quantitative (APC) method of fit testing. https://www.hse.gov.uk/ respiratory-protective-equipment/fit-testing-basics.htm

To ensure employees are getting the required level of protection, here is a checklist of all workforce respiratory protection requirements:

• Ensure RPE is suitable and adequate for the environment, risk and the mask wearer

• Support all mask wearers to ensure they are well informed and competent in the use of the RPE supplied

• Consult, discuss and arrange training for each wearer of RPE

• Check RPE to ensure the respirator is working properly before each use

• Clear instructions of doffing and donning the mask

• Before each use, carry out a wearer-seal check (fit check)

• Maintain respiratory protection in accordance with manufacturer’s instructions

• Ask:

  • – Is there a requirement for record keeping on the type of respirator issued?

  • – Is storage required?

  • – What are the disposal requirements?

All tight-fitting face masks will only be compliant and fully effective if each wearer has passed their fit test.

Hazards

Work activities can result in harmful substances becoming airborne and contaminating the atmosphere in the form of dust, mist or fume (all examples of particles – solid material, including aerosols, dusts, fibres, smokes and fume). This event can occur when carrying out many applications, such as and not limited to an aerosol generating procedure (AGP). An AGP is a medical procedure that can result in the release of airborne particles (aerosols) from the respiratory tract when treating someone who is suspected or known to be suffering from an infectious agent transmitted wholly or partly by the airborne or droplet route.

This is the list of medical procedures for COVID-19 that have been reported to be aerosol generating and are associated with an increased risk of respiratory transmission:

• Tracheal intubation and extubating

• Manual ventilation

• Tracheotomy or tracheostomy procedures (insertion or removal)

• Bronchoscopy

• Dental procedures (using high-speed devices, for example, ultrasonic scalers/high speed drills

• Non-invasive ventilation (NIV); Bi-level Positive Airway Pressure Ventilation (BiPAP) and Continuous Positive

• Airway Pressure Ventilation (CPAP)

• High flow nasal oxygen (HFNO)

• High-frequency oscillatory ventilation (HFOV)

• Induction of sputum using nebulised saline

• Respiratory tract suctioning

• Upper ENT airway procedures that involve respiratory suctioning

• Upper gastro-intestinal endoscopy where open suction of the upper respiratory tract occurs beyond the oropharynx

• High speed cutting in surgery/post-mortem procedures if respiratory tract/paranasal sinuses involved

Risk Assessment

Has the risk assessment considered and consulted COSHH 2002 (Controlling exposure to Substances? Hazardous to Health). COSHH is supported by the Approved Codes of Practice and gives practical guidance on complying and have a special status in law.

WEL (Workplace Exposure Limits) and the relevant APF

These are known as workplace exposure limits (WELs). APF is the Assigned Protection Factor allocated to each type and class of RPE. The APF number rating indicates how much protection the respiratory protection can offer.

As an example, an RPE device with an APF of 20 will reduce the wearer’s exposure by at least a factor of 20 when used correctly. As detailed in HSG53, the RPE (Respiratory Protective Equipment) is required to be ‘Adequate and Suitable’ against the hazard:

Adequate: It is right for the hazard and reduces exposure to the level required to protect the wearer’s health?

Suitable: It is right for the wearer, task and environment, to such a degree, that the wearer can work freely and without additional risks due to the RPE?

What are the RPE options?

There are many different RPE types all intended to protect the wearer from a variety of hazards, suit various work applications and match the dedicated requirements of the wearer. The two main types of RPE are Respirators and Breathing Apparatus.

RESPIRATORS

These use filters to remove airborne contaminates from the air being breathed in. They can either be:

i) Non-powered respirators (negative pressure). These reply on the individual’s ability to draw air through the filter.

ii) Powered respirators (positive pressure). These use a motor to draw air into the unit and through a filter to then deliver a supply of clean air to the wearer.

Tight-fitting respirators: These rely on achieving a good seal with the wearer’s face. These are available as unpowered (disposable masks) and powered respirator units. Please be aware that a Face Fit Test should be conducted on anyone wearing a tight fitting respirator.

Loose-fitting respirators: These rely on a flow of clean air being delivered to the wearer to prevent contaminants leaking in. These come in a variety of options; hoods, helmets and visors.

BREATHING APPARATUS

These require a source of breathing-quality air from an independent supply; airline via a compressor or from an air cylinder.

MAINTAINING RPE

1. Other than disposable respirators (single use NR = Non-Reusable), maintenance needs to be carried out by trained, competent staff in accordance with the manufacturer’s instructions. Records should be kept and the records need to be conducted at the appropriate times.

2. Replace filters where necessary. These have a limited capacity, or they may become blocked, making breathing a challenge. These should be changed if required to ensure the unit is operating effectively.

3. Clean the device: Carefully clean a reusable face piece to remove any contamination and moisture. The manufacturer (or the instructions) should offer suitable procedures and advice of appropriate cleaning products / disinfectants to use on the equipment. This should be conducted in a clean area so as to avoid any further contamination of the RPE.

4. Maintain any valves and replace any part where applicable.

5. Check straps for damage.

6. Check battery charge and flow rate indicators on powered devices.

Further details on care / maintenance can be found in HSE document HSG53.

GUIDE TO RPE FILTERS

A charcoal filter has the capabilities of removing nuisance odours

VISUAL DEMONSTRATION OF FITTING RPE

Does the customer recognise the importance of having a positive Face Fit Testing and Training programme in place? To ensure the selected RPE to be worn by an individual has the potential to protect adequately, a Face Fit Test must be carried out. This is supported by COSHH, where it is stipulated all tight-fitting respirators must be face fit tested. This will help to ensure the face piece selected offers a positive fit with no inward leakages of air borne contaminant. Support documentation can be located in the Globus NHS Hub.

FIT TESTING TO AVOID TRANSMISSION

Tight-fitting respirators (such as disposable FFP3 masks and reusable half masks) rely on having a good seal with the wearer’s face. To ensure that respiratory protective equipment (RPE) will protect the wearer:

• A Face Fit Test should be carried out the first time a worker uses a particular type of respirator

• The wearer should carry out a pre-use seal check or fit check, which they should repeat every time they put a respirator on.

When carrying out a face fit test during the coronavirus (COVID-19) pandemic, testers and wearers should take other measures to minimise the risk of transmission. View the latest guidance from the HSE https://www.hse.gov.uk/coronavirus/ppe-face-masks/face-mask-ppe-rpe.htm#minimisetherisk

MAKING THE RIGHT CHOICE

The selection should include detail and advice when selecting RPE and involving a workforce that leads to total acceptance following meaningful trials by wearers – with an opportunity to offer constructive feedback, which helps support their acceptance of the products.

Ensure that the RPE selected is offering the expected level of protection (see manufacturer’s instructions) as well as comfort – thus allowing for an individual to perform their working tasks without compromising the wearer’s fit of the mask.

Fit testing will help to ensure that the RPE selected is adequate for the wearer.

TRAINING

• Staff need to be made aware of the seriousness of inadequate protection.

• The effects of non-compliance are not always immediate.

• Encourage an awareness by offering solutions. Fit Test Training demonstrates whether the effect is positive or negative dependent on competence of fit. Attendance training details are available upon request (pdf).

• Alpha Solway offers comprehensive training and support via a team of professional Area Sales Managers.

• It is important to recognise the challenges an RPE wearer faces when trying to compromise the compatibility of other PPE (Eyewear, Hearing Protection, Visors).

• Highlight importance of ‘taking the time to correctly fit’ RPE, and encourage the use of a mirror or a buddy system.