Health care and public health workers across the world are facing an unprecedented crisis on many levels. In addition to a global pandemic sweeping through communities, big and small, they are also facing a crisis of protection. That crisis not only puts the critical health care infrastructure at risk, but also the workers and their families.
Traditional protection for health care workers has centered around disposability and affordability. N95 masks fit both criteria. N95 respirators filter 95% of all airborne particulates .3 microns and larger. They are generally inexpensive and meant to be single use/disposable. Simply put, a worker dons a respirator, sees a patient, then removes the respirator and disposes of it. When he or she sees the next patient, the process repeats itself with a brand-new respirator.
N95s are considered “tight fitting respirators” and users are required by OSHA to be fit tested. As such, these respirators are sized to the user and the proper size must be worn for the mask to be effective. Life circumstances, such as weight gain or loss, will usually result in additional fit testing requirements. Additionally, facial hair restrictions exist as with any tight-fitting respirator.
Health care workers will also don a face shield to provide additional protection against infection. These shields are generally disposable and affordable. They are meant to compliment the respirator to provide protection of the face and mouth. The method of use is usually the same as the respirator.
The Issue with Disposability in a Pandemic
As recently proven, the disposal of such products puts a strain on the supply system when events warrant mass and continued use. Burn-through rates for such equipment grows as the patient numbers swell. And resupply can prove difficult, if not, impossible. In addition, triage and screening areas may see the need for increased protection, further compounding the supply strain. The resulting lack of available equipment can force health care workers into using less protective equipment and, invariably, can put the entire system at risk. That risk is often shouldered not only by health care workers but also by those they have contact with including family, community, and other health care workers. Under normal circumstances, the relative affordability of disposable protection isn’t much of a consideration. That changes, however, when crisis strikes. With the global nature of this pandemic, supply strain is exponentially compounded, causing the disposal of this protection to become more a negative than a positive.
This is best answered by first explaining what a PAPR is. Where N95 respirators are tight-fitting air purifying respirators (APRs), a PAPR is a powered air purifying respirator. N95s require the wearer be the engine that pulls air in through the filter. PAPRs utilize a blower to pull air in through the filter(s). That provides the user with ample amounts of filtered air and reduces the strain the wearer has in breathing through a filter medium.
The trade-off for this ease of breathing is adding the weight of a blower and battery. Blowers can be mounted in a variety of ways, but usual designs provide for the blower either on the head or on the waist. Head-mounted units utilize a design meant to limit the stress of that weight on the head and neck. Waist-mounted units attach the blower to a belt that should be easily cleaned and provide for weight distribution on the hips. Additionally, waist-mounted units usually require a tube that connects the blower to the head cover, where head mounted units do not.
Many PAPRs also utilize a P100 (HEPA) filter instead of N95 filter media for health care use. The P100 provides 99.7% efficiency against particulates .3 microns or higher. PAPRs also provide for a variety of hood options. For health care applications, many PAPRs provide a protective head cover that provides face protection (much like a face shield). This head cover makes the PAPR a “loose-fitting PAPR” which has an Assigned Protection Factor (APF) of 25, versus the N95’s APF of 10. For more information on Assigned Protection Factors, please visit OHSA’s publication here. PAPRs increase protection factors over disposable N95s while eliminating the need for a separate respirator and face shield. Utilizing a loose-fitting PAPR also eliminates the need for fit testing.
While PAPRs provide many benefits, there are also other considerations infection control managers and administrators must consider. PAPRs require batteries to power the blower. A consideration for facility managers must be how to recharge batteries and rotate them to keep PAPRs in service. A battery replacement schedule may also be something a manager would have to consider. PAPRs also require replacements of head covers and filtration. This should be discussed with the supplier and/or manufacturer for any considerations, such as cleaning, filter use and reuse/decontamination of head covers. PAPRs are relatively pricey versus disposable masks and face shields. However, a cost analysis may show that the elimination of fit testing processes in both time and materials, as well as the reusability of the PAPR systems may have a minimal impact on overall PPE costs.