Professionals in emergency and healthcare settings are no strangers to respiratory protection. Being in these environments poses a high risk of exposure to hazardous gases and unknown contaminants hence the need for precautionary measures. This is where the powered air-purifying respirators (PAPRs) come in. The battery-powered equipment cleans the air before the user inhales.
PAPRs have a blower that draws air through cartridges or high-efficiency filters to purify the air. They may come in a loose-fitting or tight-fitting helmet or face piece. The former is ideal for users with facial hair and does not require fit testing compared to tight-fitting ones. Those using the tight-fitting PAPR must undergo fit-testing as per the Occupational Safety and Health Administration (OSHA) standards.
Benefits of Powered Air-Purifying Respirators
There is a high cost associated with adopting PAPRs. However, the cost of adopting this protective equipment is worthwhile considering the advantages. Remember that some PAPRs have an intrinsically safe system that prevents ignition when the user comes into contact with electrical components while operating in a hazardous environment.
1. Relaxed Breathing
PAPRs use blowers to push air through the filter. Therefore, this system does not require lung power to suck air. As a result, PAPRs ensure easy breathing since the air goes directly to the headgear through the blower. This feature is important for professionals who might need to use Battery Powered Respirators for hours.
2. No Fit-testing Required
As mentioned earlier, PAPRs come in two types of headpieces. Companies that opt for the loose-fitting design don’t need to worry about fit-testing their employees. The use of such respirators helps save time and resources, unlike the tight-fitted ones that often take time due to the testing process. Also, tight-fitted PAPRs require annual testing to remain compliant.
3. Integrated Protection
Companies looking to buy PAPRs for their hospitals benefit from an all-in-one device since some respirators come fitted with a cohesive system that includes a hard hat, eyewear, and ear muffs. It is also important to note the additional eye protection that comes with PAPRs compared to other respirators. Moreover, they offer greater field of vision and are spacious enough to allow the user to use eyeglasses.
Adoption of PAPRS in Healthcare Settings
PAPRs have been in use in healthcare settings for years and their effectiveness is evident based on several case studies. In the healthcare world, the effectiveness of Powered Air Purifying Respirators has been a subject of extensive research and practical application. The National Personal Protective Laboratory (NPPTL), in collaboration with various organizations and academic institutions, delved into this matter through two pivotal studies: the Prevalence of Respiratory Protection Devices in U.S. Healthcare Facilities Survey (2014) and the REACH II Public Health Practice Study—Respirator Evaluation in Acute Care Hospitals (2010–2012).
OSF Saint Francis Medical Center
One notable case study comes from OSF Saint Francis Medical Center in Peoria, Illinois, where the implementation of PAPRs played a crucial role during the H1N1 influenza crisis in 2010. Jo Garrison, representing the medical center, revealed that the facility initially faced challenges in preparedness with limited supplies of N95 respirators. Seizing the opportunity for improvement, a Six Sigma project was initiated to establish a standardized process ensuring employee protection and an ample supply of respirators.
The center’s 2,400 employees in the respiratory protection program underwent a comprehensive screening process, including a health history questionnaire and mandatory computer-based respiratory education modules. Fit testing, with a compliance goal of 80 percent annually, was an integral part of the program. Despite its labor intensity, the PAPR program at OSF Saint Francis gained popularity among employees due to its efficiency—eliminating the need for the time-consuming N95 fit test.
From a managerial standpoint, PAPRs offer the advantage of not disrupting workflow or patient care, since employees can sidestep N95 respirator training. For employees, the appeal lies in the comfort and user-friendliness of PAPRs, accommodating facial hair and providing a less intimidating appearance to patients compared to N95 respirators.
However, the main hurdle in widespread PAPR adoption is financial because they are relatively expensive. Additionally, challenges in tracking and maintaining PAPRs have surfaced, leading to a debate on centralized versus departmental storage.
Service Employees International Union
Mark Catlin, representing the Service Employees International Union (SEIU), presented the perspective of over 2 million members, with a significant portion working in healthcare. A survey conducted among SEIU members showed a stronger inclination towards PAPRs, citing a perceived higher level of protection, comfort, and cooler wear. Despite these advantages, challenges like infrequent usage and equipment maintenance issues were noted.
Catlin proposed several measures to enhance PAPR utilization, including modifications to design, noise reduction, weight reduction, and improved training. He also emphasized the need for clear employer policies and supervisor support to ensure consistent adherence to respiratory protection protocols.
University of Maryland Medical Center
Another example is the University of Maryland Medical Center (UMMC) in Baltimore, where Jim Chang highlighted the challenges faced in respiratory protection, ranging from tuberculosis and hazardous medications to emerging pathogens like H1N1 influenza, MERS-CoV, and Ebola. During the H1N1 influenza pandemic in 2009, UMMC encountered difficulties in procuring N95 respirators due to high demand prioritization by their primary vendor. In response, a comprehensive strategy was devised, incorporating stockpiled reusable elastomeric air-purifying respirators, a limited number of N95 respirators, and a substantial investment in PAPRs.
The mixed protection approach proved pivotal in ensuring respiratory protection for all employees, reducing the need for extensive fit testing, and providing an alternative for those who are ineligible for tight-fitting respirators. Lessons learned from the H1N1 experience led to a refined strategy, with high-risk care units and services identified for mandatory elastomeric air purifying respirator fit testing for new employees and annual testing for current staff. PAPRs are strategically deployed to high-risk units, with an equipment distribution group managing their maintenance and deployment.
Jim Chang emphasized three key areas for advancing the effective use of PAPRs in healthcare. First, manufacturers ought to tailor equipment design to meet the distinct needs of different users, such as bedside care staff and maintenance staff. Second, respirators should be designed for easy use, assembly, cleaning, and testing by healthcare workers, considering that some may only use a PAPR sporadically. Lastly, standardization of consumable items, such as head covers, is encouraged to enhance compatibility and efficiency during emergencies.
The experience at the University of Maryland Medical Center provides valuable insights into the challenges and successes of integrating PAPRs into respiratory protection strategies within healthcare settings. As the healthcare industry evolves, optimizing the design, usability, and standardization of PAPRs will be crucial in enhancing their effectiveness and ensuring the safety of healthcare workers facing diverse respiratory hazards.
The Johns Hopkins Health System
In the exploration of the use and effectiveness of Powered Air Purifying Respirators, the Johns Hopkins Health System in Baltimore, Maryland, played a pivotal role, as revealed by Trish Perl from the Johns Hopkins University School of Medicine. Back in 2003, the health system established a two-tiered respiratory protection program, incorporating both N95 respirators and PAPRs to safeguard staff against various respiratory hazards.
High-risk area staff underwent comprehensive training on PAPR usage and were fit-tested for N95 respirators. The Department of Health, Safety, and Environment oversaw the fit testing and maintenance of PAPRs, with strict protocols in place. Medical screening examinations were mandatory for staff treating patients with airborne infections, conducting aerosol-generating procedures, or administering hazardous aerosolized drugs. PAPRs were strategically positioned in all high-risk care units, with a central store system available for requests.
In 2011, during a simulation of a pediatric resuscitation amid the H1N1 influenza pandemic, only six percent of the staff used PAPRs, while 75 percent opted for N95 respirators. The complexity of PAPR instructions and the institution’s intricate troubleshooting policies contributed to some reluctance among staff. Barriers to PAPR use included the time-consuming donning process, device bulkiness hindering patient care, and challenges in finding the equipment when needed.
The cost of PAPRs along with additional expenses for batteries, chargers, and maintenance staff, posed a significant problem. However, Perl emphasized that despite these challenges, healthcare workers acknowledged the advantages of using PAPRs. The equipment instilled a sense of safety, eliminated the need to breathe through a facepiece, and proved more convenient for certain individuals, especially those with respiratory issues.
Perl identified key opportunities to enhance the effective use of PAPRs in healthcare settings, including decreasing noise, simplifying cleaning and storage requirements, and improving battery life. Additionally, she proposed research avenues to refine NIOSH certification for PAPRs by clarifying cleaning requirements and verifying improved filtration efficacy for enhanced healthcare worker safety.
The experience at Johns Hopkins Health System underscores both the advantages and challenges associated with the integration of PAPRs into respiratory protection programs. As the healthcare industry navigates evolving respiratory threats, optimizing PAPR usability and addressing barriers will be crucial in ensuring the safety and well-being of healthcare workers.
The use of Powered Air Purifying Respirators in healthcare, as revealed by case studies and union perspectives, highlights both the benefits and challenges associated with this advanced respiratory protection technology. PAPRs are useful and necessary for professionals in healthcare from first responders who offer assistance during natural disasters to researchers dealing with biological outbreaks. However, balancing cost considerations, equipment maintenance, and employee training will be pivotal in optimizing the use and effectiveness of PAPRs within healthcare and emergency response facilities.
