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Coronavirus (COVID-19) - Considerations When Selecting Respiratory Protective Equipment (RPE)

Updated: Apr 17, 2020

Introduction


Sales of respirators and surgical masks have increased in the UK over previous days. The Coronavirus (COVID-19) pandemic has elevated sales and caused manufacturers to maximise their production capacities. People on the streets are seen to be wearing respirators, the UK NHS is battling the disease utilising Respirators and surgical masks to help protect themselves and others around them. In light of this, we see this as a good time to explain the principles of Respiratory Protective Equipment (RPE).


The details within this article not only count for wearing RPE during these trying times. However, following the implementation of the Personal Protective Equipment at Work Regulations in 1992, adequate supply and provisions of PPE applies in a normal place of work, and not just as a means of attempting to prevent exposure to Coronavirus.


We have put together this article to explain the fundamentals of RPE in particular. Our aim is to communicate how to maintain the highest level of protection whilst utilising respiratory protection.


Contained within this article, information is provided to help readers understand the legal and moral requirements surrounding selecting and using RPE. This also helps the general public understand the fundamentals surrounding RPE too.


Coronavirus (COVID-19) - What We Know So Far


Over the last few weeks, we in the UK have seen increased development in the Coronavirus pandemic. Thousands of people are now infected with the Virus, with deaths now being reported in high numbers. Following recent government enforcements, you must now self isolate, refrain from leaving the house unless you are classed as a key worker. Most businesses have implemented a work from home policy. All of this in an attempt to restrict the spread of the virus.


The spark in media coverage has caused mass panic amongst UK citizens, with increased levels of panic buying leaving supermarkets and shops low on stocks of essentials, such as antibacterial products, drugs, and other necessities. The medical, health and safety industry has increased demand for Personal Protective Equipment which has sparked an increase in sales of disposable respirators, surgical masks, protective gloves, coveralls, visors and the like.


We notice further that respirators and surgical masks are now being worn on the streets as well as in workplaces. But are these people protected?


To us, this pandemic has highlighted a lack of understanding around the importance of the application of a "suitable and sufficient face fit-test". It has also highlighted that individuals have little understanding of the difference between a respirator and a surgical mask.


Its a fact that people are wearing poorly fitted respirators, masks that arent suitable to defend against this kind of biological agent. However, what kind of effect could this have on the degree of protection offered against a biological like COVID-19, or a substance hazardous to health?


Size of the Problem


A great post was circulating last week on social media which puts into perspective the importance of selecting the correct respirator to maximise protection against biological agents and the virus.


The image below illustrates just how small the Coronavirus is in comparison to other particles. This puts into context how serious this virus can be, especially as particle sizes of that nature are capable of penetrating deep into the lung.

Coronavirus, Covid-19, World Health Organisation, Pandemic, Occupational Hygiene, Occupational Health and Safety.
Image provided by the World Health Organisation.

The above diagram should highlight how easy it could be for the virus to enter the airways by bypassing a poorly fitting, or an incorrect respirator.


Different Types of Respiratory Protection

Surgical masks seem to be a preferred choice of protection by the general public. Some health workers have been provided with this type of mask in what we believe to be "low risk" areas of their hospitals. These masks were originally designed to prevent the spread of “your” germs onto others; particularly during surgical procedures. These may help stop the virus being spread through the breath and light coughing, but offers minimal protection against inhaling the virus. These are not classed as respirators for this reason. You may have seen this type of mask being widely used in countries with poor air quality to prevent inhalation of polluted air. Again, it is unlikely that these would have much effect on protecting against the inhalation of a hazardous substance, particularly a biological agent which is much smaller in size than most particles.


Health workers would wear these types of masks to help protect their patients. Here is the HSE RR619: Evaluating the Protection Afforded by Surgical Masks Document. https://www.hse.gov.uk/research/rrpdf/rr619.pdf


A common type of protection used is a half-face respirator (Figure 1). Although these offer some degree of protection against certain airborne particles, often this form of RPE can become saturated with the contaminant quite quickly. Hence why these are classed as disposable single-use masks. These often fit very poorly if the size and design are not suitably matched with the facial anthropometrics of the wearer which leads to a lack of seal between the RPE and the face. This often results in personal exposure to the contaminant. The respirators are made from a material that offers a level of protection, distinguished by its Assigned Protection Factor (APF).

RPE, Respiratory Protection, Health and Safety, Occupational Hygiene, Fit2fit.
Image provided in INDG479 (https://www.hse.gov.uk/pubns/indg479.pdf)

Figure 2 shows a Reusable half-face respirator. The material which fits around the face can offer a greater success rate due to it molding to the face forming a tighter seal. Again though, size and design are critical attributes that still must be considered. A useful consideration for this form of RPE is that the filters can be changed to suit the contaminant of concern. Filters are applied as cartridges. As above, the cartridge contains material that filters out the hazardous substance or biological agent and is distinguished by its APF.


Figure 3 shows a full-face Respirator. This type of respirator has the same characteristics as a half-face respirator shown in figure 2, however, allows for the further protection to the upper face, including the skin and eyes. Again, filters are applied as cartridges. As above, the cartridge contains material that filters out the hazardous substance or biological agent and is distinguished by its APF.


3M has provided a great article also explaining the application of APF: https://multimedia.3m.com/mws/media/418650O/assigned-protection-factors-for-hoods-and-helmets-technical-data-bulletin.pdf


Health experts have recommended an APF of 20, equivalent to an FFP3 as seen in this letter provided for all NHS workers.


https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/PPE-Letter-FINAL-20-March-2020-updated-on-22-March-2020.pdf


The RPE we have discussed are recognised as Negative Pressure Orinasal devices which must be subjected to a successful fit test before the wearer uses them.


Other forms of respiratory protection are those which "supply air" to the wearer. This falls into the category of Breathing Air (BA) apparatus. Often this type of RPE is worn during high-risk operations such as firefighting, diving, working in confined spaces or working with toxic chemicals where the risk of exposure may result in severe injury and even a fatality. These types of RPE are usually worn in oxygen-depleted environments.


Breathing Air (BA) apparatus and Negative Pressure Orinasal RPE can be worn in conjunction with what is also known as a HAZMAT Suite. These are worn in extreme cases where a risk of exposure is deemed highly likely and foreseeable due to the nature of a task or process being carried out.



The Institute for Hazardous Materials Management defines HAZMAT as "any item or agent (biological, chemical, radiological, and/or physical), which has the potential to cause harm to humans, animals, or the environment, either by itself or through interaction with other factors."



How a Respirator Can Be Tested to Ensure Effective Protection is Achieved


There are many factors that will affect the suitability of a respirator.


  • Anthropometrics - face shapes, sizes relating to weight, pre-existing injury, and facial deformities.

  • Facial Hair - preventing a tight seal to be achieved.

  • Storage and Maintenance - Poor maintenance and the inability to correctly store RPE in a clean environment can decrease the effectiveness of the RPE. Particularly if seals are damaged and filters are saturated.


In order to check a respirator is providing the desired level of protection, it is a statutory requirement for businesses to provide a "face-fit-test". A face-fit-test or RPE Fit Testing can be carried out to measure and check for any deficiencies, which would put the wearer at risk of exposure.


Both qualitative and quantitative assessments can be performed to assess the effectiveness of the RPE provided. This should be done in line with UK legislation.


In relation to the COVID-19 breakout, masks that are worn with beards, stubble or that are ill-fitting would not afford an adequate level of protection against a hazardous agent due to the lack of seal between the mask and the face.


Now of course, as with the control of any hazardous agent (Chemical or Biological), the use of personal protective equipment sits firmly at the bottom of the hierarchy of control measure, the best form of protection is to self isolate away from others who could be carriers of the virus. Taking measures to eliminate the exposure by segregating workers and the general public from busy places, groups of people as such would reduce the need to rely on using RPE.


Remember government guidelines:


  • Stay 2 meters apart

  • Wash your hands for a minimum of 20 seconds

  • Self isolate and remain indoors if you aren't classed as a key worker

  • Don't go an visit family or friends


We would like to wish you all good health and take this opportunity to thank you for keeping up to date with industry knowledge and helping us share our message of creating safer environments together.


"REMEMBER not to purchase defective, preused or "fake and copied" Respirators. These WILL PUT YOU AT RISK. Purchase from an approved supplier. If you are thinking of providing RPE, ensure it is fit for purpose and not manufactured outside of the suppliers' capabilities. There are many companies capatalising on this situation by providing useless pieces of equipment but still taking money in exchange for defective goods."


Below we have further provided some useful resources which you may find useful when selecting RPE.


Useful Resources


In this section, we have provided some useful resources to help you understand RPE and how it should be managed in order to comply with the legal requirements.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670234/

https://www.cdc.gov/niosh/npptl/topics/respirators/factsheets/respfact.html

https://www.hse.gov.uk/pubns/indg479.pdf

https://blogs.cdc.gov/publichealthmatters/2019/06/picking-a-respirator/

https://blogs.cdc.gov/publichealthmatters/2019/06/using-a-respirator/

https://blogs.cdc.gov/niosh-science-blog/2018/01/04/respirators-public-use/

https://multimedia.3m.com/mws/media/409903O/respiratory-protection-against-biohazards.pdf

https://www.hsa.ie/eng/Publications_and_Forms/Publications/Chemical_and_Hazardous_Substances/Guidelines-for-Biological-Agents-2014.pdf

http://www.3m.co.uk/intl/uk/ohes/segments/healthcare/(12164)OH_MortuariesProduct%20selector_bro.pdf


Videos:


https://www.youtube.com/watch?v=-LKVUarhtvE (Hand Washing With Soap)

https://www.youtube.com/watch?v=sHP0UIdZyI4 (What is the Coronavirus - COVID-19)

https://www.youtube.com/watch?v=kIL5m5XznNY (Coronavirus - COVID-19 Explained)

https://www.youtube.com/watch?v=BtN-goy9VOY (Animation of the Coronavirus - COVID-19)


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