Detroit Medical Center - N95 Respirators, Fit Testing and Respirator Certification

N95 Respirators, Fit Testing and Respirator Certification

What is an N95 Respirator and how does it differ from a Facemask?
An N95 respirator is a mask that is approved by the National Institute for Occupational Safety and Health (NIOSH) and worn to filter out 95% of airborne particulate matter. The N95 provides protection against both aerosols (fine particles suspended in air) and droplets (liquid drops sprayed into the air, but which do not remain suspended), whereas a surgical type facemask will protect only against droplets.

Who is authorized to wear an N95 Respirator?
In compliance with OSHA requirements, all DMC employees and staff must be fit tested and up-to-date certification to wear an N95 respirator before performing any tasks for which this mask is indicated. In order to be fit tested, there must be no interfering facial hair such as a beard or large mustache that affects the face seal of the mask. The fit test and certification is required annually.

When is an N95 Respirator required?
Clinical situations requiring an N95 respirator include caring for patients with tuberculosis, and caring for patients with influenza who are undergoing procedures which may generate aerosols, such as bronchoscopy, suctioning, sputum induction, collection of nasopharyngeal swabs, and intubation/extubation. Also, when performing such procedures, use additional infection control procedures as indicated. The N95 respirator may also be worn by individuals who require a higher level of protection (e.g. those who are pregnant or have certain medical conditions placing them at higher risk) when they are around patients with influenza-like illness. However, it is important that such individuals at higher risk not be around influenza aerosol producing procedures, regardless of the use of an N95.

If the DMC is ever faced with a future outbreak of influenza that is more virulent and/or communicable than the current strains of seasonal and H1N1 (e.g. recall the SARS outbreak), an N95 could be required for routine care of patients with influenza.

Are there alternatives for those who cannot be fitted?
Individuals who cannot be fitted and certified to use an N95 mask may use a Powered Air Purifying Respirator (PAPR) which does not require fit testing. PAPRs are expensive, limited in supply, and cumbersome to wear while providing patient care. This is not a practical solution for most departments.

How does the N95 requirement impact clinical staffing?
DMC employees and staff are prohibited from caring for patients with TB, entering TB isolation rooms, or entering environments during influenza aerosol generating procedures without an N95 mask. In order to assure adequate staffing, all managers must anticipate needs and ensure that there are enough individuals with up-to-date N95 certification to perform the required duties of their departments. Planning must consider preparation for disease outbreaks and pandemics. For future planning, some individuals with beards, but who currently do not need to wear an N95, and their departments, may need to anticipate “just-in-time” shaving and fit testing in the event the need arises.

What is the process for having employees N95 certified?
N95 fit testing and certification is conducted by OHS and 244 unit-based N95 Trainer/Fit-testers. This requires training, practice, medical clearance and fit testing.

OHS distributes a monthly report listing individuals who are currently certified, along with their expiration dates (certification is valid for only 12 months). Included with this report is a roster of approved N95 Trainer/Fit-Testers and department/unit locations. Managers and supervisors can make arrangements for their staff to be trained and fit tested by contacting OHS or their designated unit-based trainer/fit-testers. Departments/units that would like to have one or more of their staff members trained as a unit based N95 Trainer/Fit-Tester should contact DMC OHS.