Respiratory Protection Program for Healthcare Workers

What this guideline says

GMJ summary

This 2022 PAHO manual provides a complete framework for establishing and managing respiratory protection programmes in healthcare facilities. It covers four modules: respiratory hazards in healthcare settings, types of respirators and their selection, programme development and administration, and fit testing and maintenance procedures.

The document emphasises that respirators are the last line of defence in the hierarchy of controls, after elimination, substitution, and engineering controls. It provides detailed technical specifications for N95, elastomeric, and powered air-purifying respirators (PAPR), explaining filtration mechanisms, assigned protection factors (APF), and maximum use concentrations. The manual requires medical screening of all respirator users, annual fit testing for tight-fitting respirators, documented training, and regular programme evaluation following PDCA (Plan-Do-Check-Act) cycles.

Key programme elements include: assigning a competent respiratory protection administrator; conducting risk assessments for both chemical and biological hazards; selecting appropriate respirators based on APF and exposure levels; implementing standard and airborne precautions; maintaining proper storage conditions (–20 °C to +30 °C, ≤80% relative humidity); and ensuring respirators are not used beyond their five-year shelf life from manufacture.

Key points

For clinicians — doses and thresholds as stated in the guideline

1. N95 respirators filter ≥95% of 0.3 µm particles and have an assigned protection factor (APF) of 10, meaning they can be used up to 10 times the occupational exposure limit
2. Half-face elastomeric respirators have APF of 10; full-face elastomeric APF of 50; loose-fitting PAPR APF of 25; tight-fitting PAPR (blower off) APF of 1,000
3. All tight-fitting respirator users require medical screening before use, annual fit testing, and retraining every 12 months or when respirator model changes
4. Respirators must be stored at –20 °C to +30 °C, ≤80% relative humidity, away from sunlight and chemicals, with a maximum shelf life of 5 years from manufacture date
5. Qualitative fit testing uses Bitrex® or saccharin with 10–30 squeezes; quantitative fit testing uses instruments to measure air leakage and provides a numerical fit factor
6. Seal checks (positive and negative pressure) must be performed every time before entering a contaminated area, distinct from annual fit testing
7. Elastomeric respirators can be disinfected by submersion for 2 minutes in 50 ppm sodium hypochlorite solution at 43 °C; disposable N95s should not be disinfected except in crisis/outbreak situations
8. Airborne precautions require negative-pressure isolation rooms, N95 or higher respiratory protection, and patient masking during transport; required for TB, measles, varicella, SARS, smallpox, monkeypox

OSHA Assigned Protection Factors (APF) by respirator type

Table extracted from the guideline

Source: Pan American Health Organization, Respiratory Protection Program for Healthcare Workers. Reproduced in summary form.

From the guideline

Verbatim

“PPE would be less effective than engineering controls, such as isolation rooms, biological cabinets, ventilation systems, etc.”

Editor’s perspective

Why this matters for Georgia and the region

Applicability

Georgia and the South Caucasus

Questions this guideline answers

Quick answers

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