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Ebola PPE -- the role of respirators?

By Donald Milton | 15 Oct, 2014

I have assumed that MSF's experience with relatively few infected caregivers while treating many EHF patients was the best argument for absence of close range airborne transmission, because I have not heard of MSF advocating airborne/respiratory precautions. To further investigate this, I would like to hear more about what MSF is actually able to do on the ground. Are they using N95 respirators? Are they fit testing? Or, are they in practice using masks of variable efficiency and fit?

I've looked at the MSF 2007 and 2008 documents found on the web (see posts under recent discussion of 2nd US nurse infected for links). In the 2007 document under "Quality and Requirements for Protective Equipment" on page 293 it states that masks should be "Preferably HEPA-filtration, minimum N95". No mention of fit testing is made in the document. It does say that "edges should seal well to the face." On page 58-59 it states that "The use of respiratory masks with full beards is not recommended, as an effective seal around the mask is impossible to achieve. High Efficiency Particulate filtration (HEPA) masks are preferred." Thus, the documents available to me suggest that they are trying to do some airborne/respiratory protection -- but maybe not as assiduously as they do standard and droplet spray precautions.

Can anyone shed light on the MSF practices and supplies?



Elizabeth Glaser Moderator Emeritus Replied at 10:51 PM, 15 Oct 2014

In recent photos I see what may be one of two different types of Kimberly-Clark products: a Kimtech pure m3 pouch-style face mask and perhaps a Kimberly-Clark PFR95 N95 Respirator, but this is my guess based on matching news photos to images in a catalog so there is high degree of uncertainty.

Elizabeth Glaser Moderator Emeritus Replied at 11:22 PM, 15 Oct 2014

Found more stringent guidelines in 1998 vs 2014 WHO/CDC documents. In 2014 ,HEPA or N95 mentioned for particular high risk activities such as suctioning or autopsy vs in 1998 HEPA-filter (or other biosafety mask recommended for staff to wear in isolation areas when caring for a suspect case

1. Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting. Atlanta, Centers for Disease Control and Prevention, 1998: 1-198., a joint CDC, WHO publication, (with inputs from other groups including MSF), page 45..

2. Clinical Management of Patients with Viral Haemorrhagic Fever: A Pocket Guide for the Front-line Health Worker 13 April 2014, WHO. page 32; 46; 87.

Pryanka Relan Replied at 12:48 PM, 16 Oct 2014

Hi all,

As an emergency doctor in training in new york, we are constantly being educated and updated on appropriate standard precautions for suspected case comes to our hospital. We are encouraged to use N95 respirators for patients presenting with symptoms consisted with Ebola and have instituted an "ask and mask" campaign in which any patient who has a fever is also asked to don a basic face mask.

As per 2014 September WHO guidelines, an N95 respirator mask should be used "if any procedures that stimulate coughing or promote the generation of aerosols (e.g., aerosolized or nebulized medication administration, diagnostic sputum induction, bronchoscopy, airway suctioning, endotracheal intubation, positive pressure ventilation via face mask) are planned to be performed" on anyone suspected to have Ebola.

Still not sure on MSF's stance on respirators and Ebola.

Daniel Erwin Replied at 9:52 PM, 16 Oct 2014

Dear Dr. Relan,

I am a health care safety professional. When an N95 respirator is selected for Ebola, preference should be for a "surgical N95", i.e., a N95 that has also been cleared as a surgical mask by the FDA. This is critical to ensure it meets the FDA fluid resistance requirements. You can learn more info on FDA cleared NIOSH-approved N95 respirators here
and here

Of course, head, face and eye protection are absolutely critical when N95s are worn for Ebola, as are donning and doffing protocols to prevent inadvertent transfer of infectious fluids.

I am currently researching MSF Ebola PPE guidelines and protocols.

Hope this helps.

Daniel Erwin

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