Adembescherming

  • Welke type ademmasker is nodig? 
    Er zijn verschillende adviezen:

RIVM stelt op 6 april 2020: https://lci.rivm.nl/index.php/richtlijnen/covid-19#index_Preventie :

Het RIVM heeft op 18 maart 2020 geadviseerd over Ademhalingsbeschermingsmaskers voor COVID-19:

Het RIVM heeft op 18 maart 2020 geadviseerd over Ademhalingsbeschermingsmaskers voor COVID-19 https://lci.rivm.nl/sites/default/files/2020-03/Advies%20Ademhalingsbeschermingsmaskers%20voor%20COVID_19%20%20dd%20180320.pdf 

Op basis van de huidige kennis ten aanzien van de transmissieroute van COVID-19 via druppels en (in)direct contact, biedt een chirurgisch mondneusmakers voldoende bescherming voor gezondheidsmedewerkers die patiënten moeten verzorgen met COVID-19.

Over dit advies is binnen de gemeenschap van arboprofessionals veel discussie ontstaan.

  • Question : Can a valved respirator be used for protection from the virus that causes H1N1? 
    A valved respirator is designed to allow for easy exhalation through a one-way exhalation valve. If a person is wearing a respirator to help reduce his or her exposure to airborne viruses, a respirator with an exhalation valve would be acceptable. It would not be acceptable for someone to wear a valved respirator if they have a suspected/probable/confirmed case of H1N1 as they would be exhaling into the environment.
    Where healthcare workers are required to wear a respirator the use of a valved respirator must be in accordance with national and employer guidelines. For example, in some regions of the world such as Canada and the US, it is not acceptable for a healthcare worker to wear a valved respirator in a situation requiring a sterile environment, such as the operating room. Respirators should not be worn by a person whose respiratory system has been compromised or who may have trouble breathing through a respirator, unless otherwise advised by your personal physician. https://multimedia.3m.com/mws/media/604799O/ohes-h1n1-influenza-a-faq.pdf
     
  • I-SZW - Productveiligheid en certificatie - Update vanwege Covid-19
    https://www.inspectieszw.nl/onderwerpen/algemeen-productveiligheid-en-certificatie
  • NVVK - PBM-alert 4 Adembescherming voor bescherming tegen Coronavirus, dd 5 febr 2020.
    Gewone mondmaskers geven geen of onvoldoende doelmatige bescherming tegen het Coronavirus. 
    Filterende gelaatsmaskers dienen te voldoen aan de EU norm NEN-EN 149:2001+A1:2009, minimaal type FFP2 of bij voorkeur FFP3 voor een betere bescherming bij micro biologische agentia (risico klasse II).
    Voor personen die (mogelijk) besmettelijk zijn wordt geadviseerd een chirurgisch masker te laten gebruiken. Deze mondmaskers dienen te voldoen aan de norm NEN-EN 14683:2019+C1:2019, type IIR (niet vocht doorlatend). (deze valt niet onder de regelgeving voor PBM)
    Het is van belang om hygiënische maatregelen te nemen ter voorkoming van verdere verspreiding van het virus zoals o.m. regelmatig handen wassen, gebruik van handschoenen, veiligheidsbril voor bescherming tegen vloeistofspatten, vloeistof bestendig schort e.e.a. op basis van een risico- inventarisatie en –evaluatie.
    Het RIVM adviseert op dit moment alleen adembescherming (mondmaskers) voor medisch personeel. Voor niet-besmettelijke personen wordt het gebruik van mondmaskers niet geadviseerd.
  • Volgelaatmasker 
    • (toegevoegd 14-4-2020) Webinar Elastomeric Respirators for U.S. Healthcare Delivery During N95 Shortages https://youtu.be/8wd5Bx2fVDI 
      This recorded webinar provides an overview of respiratory protection and guidance surrounding supply shortages. It also provides information on infection prevention measures, strategies for optimizing the supply of N95 respirators, and a broad overview of the use of elastomeric respirators in healthcare.
      ​
  • Aangeblazen lucht systemen / PAPR powered air purifying respirators
    • (toegevoegd 14-4-2020) Selection and Use of Respiratory Protection by Healthcare Workers to Protect from Infectious Diseases in Hospital Settings  Annals of Work Exposures and Health, wxaa020, https://doi.org/10.1093/annweh/wxaa020  07 March 2020
      https://academic.oup.com/annweh/article/doi/10.1093/annweh/wxaa020/5788727 
      Most participants believed that PAPRs provide higher protection, comfort and reusability over N95 FFR and can be used during pandemics and other high-risk situations. 
      ​HCWs should be aware of infection control policies and training should be provided on the correct use of respiratory protective devices. PAPRs can be used in hospital settings to protect HCWs from certain highly infectious and emerging pathogens, however, HCWs require adequate training on storage, use, and cleaning of PAPRs.
    • (toegevoegd 14-4-2020) Research Gaps in Protecting Healthcare Workers From SARS and Other Respiratory Pathogens: An Interdisciplinary, Multi-Stakeholder, Evidence-Based Approach  J Occup Environ Med. 2005 January ; 47(1): 41–50.  Yassi et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4880470/  
      Dit artikel beschrijft o.a. de mate van bescherming tegen TB met verschillende soorten adembescherming. HEPA-fitted PAPR werkt het beste.
    • (toegevoegd 14-4-2020) Powered air-purifying respirator use in healthcare: Effects on thermal sensations and comfort.J Occup Environ Hyg. 2017 Dec;14(12). https://www.ncbi.nlm.nih.gov/pubmed/28763290
    • Cleaning and Disinfecting 3M™ Versaflo™ Powered Air Purifying Respirator Assemblies following Potential Exposure to Coronaviruses
      https://multimedia.3m.com/mws/media/1793956O/cleaning-and-disinfecting-3m-paprs-following-potential-exposure-to-coronaviruses.pdf
    • The Use and Effectiveness of Powered Air Purifying Respirators in Health Care: Workshop Summary 2015. https://www.ncbi.nlm.nih.gov/books/NBK294215/pdf/Bookshelf_NBK294215.pdf
    • Strategies for Optimizing the Supply of N95 Respirators: Crisis/Alternate Strategies
      https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/crisis-alternate-strategies.html bevat ook info over PAPR's
    • OSHA en MERS, waarin ook over PAPR geschreven wordt:
      Acceptable respiratory protection devices for protection against MERS-CoV include a properly fit-tested, NIOSH-approved filtering face piece respirator (N95 or higher level), half- or full-face air-purifying respirator (APR), or a powered air-purifying respirator (PAPR) equipped with high-efficiency particulate arrest (HEPA) filters. Work tasks, including cleaning and decontamination activities, that involve an increase in moisture and spray may adversely affect disposable N95 respirators and certain other respirators. In such instances, a supplied-air respirator (SAR) may be an alternative to improve worker protection. Loose-fitting PAPRs and SARs may also improve worker comfort when wearing respirators for long periods. https://www.osha.gov/SLTC/mers/control_prevention.html
    • Question : I'm trying to set up an intubation team to do all intubations for the entire hospital to minimize staff exposure and PPE used. Has this been done and what is the optimal number of persons or teams that my hospital should designate? 
      Several team-based models have been implemented in hospitals within the United States – including those for intubation/extubation, patient positioning and other features of COVID-19 care. There are many examples based upon local need and resources. At one hospital, an initial team is made of five physician anesthesiologists are working a 12-hour shift. This team and others use PPE that follows CDC guidance, including the use of N95 masks, gloves, gowns and eye protection.  Equipment also includes the use of a video laryngoscope while performing an RSI.  A powered air-purifying respirator (PAPR) can also be used for intubation if individuals have received training for donning and doffing for the device. https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus/clinical-faqs  
    • (toegevoegd 12-5-2020) Are Powered Air Purifying Respirators a Solution for Protecting Healthcare Workers from Emerging Aerosol-Transmissible Diseases? https://academic.oup.com/annweh/article/64/4/339/5802550  
  • PBM's aandoen & uitdoen / Donning & Doffing

Opzetten / Donning:

Afzetten / PPE Doffing: 

Foto's adembescherming Terug naar COVID-19 pagina