Are You Using the Right Mask?

[indigo girl]

http://afludiary.blogspot.com/2009/08/though-your-mask-is-lovely-its-wrong.html

I continue to read of nurses being given surgical masks for protection with swine flu cases. You would think that by now, nurses everywhere would know better, but these stories keep popping up. So for the few of you, who don't know, the N95 is the currently recommended PPE for swine flu. Goggles are recommended as well.

Be careful out there.

NHS workers battling swine flu have been put at extra risk after being given the wrong protective face masks, nurses have claimed.

A mix-up with orders of specialised fluid-repellent masks has left frontline workers having to wear ordinary surgical masks which are virtually useless at protecting those wearing them against swine flu.

One NHS worker from Swansea, who asked not to be named, said: "We were all given masks but then they sent out a letter to everyone to say they were the wrong ones and would have to be replaced.

"Some of the nurses queried straight away whether they were the correct ones and it turns out they weren't.

"Staff are still wearing the masks but they know they do not offer a lot of protection."

The nurse said many of the workers felt let down by the failure and said it had increased the risk of doctors and nurses catching the disease.

[caroladybelle, BSN, RN]

I would appreciate it if some others would give the links a read also. My first impression, and I have only skimmed them once, was that this was a choice that they made, and they could just have easily chosen the other option.

Maybe you are right catnip, that it was cost driven. As we continue to track the fatalities especially in HCW, this might prove to be a costly choice, but again, they aren't the ones at the bedside providing care.

On a positive note, the report did say that pregnant staff should be reassigned, but this is not official policy at most facilities yet. How many of you are working in places that are reassigning pregnant staff away from suspected or confirmed cases of swine flu? Mostly I am hearing from pregnant nurses trading with colleagues or individuals volunteering to take those cases to protect pregnant co-workers.

What we do. During the initial few days, when there was a lot of coughing, we stuck to the N95 as I work with predominantly immunosuppressed pts. I am required to mask for all pts anyway. Later, in treatment, I felt more comfortable with using regular surgical mask after the serious amounts of coughing (potential for spraying droplets) had ceased. We also gown and glove.

My issue. People have to remember to trash the mask after each use. No hanging it in the anteroom, no leaving it around your neck but down after use. Given that we mask for everyone, I worry about people with the regular surgical mask forgetting to remove it and using in another pts room. The N95 is heavy ehough - more people remove it than leave it hanging on their neck.

That and the visitors being non-compliant.

We are thus far not assigning pregnant nurses to the room.

[Infnurse]

Hi what you tell is akward - hope you are always fine ...

A few comments:

An N95 mask does not filter vapors, only particulates and aerosols. So it can happen you taste the smell of some odours/gases. BUT if you taste during the fit test with approved testing methods the odours, your mask is not right fitted. Which model do you wear ?

In France nobody knows what fit test is - you see the point ! (Tchernobyl clouds did never got the borders of France, you know !).

As for the nurse you saw running out of the room to get the proper protection ... I don't understand if the patient was under respiratory ass with the ventilator? If so, as stated by some tests, everyone being in the room is at risk if not wearing the appropriate mask. Infected particulates are exhausted by the system in the room while the patient breathes on et out, or coughs. She was yet exposed while the patient was not coughing, and more severely when the accident happened.

[lamazeteacher]

"We are thus far not assigning pregnant nurses to the room." quote from post # 24 by caroladybelle

It would be much safer to assign only those without a uterus, or over age 55 to those patients, since CDC thinks older persons may be immune to H1N1; and those without uteri cannpt be pregnant.

That may get some older/senior nurses their jobs back...... or at least job opportunities.

[NotReady4PrimeTime, RN]

Since I last posted to this thread there have been some more changes to our battle plan. Our respiratory therapy manager is leading the charge to ensure that any and every person in a room with a suspect H1N1 patient wear full PPE - N95, gown, gloves and goggles. I've decided I'm not going to worry about the fit of my mask. I've been vaccinated and I'm going to wear the mask I was told fits me (8210) and do whatever else I can to keep myself healthy. Now that we've had our first death on the unit, people are taking it all a little more seriously. I just wish our management would restrict visitors...

[lamazeteacher]

What boggles my mind, is that there has been little uniformity of policies for H1N1, as a result of leaders conferring conclusions from their vast resources of knowledge there. They seem to be leaving a lot to individual facilities, as they did the priority policy for those at high risk, in the procedure(s) used by local Health Departments for H1N1 flu vaccine administration, with less than ideal results.

A man told me yesterday, that since he accompanied his children for their vaccinations, the nurse (?) giving the vaccine said although he wasn't in any high risk group, she'd give him the vaccine. too. No wonder they're running out of the stuff before those who are pregnant, caring for infants under 6 months, health care workers, and in the dangerous age range or chronically respiratory impaired!

My understanding regarding the use of proper masks, is that a reliable patient who has H1N1 flu and who hasn't tubes sticking out of their mouths or tracheas (can't get a good fit there), should wear the properly fitted N95 mask when anyone else (including visitors) is present in the room. That catches infective particulates, etc.before they voyage onto another's nose or mouth. When staff or visitors enter the room, both should wear masks, and again if the patient is adequately N95 masked, the other person can wear whatever cheapo mask the hospital sees fit to provide. However, it should be noted that all masks must be changed when sufficient moisture accumulates in either mask, that microorganisms can be propelled faster through the material of the mask they're wearing (that's after sneezing or frequent productive coughing or 10 minutes, whichever comes first).

Now if uncooperative, noncompliant or barely conscious patients are infected with H1N1, the others should wear the N95 masks. Visitors (wearing N95 properly fitted masks - haha) should be restricted to close family and a "significant other", with care taken to allow only 2 visitors in the patient's room at a time, to avoid their visiting each other. That requires supervision, hence a lower ratio of patients:HCWs....... That's if I was the IC nurse at a facility, as I was before becoming undesirably old. :imbar

[NotReady4PrimeTime, RN]

Our visiting "policy" is such a farce. As it stands, we are supposed to have no more than 2 visitors per patient, limited to parents only after 8 pm, and no one is to visit without a parent present. In reality it's a free-for-all. There are often three or more people at the bedside, any Tom, Dick or Mary who has even a glancing acquaintance with the family, any time they feel like it. In our First Nations communities, everybody is an "auntie", even people who live hundreds of miles away who have the same last name but no blood connection and who can't even give you the child's first name. It's so difficult. They come and go at all hours... and when it's suggested that the middle of the night isn't the best time to visit a critically ill child, you hear, "But we just drove x hundred miles to see my auntie's kid..." We get NO support from our management over restricting these visitors, although they'll stand at the desk gesturing at all the people and glaring at the nurse. So far, the presence of H1N1 on the unit hasn't had any effect on this.

[lamazeteacher]

Visitors to patients have disregarded rules throughout time, and especially now, since respect for nurses is waining. It might be good to tell the visitors that observation cameras will record their refusal to obey the rules. When they bring the disease back to their reservation, they can be blamed for deaths that occur because of that...... Good acting is a requirement for that to have the desired effect.

Good luck!

[Infnurse]

" My understanding regarding the use of proper masks, is that a reliable patient who has H1N1 flu and who hasn't tubes sticking out of their mouths or tracheas (can't get a good fit there), should wear the properly fitted N95 mask when anyone else (including visitors) is present in the room. That catches infective particulates, etc.before they voyage onto another's nose or mouth. When staff or visitors enter the room, both should wear masks, and again if the patient is adequately N95 masked, the other person can wear whatever cheapo mask the hospital sees fit to provide. However, it should be noted that all masks must be changed when sufficient moisture accumulates in either mask, that microorganisms can be propelled faster through the material of the mask they're wearing (that's after sneezing or frequent productive coughing or 10 minutes, whichever comes first)."

:cry:Sorry - The proper use is the reverse rule : the patient wears (if he/she can support) a surgical mask tied in the right way; visitors wear the N95. the more tight sealed the mask, the more likely the patient will blow up it when couhing, talking, and makes the respirator leaks; non speaking of the uncomfort.

[Infnurse]

Since I last posted to this thread there have been some more changes to our battle plan. Our respiratory therapy manager is leading the charge to ensure that any and every person in a room with a suspect H1N1 patient wear full PPE - N95, gown, gloves and goggles. I've decided I'm not going to worry about the fit of my mask. I've been vaccinated and I'm going to wear the mask I was told fits me (8210) and do whatever else I can to keep myself healthy. Now that we've had our first death on the unit, people are taking it all a little more seriously. I just wish our management would restrict visitors...

Hi the 8210 is a good mask, similar to the green 1860,minus the extra green protective shield agaisnt the fluids, which is a +++ in bad penumonia/flu cases. But i suppose you wear the standard size; the 1860S, in "small" size is widely worn by female nurses, since it makes a tight seal to their face... Just a hint to try.

[lamazeteacher]

It's not OK for a unit to be without necessary PPE. Even though you eventually got the correct mask, please drop an email or whatever your method of communication is, and give your Infection Control Nurse a "heads up" about not having them when you needed one. The surgical mask isn't sufficient at all. The plastic shield protects your eyes against a splash, but is very expensive and unless you were doing a procedure wherein it was likely that your face would be splashed, using that was a waste.

I guess your patient had a positive test for H1N1 (since other "flu" bugs can be identified only at specialized labs), and if so, I don't see why you worried excessively, as you already had that vaccine, which shouldn't have irritated a nerve in your arm. It could have been the mechanical action of the needle hitting a nerve, but I've never known that to more than temporarily cause pain.

You certainly could have gotten the flu vaccine in an oral spray, if you're not pregnant or over 50 years of age, but not at the same time as the H1N1 oral spray vaccination. It does take over 2 weeks to attain full immunity to H1N1/seasonal flu after the shot........Since the flu vaccine contains live, attenuated virus, it isn't wise to give the two vaccinations at the same time (or week).

For more information, go to flu.gov

[Infnurse]

:yawn:Your unit is wrong, if N95 masks are not available at any time (a worse case could be a MDR or XDR tuberculosis patient!), you should have denied to enter the room without being fitted with the appropriate respirator.

At least, in emergency as you tell, you should have put on 2 or 3 surgical masks tightly sealed on your face, and not a single one (this procedure was widely used during sars and avian flu, regarding the failure of N95, please see the pics).

Regards, dont freak too much yet ! Please keep in touch if you need.

:nurse:Anita

[NeoNurseTX, RN]

It's not OK for a unit to be without necessary PPE. Even though you eventually got the correct mask, please drop an email or whatever your method of communication is, and give your Infection Control Nurse a "heads up" about not having them when you needed one. The surgical mask isn't sufficient at all. The plastic shield protects your eyes against a splash, but is very expensive and unless you were doing a procedure wherein it was likely that your face would be splashed, using that was a waste.

I guess your patient had a positive test for H1N1 (since other "flu" bugs can be identified only at specialized labs), and if so, I don't see why you worried excessively, as you already had that vaccine, which shouldn't have irritated a nerve in your arm. It could have been the mechanical action of the needle hitting a nerve, but I've never known that to more than temporarily cause pain.

You certainly could have gotten the flu vaccine in an oral spray, if you're not pregnant or over 50 years of age, but not at the same time as the H1N1 oral spray vaccination. It does take over 2 weeks to attain full immunity to H1N1/seasonal flu after the shot........Since the flu vaccine contains live, attenuated virus, it isn't wise to give the two vaccinations at the same time (or week).

For more information, go to flu.gov

The shot was in 2009 so does it last that long? Yes, it was confirmed H1N1 and we are not allowed to have the nasal spray as it is live and I work with babies. I've heard several complaints of the 2009 H1N1 vaccine causing nerve pain. The shot itself was painless but the symptoms started 2-3 days later and I had treatment under an orthopedic surgeon because it was classic signs of carpal tunnel syndrome, but he did some tests and told me it wasn't.

I was on the CDC and flu.gov sites for quite some time last night and have emailed my manager with the issue (no one else had been using the N95s) so some unit education is definitely needed here as this is something we don't see often.