Coronavirus: The importance of using the right respiratory protective equipment (RPE) – Ghana's case

Personal Protective Equipment (PPE), according to Health Safety Executive (HSE), UK can simply be defined as any equipment that will protect the user from health and safety risks at work. PPE is the last in the hierarchy of controls when it comes to health and safety.

First is Elimination, Substitution, Engineering Controls, Administrative Controls, and lastly PPE. Thus, efforts must be made to follow the afore-mentioned steps before resorting to PPE. The simple reason being that, the hierarchy of controls starts with the most effective control to the least effective control.

If we look at the guidelines issued by the World Health Organization (WHO), The Centre for Disease Control, and the Health and Safety Executive on COVID 19, it follows the hierarchy of controls listed below.

ELIMINATION:

Stay at home or working from home/remotely.

SUBSTITUTION / REDUCTION:

Social or Physical Distancing (2m rule) and use of hand sanitizers. Rotation of breaks when at work, plan works to Incorporate distancing etc.

ENGINEERING CONTROLS:

Use of Veronica Buckets or similar handwashing equipment and frequent washing of hands.

ADMINISTRATIVE CONTROLS:

Following government/employers’ guidelines & procedures – Ghana Health Service new guidelines;

RPE

Use of face masks / Respirators.

Respiratory Protective Equipment (RPE) are a category of Personal Protective Equipment designed to protect the individual/user from contamination through inhalation of hazardous substances whilst performing various activities. RPEs should only be used where other adequate control measures cannot protect the individual. In addition, they must be used with the other hierarchy of control measures.

There are different types of RPE’s for different purposes.

For this article we will focus on the COVID-19 and Respirators: Air-purifying – Unpowered – Disposable filtering respirators and face masks. The COVID 19 pandemic has suddenly seen an upsurge in the demand for us to have some form of RPE protection as we go about our daily activities.

Respiratory viruses spread from person to person in close proximity to each other. The “face mask” essentially a mask worn covering the nose and mouth of the user making it impossible for droplets including respiratory particles to contaminate the immediate environment when the user coughs or sneezes or exhales. Depending on the particular type of mask being used, it may not adequately filter out very small particles from the air we inhale. Secondly, they may not provide a tight seal around the nose and mouth of the user.

However, with the COVID 19 pandemic, the face mask when used in combination with the other hierarchy of controls such as frequent and effective handwashing with soap, frequent use of alcohol-based sanitizers, social and “physical” distancing, staying at home unless it is necessary to go out during the lockdown, and keeping our hands away from touching our face that is, mouth, ears, and nose, will serve as an effective tool in minimizing the spread of COVID 19. In fact, the Center for Disease Control (CDC) in the United States has recommended the use of the basic face masks as a means of a barrier of protection during these times of COVID 19 and beyond.

Unpowered Face Filtering respirator is a type of RPE, that protects the user from breathing in substances likely to cause harm to the user from hazardous chemicals and infectious particles such aqueous fog, respirable dust and smoke. They must be CE Marked or comply with OSHA 1910.134, to make sure they conform to set international standards.

In the case of an employer, selecting the right and appropriate respirator will involve a risk assessment to clearly identify what constitutes the respiratory hazard to be eliminated. This must be undertaken by a competent health and safety professional. However, suppliers and manufacturers must offer support and advise to members of the public on the appropriate type, its use and maintenance. Furthermore, international best practice and statutory regulations mandate that, any user of an RPE must undergo an annual “face fit” test to determine the exact fit of a face filtering piece or respirator the user may require and need. This can be achieved through a Qualitative or Quantitative method depending on the type of mask. Furthermore, users must not have any facial hair or trimmed facial hair to be able to get a sealed fit around the nose and mouth for the respirator.

There are various types of these non-powered respirators being used in Ghana in wake of the COVID 19 Pandemic, some being used inappropriately.

There are three classes of non-powered face filtering piece / respirators meant to protect us against smoke, dust and aerosols but do not offer any barrier against vapours or gases. These face filtering pieces are designed to cover and provide a tight seal over the nose and mouth thereby preventing us inadvertently from inhaling contaminated respirable dust, smoke and aerosols. There essentially are made of fabric and designed to purify the air we inhale or the impurities listed above among others.


FFP1:
FFP 1 Respirators are designed to offer the user protection from impurities of concentration levels up to 4 times the Occupational Exposure Limit. They will normally filter about 75 -80% of particles with a leakage of about 25% of particles.

FFP 2:
FFP 2 Respirators are designed to offer the user protection from impurities of concentration levels up to 12 times the Occupational Exposure Limit. These will filter about 95% of the particles and maximum leakage of 10 % of particles.

FFP 3:
FFP 3 Respirators are designed to offer the user protection from impurities of concentration levels up to 50 times the Occupational Exposure Limit. This offers protection against both liquid and solid aerosols. They filter close to 99% of particles and maximum leakage will not exceed 5% of particles. They also filter toxic, carcinogenic and radioactive particles.

FFP 2 and FFP 3 respirators are usually referred to as N95 respirators in the United States of America.

These respirators come in various types, such as folded, molded, valved and non-valved with their peculiar characteristics and functions which must be considered when deciding which face filtering piece / respirator is to be used based on the earlier risk assessment, which must be undertaken.

For instance, it is not all persons who can use non-valved respirator as barrier of protection. People who have certain conditions such as, asthma may not be able to breathe easily through a non-valved respirator, thus they may require a valved respirator, as indicated earlier based on risk assessment undertaken. Furthermore, also health care professionals who in addition to respirator have face protection equipment such as face shields may find valved respirators suitable for certain work processes and non-valved respirators for other work processes depending on risk assessment undertaken for the particular work process or activity. Health Care Professionals (HCP) who use medicated glasses may have to consider this fact when choosing a suitable respirator.

It is pertinent to note that, Section 9 (a) and (c) of the Labour Act 2003 (Act 651) and the International Labour Organization standards for the protection of workers, mandates employers to provide all employees with requisite PPE based on risk assessment of work processes. In addition, the employee, must have had the, “requisite training in the use of that PPE / RPE as required by law, when and why he must use the PPE / RPE, what type of PPE / RPE must be used for each process, how to properly use the PPE / RPE, knowledge of the limitations of that PPE / RPE, and requisite training in the care and maintenance of that PPE / RPE”.

From the foregoing, it is evident that, what pertains here in Ghana and to some extent globally, is not in conformity to statute and international best practice, healthcare professionals do not have access to the appropriate RPE whereas, ordinary people have access to the RPE’s needed most in the health care sector which are in short supply globally. We have also seen the improper use of RPEs by the public with RPE not strapped as directed around the head and nose thereby defeating the purpose of the RPE which is to provide a “total and leak proof seal” around the nose and mouth. Removal of RPE whilst conducting interviews or whilst in use due to the challenges with breathing easily as indicated earlier ,thereby contaminating the RPE and rendering its function void, and most importantly how to properly care and maintain these RPEs in this time of global short supply.


We have seen the Centre for Disease Control in the United States of America recently issue guidelines on face masks and other respirators concerning their use and maintenance in these not so ordinary times around the world. Furthermore, we have to contend with wearing face masks in certain public places like hospitals, pharmacy shops, shopping malls among others for the foreseeable future.


Credit: www.hse.gov.uk
www.cdc.gov
www.ilo.org
Labour Act 2003 (Act 651).
Public Health Act 2012 (Act 851).