The pathogens on the filter materials of the respirator may be transferred to the wearer upon contact with the respirator during activities such as adjusting the respirator, improper doffing of the respirator, or when performing a user-seal check when redonnng a previously worn respirator. Elastomeric respirators should not be used in surgical settings due to concerns that air coming out of the exhalation valve may contaminate the sterile field. Therefore, they are considered to be suitable alternatives to provide protection during the COVID-19 response when supplies are short. It does not address other aspects of pandemic planning; for those, healthcare  facilities can refer to COVID-19 preparedness plans. When caring for measles patients, N95 respirator use by healthcare workers (HCWs) with documented immunity is not uniformly required or practiced. Many filtering facepiece respirators have exhalation valves and should not be used in surgical settings as unfiltered exhaled breath would compromise the sterile field. Every other NIOSH approved filtering facepiece respirators is at least as protective as the N95. However, it is unknown what the potential contribution of contact transmission is for SARS-CoV-2, and caution should be used. For more information on cohorting of patients, refer to 2007 Guideline for Isolation  Precautions: Preventing Transmission of Infectious Agents in Healthcare Settingspdf icon. In addition, consideration can be given to use N95 respirators that have not been evaluated by NIOSH beyond the manufacturer-designated shelf life. For example, HCP should be educated on the use of N95 respirators when caring for patients managed with airborne precautions, and other instances for respirator use, such as the performance of aerosol generating procedures. Use NIOSH approved alternatives to N95 respiratorspdf icon where feasible. Surge capacity refers to the ability to manage a sudden increase in patient volume that would severely challenge or exceed the present capacity of a facility. If not already implemented, these strategies can be considered by healthcare settings in the face of a potential N95 respirator shortage before implementing the contingency strategies that are listed further below. This technology consists of lightweight, sturdy, and adjustable aluminum framing with a retractable plastic canopy. However, exposures to transmissible respiratory pathogens in healthcare facilities can often be reduced or possibly avoided through engineering and administrative controls and PPE. N95 respirators are the PPE most often used to control exposures to infections transmitted via the airborne route, though their effectiveness is highly dependent upon proper fit and use. Another cornerstone of engineering controls are ventilation systems that provide air movement from a clean (HCP workstation or area) to contaminated (sick patient) flow direction (along with appropriate filtration, exchange rate) that are installed and properly maintained. A quantitative fit test numerically measures the effectiveness of the respirator to seal with the wearer’s face, without relying on the wearer’s voluntary or involuntary response to a test agent. Cohorting has been used extensively for managing outbreaks of multidrug resistant organisms including MRSA, VRE, MDR-ESBLs, Pseudomonas aeruginosa; methicillin-susceptible Staphylococcus aureus, RSV, adenovirus keratoconjunctivitis, rotavirus, and SARS. If N95 or other airborne respirators are unavailable, health care staff … This practice is often referred to as “limited reuse” because restrictions are in place to limit the number of times the same respirator is reused. Elastomeric respirators are half-facepiece, tight-fitting respirators that are made of synthetic or rubber material permitting them to be repeatedly disinfected, cleaned, and reused.

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