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Self-management: The abilities to manage one’s emotions, thoughts, and behaviors effectively in different situations and to achieve goals and aspirations. This includes the capacities to delay gratification, manage stress, and feel motivation and agency to accomplish personal and collective goals.

Self-awareness: The abilities to understand one’s own emotions, thoughts, and values and how they influence behavior across contexts. This includes capacities to recognize one’s strengths and limitations with a well-grounded sense of confidence and purpose.

A recent NETEC webinar, “PPE from A to Z: PAPRs for Respiratory Protection,” offers health care workers a guide to multiple types of PAPRs, including use and maintenance, and how PAPRs fit into a health care respiratory protection program. Watch the webinar.

The process used and the components included in the decontamination process depend on the PAPR model, the exposure or contamination risk, and the other protective or PPE devices used. Disinfection should be thoughtful and meet the wet time for the disinfectant you are using. The process should reflect the manufacturer’s recommendation. You may need a stepwise process and identified decontamination personnel on your team to conduct the stepwise process and move equipment from dirty to clean/ready-to-use.

When used in high-risk environments, such as the care of Ebola patients, some facilities chose to dispose of the corrugated tubing that connects the hood to the blower motor rather than attempting to clean and decontaminate it.

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Selecting the right filters for PAPRs involves careful consideration of the chemicals and hazardous substances present in the work environment. Resources including the Emergency Response Guidebook from the Department of Transportation and a downloadable guide from 3M offer valuable insights into filter selection and maintenance. Additionally, the CDC’s National Institute for Occupational Safety and Health (NIOSH) provides a searchable Certified Equipment List to help identify suitable respirators for specific types of protection, including those for Chemical, Biological, Radiological, and Nuclear (CBRN) hazards. Adhering to OSHA requirements and manufacturer recommendations ensures timely filter changes, thereby optimizing respiratory protection.

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Communities. Community partners often provide safe and developmentally rich settings for learning and development, have deep understanding of community needs and assets, are seen as trusted partners by families and students, and have connections to additional supports and services that school and families need. Community programs also offer opportunities for young people to practice their social and emotional skills in settings that are both personally relevant and can open opportunities for their future. To integrate SEL efforts across the school day and out-of-school time, school staff and community partners should align on common language and coordinate strategies and communication around SEL-related efforts and initiatives.

SEL advances educational equity and excellence through authentic school-family-community partnerships to establish learning environments and experiences that feature trusting and collaborative relationships, rigorous and meaningful curriculum and instruction, and ongoing evaluation. SEL can help address various forms of inequity and empower young people and adults to co-create thriving schools and contribute to safe, healthy, and just communities.

PAPRfit testing requirements

Families & Caregivers. When schools and families form authentic partnerships, they can build strong connections that reinforce students’ social and emotional development. Families and caregivers are children’s first teachers, and bring deep expertise about their development, experiences, culture, and learning needs. These insights and perspectives are critical to informing, supporting, and sustaining SEL efforts. Research suggests that evidence-based SEL programs are more effective when they extend into the home, and families are far more likely to form partnerships with schools when their schools’ norms, values, and cultural representations reflect their own experiences. Schools need inclusive decision-making processes that ensure that families—particularly those from historically marginalized groups—are part of planning, implementing, and continuously improving SEL.

CASEL offers a presentation on the definition of SEL and CASEL framework for those seeking to learn more about the competencies and key settings.

The CDC acknowledges that studies on the use of PAPRs in operating rooms are ongoing, however, PAPRs may be an alternative for operating room staff who cannot pass a fit test with an N95 respirator. The PAPR should vent under the shroud in which exhalation gases vent underneath the gown. Ensure you can wear the PAPR shroud in this fashion (under the gown) by checking the manufacturer’s instructions. PAPRs venting to the rear of the PAPR wearer likely provide less contamination to the surgical field. PAPRs venting to the front may contaminate the surgical field.

Risk assessment is emphasized as a crucial aspect of RPP, encompassing not only special pathogens and biological hazards but also chemical and radiation risks. Different situations may require different types of respiratory protection, and staff should be educated on when to use each type appropriately. It’s important to understand the differences between protection for chemical, biological, and radiological hazards and ensure staff are trained accordingly. Post-event considerations such as disinfection also need to be addressed.

PAPRmask

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Resources and toolkits are available to assist institutions in developing their respiratory protection programs. There are several educational tools (including slide presentations, posters, and flyers) listed in the “References, Resources, and Tools” section on page 36. You may use these materials during your annual training and as needed year-round to make sure that employees are up to date on their knowledge of respiratory protection and its proper use. However, you must ensure that respirator users are fully trained on the specific risks, programs, and procedures at your hospital; can correctly put on and take off their respirators; and can recognize when their respirator needs to be repaired or replaced.

According to the manufacturers of the types of PAPR/CAPR’s discussed in the webinar, the flow alarm or light indicates when the filters must be changed. Changing filters more frequently than manufacturer recommendations may be done at the discretion of your facility in conversation with infection prevention, clinical engineering, and other partners. How often the PAPR is being used may also play a role in the frequency of changing the filters.

Classrooms. Research has shown that social and emotional competence can be enhanced using a variety of classroom-based approaches such as: (a) explicit instruction through which social and emotional skills and attitudes are taught and practiced in developmentally, contextually, and culturally responsive ways; (b) teaching practices such as cooperative learning and project-based learning; and (c) integration of SEL and academic curriculum such as language arts, math, science, social studies, health, and performing arts. High-quality SEL instruction has four elements represented by the acronym SAFE: Sequenced – following a coordinated set of training approaches to foster the development of competencies; Active – emphasizing active forms of learning to help students practice and master new skills; Focused – implementing curriculum that intentionally emphasizes the development of SEL competencies; and Explicit – defining and targeting specific skills, attitudes, and knowledge.

PAPRs and other PPE components require certain temperature and humidity considerations for storage. Because of the materials they are made of, the need for dry filtration material, and the lifespan of batteries, PAPR and related PPE should be kept in a temperature and humidity-controlled environment. For example, a garage without HVAC controls would not be appropriate.

The suitability of PAPR models varies based on the demands of specific workplace settings. For instance, in mobile environments like Emergency Medical Services (EMS) and ambulance care, selecting PAPRs tailored to mobility is crucial.

Our framework provides a foundation for communities to use evidence-based SEL strategies in ways that are most meaningful to their local context. It can be applied to many different priorities and aligned with each community’s strengths, needs, and cultures.

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Our SEL framework, known to many as the “CASEL wheel,” helps cultivate skills and environments that advance students’ learning and development.

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Relationship skills: The abilities to establish and maintain healthy and supportive relationships and to effectively navigate settings with diverse individuals and groups. This includes the capacities to communicate clearly, listen actively, cooperate, work collaboratively to problem solve and negotiate conflict constructively, navigate settings with differing social and cultural demands and opportunities, provide leadership, and seek or offer help when needed.

If a PAPR is worn in the care of immune-compromised patients, your Infection Prevention and Employee Health professionals may advise other strategies that may include employee screening, immunizations, or testing.

Because the school setting includes many contexts—classrooms, hallways, cafeteria, playground, bus—fostering a healthy school climate and culture requires active engagement from all adults and students. A strong school culture is rooted in students’ sense of belonging, with evidence that suggests that it plays a crucial role in students’ engagement. SEL also offers an opportunity to enhance existing systems of student support by integrating SEL goals and practices with universal, targeted, and intensive academic and behavioral supports. By coordinating and building upon SEL practices and programs, schools can create an environment that infuses SEL into every part of students’ educational experience and promotes positive social, emotional, and academic outcomes for all students.

The content presented in the webinar and this blog post about Powered Air-Purifying Respirators (PAPRs) is intended for educational purposes only. NETEC does not endorse or promote any specific brand or manufacturer of PAPRs. The information provided is meant to offer general guidance and knowledge about PAPRs and their use in health care settings. Conduct your own research and consult with appropriate experts or regulatory bodies when considering the selection or purchase of PAPRs for your specific needs. Any references to particular brands or products are purely for illustrative purposes and should not be interpreted as an endorsement by NETEC. We strive to provide unbiased and impartial information to support health care professionals in making informed decisions regarding infection prevention and control.

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Health care professionals should understand the use of Powered Air-Purifying Respirators (PAPRs) as part of their institution’s Respiratory Protection Programs, including the importance of complying with regulatory standards, receiving thorough training, and conducting tailored risk assessments. By focusing on key aspects, such as PAPR selection and maintenance, and following manufacturer recommendations and CDC guidelines for filter selection, maintenance, and disinfection, health care institutions can enhance the safety and resilience of their workforce, ensuring optimal patient care amidst evolving occupational hazards.

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Most PAPR products were developed before source control was noted as an issue (pre-pandemic), so they don’t have specific source control features. Some have shrouds you can tuck into the suit, essentially allowing all exit air to travel out away from your breathing zone. In most cases, it would be wise to wear a surgical mask when source control is a consideration. The obvious challenge with this option is not being able to see expressions or read lips.

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Social and emotional learning is essential to helping us all lead healthy, fulfilling lives. Take our free online course to learn more about how to develop these critical skills.

The Occupational Safety and Health Administration (OSHA) mandates comprehensive training on PAPR usage, including hands-on demonstrations covering essential topics outlined in the Respiratory Protection Program (RPP) Toolkit.

An institution’s respiratory protection program is typically overseen by infection prevention departments, although they may also involve safety, occupational health, or other emergency management roles depending on the organization’s size. The key elements of respiratory protection programs include risk assessments, health assessments, which are required regardless of the need for fit testing, as well as education and training for personnel, and record keeping.

Eye protection is part of standard precautions and is recommended in most biocontainment care situations. The use of eye protection should be based on a risk assessment that accounts for the reasonable anticipation of facial exposure. OSHA requirements state that masks, in combination with eye protection devices, such as glasses with solid side shields, goggles, or chin-length face shields, shall be worn whenever splashes, spray, spatter, or droplets of blood or other potentially infectious materials (OPIM) may be generated and eye, nose, or mouth contamination can be reasonably anticipated.

The CASEL 5 addresses five broad and interrelated areas of competence and highlights examples for each: self-awareness, self-management, social awareness, relationship skills, and responsible decision-making. The CASEL 5 can be taught and applied at various developmental stages from childhood to adulthood and across diverse cultural contexts. Many school districts, states, and countries have used the CASEL 5 to establish preschool to high school learning standards and competencies that articulate what students should know and be able to do for academic success, school and civic engagement, health and wellness, and fulfilling careers.

There are different types of PAPRs—the hood style PAPR hangs down lower over the wearer’s body versus the loose-fitting style PAPR that is fitted over the face. The exhalation of respiration from the wearer exits each device differently. The manufacturer’s instructions for use should be consulted to determine if a hood style PAPR may be worn under a sterile surgical gown, which may reduce contamination of the sterile field.

PAPR3M

Schools can also create other avenues for family partnership that may include creating ongoing two-way communication with families, helping caregivers understand child development, helping teachers understand family backgrounds and cultures, providing opportunities for families to volunteer in schools, extending learning activities and discussions into homes, and coordinating family services with community partners. These efforts should engage families in understanding, experiencing, informing, and supporting the social and emotional development of their students.

SEL instruction is carried out most effectively in nurturing, safe environments characterized by positive, caring relationships among students and teachers. To facilitate age-appropriate and culturally responsive instruction, adults must understand and appreciate the unique strengths and needs of each student and support students’ identities. When adults incorporate students’ personal experiences and cultural backgrounds and seek their input, they create an inclusive classroom environment where students are partners in the educational process, elevating their own agency. Strong relationships between adults and students can facilitate co-learning, foster student and adult growth, and generate collaborative solutions to shared concerns.

We have confirmed that the 3M Breatheasy will continue to be supported. The original text of this post stated that it had been discontinued.

Exploring your facility’s options for other types of wipes and cross-checking them with the Instructions for Use (IFU) may yield a more convenient disinfection method.

Schools. Effectively integrating SEL schoolwide involves ongoing planning, implementation, evaluation, and continuous improvement by all members of the school community. SEL efforts both contribute to and depend upon a school climate where all students and adults feel respected, supported, and engaged.

Transportation introduces additional wear considerations for choosing a PAPR, including confined spaces, prolonged sitting or leaning over patients, and communication challenges due to PAPR noise levels and compatibility with radios. Doffing considerations may include doing so in unfamiliar or confined settings, the potential need for assistance or tools, and the need for plans for handling reusable and disposable contaminated equipment and supplies. Careful consideration of these factors, among others, ensures the effective implementation of PAPRs in healthcare settings.

Personal Protective Equipment (PPE) is an essential element of health care worker safety, protecting against various occupational hazards. Powered Air-Purifying Respirators (PAPRs) are an important type of protective gear that plays a critical role in maintaining respiratory health and safety in different work environments.

Resources to assist healthcare institutions in developing effective respiratory protection programs tailored to their specific needs:

This blog post originally stated in error that the 3M Breatheasy is discontinued. We have since confirmed that the 3M Breatheasy PAPR ensemble will continue to be supported. The updates are included in the post below.

Exhalation valves exist primarily for breathing comfort in high-dust environments; health care is not typically a high-dust particle environment. While they were used during the pandemic to address the shortage of typical health care respirators, the CDC does not recommend the use of a respirator with an exhalation valve in certain health care situations, including but not limited to operating rooms, because the valve may allow contaminants to escape and reach others.

It is impossible to fully know the risks associated with using expired PPE. NIOSH-NPPTL researchers looked at expired respirators but their study did not include PAPRs or PAPR filters.

In several studies, PAPRs have been found to be as effective as face masks in reducing outward particle spread, but it is important to be aware of how and where exhaled air exits a PAPR hood, helmet, or shroud. For those respiratory illnesses spread predominantly by a droplet pathway, the passive exhalation under a gown, coverall, hood, or shroud is likely to decrease droplet spread but does not completely rule out aerosols (droplet nuclei).

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There is not currently a NIOSH or OSHA-certified eye protection product for blood and OPIM. In 2021, new guidance was created for the selection, care, and use of these items along with how they should be tested and marked: ANSI/ISEA Z87.62-2021.

Students, families, schools, and communities are all part of broader systems that shape learning, development, and experiences. Inequities based on race, ethnicity, class, language, gender identity, sexual orientation, and other factors are deeply ingrained in the vast majority of these systems and impact student and adult social, emotional, and academic learning. While SEL alone will not solve longstanding and deep-seated inequities in the education system, it can create the conditions needed for individuals and schools to examine and interrupt inequitable policies and practices, create more inclusive learning environments, and reveal and nurture the interests and assets of all individuals.

Responsible decision-making: The abilities to make caring and constructive choices about personal behavior and social interactions across diverse situations. This includes the capacities to consider ethical standards and safety concerns, and to evaluate the benefits and consequences of various actions for personal, social, and collective well-being.

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The PAPR blower is attached to a belt worn at the waist and exhausts air. The blower exhaust should be directed away from the sterile field. The perioperative team member that is wearing the PAPR may need to stand in a different location, to reduce the risk of PAPR exhaust blowing onto the sterile field. Alternatively, it may be necessary to move the sterile field out of the direction of the blower exhaust depending on the room configuration.

OSHA requires a conservative approach to filter maintenance that is defined at your facility. While these are typically based upon the End-of-Service-Life Indicator (ESLI), there is not one for infectious particles. According to OSHA regulations, “If there is no ESLI appropriate for conditions in the employer’s workplace, the employer implements a change schedule for canisters and cartridges that is based on objective information or data that will ensure that canisters and cartridges are changed before the end of their service life. The employer shall describe in the respirator program the information and data relied upon and the basis for the canister and cartridge change schedule and the basis for reliance on the data.”

Understanding the nuances of PAPR use in settings such as operating rooms and biocontainment units requires careful evaluation of ventilation mechanisms and contamination risks.

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Work with your Infection Preventionist, Safety Office, Occupational Health team, or Public Health Department to do a risk assessment based on your patient population. They will want to consider what tasks staff will be performing, how close contact needs to be, the duration of close contact, and what other controls are in place to protect staff and the workplace. These hazard assessments are a required part of a Respiratory Protection Program.

We take a systemic approach that emphasizes the importance of establishing equitable learning environments and coordinating practices across key settings of classrooms, schools, families, and communities to enhance all students’ social, emotional, and academic learning. Quality implementation of well-designed, evidence-based, classroom programs and practices is a foundational element of effective SEL. We believe it is most beneficial to integrate SEL throughout the school’s academic curricula and culture, across the broader contexts of schoolwide practices and policies, and through ongoing collaboration with families and community organizations. These coordinated efforts should foster youth voice, agency, and engagement; establish supportive classroom and school climates and approaches to discipline; enhance adult SEL competence; and establish authentic family and community partnerships.

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For more information on selecting a gown for hazmat decontamination, watch the NETEC webinar “PPE from A to Z: Exploring the Latest Standards and Regulations for Health Care Personnel,” which provides updates to the standards for liquid barrier protection of PPE in health care facilities and links to a downloadable one-page guide for health care personnel to reference when selecting a gown.

Social and emotional learning (SEL) is an integral part of education and human development. SEL is the process through which all young people and adults acquire and apply the knowledge, skills, and attitudes to develop healthy identities, manage emotions and achieve personal and collective goals, feel and show empathy for others, establish and maintain supportive relationships, and make responsible and caring decisions.

Social awareness: The abilities to understand the perspectives of and empathize with others, including those from diverse backgrounds, cultures, and contexts. This includes the capacities to feel compassion for others, understand broader historical and social norms for behavior in different settings, and recognize family, school, and community resources and supports.

A developmental perspective to SEL considers how the social and emotional competencies can be expressed and enhanced at different ages from preschool through adulthood. Students’ social, emotional, and cognitive developmental levels and age-appropriate tasks and challenges should inform the design of SEL standards, instruction, and assessment. Given that, stakeholders should decide how best to prioritize, teach, and assess the growth and development of the CASEL 5 in their local schools and communities.

Proper maintenance and cleaning procedures are vital for extending the lifespan of PAPRs and ensuring their effectiveness. Following CDC guidelines for cleaning and disinfection, along with adhering to manufacturer recommendations, is essential. Considerations for high-risk environments and disposable components underscore the importance of meticulous decontamination practices.

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