FW: [ACIPC_Infexion_Connexion] MRI compatible P2/N95 mask for Patients on Airborne Precautions

[Glenys Harrington]

Hi All,

Apologies for coming back to this thread so late.

I just wanted to mention to Sharyn that even though the OR is positively
ventilated the air exchange is such that with each air exchange the
organisms are diluted and hence the infectious dose is decreased and
infections do not occur.

In addition OR ventilation systems are dedicated to individual operating
rooms and not part of other areas in the hospital therefore dispersion to
other parts of the hospital will not occur. This is the same for other areas
in an operating theatre complex.

The same dilution process/practice can be achieved in an MRI setting using
the table previously posted showing the time (and air exchanges) required
for the ventilation to dilute and clear possible airborne contaminates from
the room.

Negative ventilation did not come along in Australia until 1994 or later and
was one of a number of measures detailed in new CDC TB guidelines in
response to a resurgence of TB that occurred in the United States in the
mid-1980s and early 1990s, which included several healthcare associated
outbreaks related to an increase in the prevalence of TB disease and HIV
coinfection, lapses in infection control practices, delays in the diagnosis
and treatment of persons with infectious TB disease, and the appearance and
transmission of multidrug-resistant (MDR) TB.

Hence dilution processes/practices or cross ventilation in the absence of
ventilation systems (when natural breezes are given a pathway through the
room to the external environment) were the infection control management
strategies for TB prior to the early 90’s.

Cross ventilation is still practiced successfully in many developing
countries today where negative ventilation is prohibitive or ventilations
systems are not available.

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Sarah Bailey
Patients on Airborne Precautions

Hi Sharyn,

With regard to using the ventilation system of the procedure room as part of
the infection control measures, this is probably not possible, depending on
the set up of the system.

For a patient under airborne precautions, they would be cared for in a room
with negative pressure, to prevent infectious microorganisms entering the
rest of the ward. For Operating theatres and procedure rooms, these have to
be under positive pressure. This would mean that although the air changes
would be sufficient to clear any infectious organisms from the room, they
would be distributed to the rest of the hospital by air leaving the
procedure room. If the room only has an ordinary air-conditioning system,
this isn’t HEPA filtered and air is recycled, so this would also not be a
control method that could be used.

Regards,

Sarah Bailey MSc PGDip Med Myc

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Of Louisa Sasko

Hi Sharyn,

Many moons ago I use to work as an RN in Interventional Radiology department
of a Tertiary Hospital.

When working in the MRI unit, if a patient required Airborne precautions the
patient would wear a surgical mask when leaving their room on the ward until
they returned back to their room. This is in line with MoH policy.

The staff would wear the P2/N95 duckbilled mask inside the scanning room
with no trouble without altering the mask. The small aluminium strip didn’t
pose a problem.

The surgical mask didn’t pose a problem with artefact during brain scans.

Kind Regards

Louisa Sasko

Clinical Nurse Consultant | Infection Control & Physical Health Care

Mental Health Drug & Alcohol NSLHD

Macquarie Hospital

Tel (02) 9887 5479 | Fax (02) 9887 5678 | Mob 0422 005 640

Masters Candidate | Western Sydney University | School of Nursing

Conjoint Associate Lecturer | Western Sydney University | School of Medicine

Louisa.sasko@health.nsw.gov.au

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Of Glenys Harrington

Hi Sharyn,

I’m assuming the MRI procedure room itself had dedicated ventilation that is
not shared with other areas?

If so the patient can be managed in airborne precautions during the MRI
procedure and the patient does not need to wear a P2/N95 mask (which
contains metal).

After entering the room the patient can remove the mask and this can be
taken out of the room by staff who would be wearing a P2/N95 mask.

Once the procedure is completed the patient can be given another P2/N95 mask
for transfer back to their ward/unit. This is assuming that the patient can
tolerate P2/N95 mask.

If not then the same would apply if the patient was only able to wear a
surgical mask (which also has metal).

Depending on the ventilation air exchange per hour in the MRI room you would
also want to allow time for the ventilation to clear possible airborne
contaminates from the room (i.e. TB).

See Appendix B, Table B1 – Air change/hour and time required for airborne
contaminant removal efficiencies of 99% and 99.9%.

This table is in the from the USA Centers for Disease Control and Prevention
– Guidelines for Environmental Infection Control in Health-Care Facilities –
extract attached

Regards

Glenys

Glenys Harrington

Consultant

Infection Control Consultancy (ICC)

PO Box 5202

Middle Park

Victoria, 3206

Australia

M: +61 404 816 434

infexion@ozemail.com.au

ABN 47533508426

Of Sharyn Hughes
on Airborne Precautions

Dear All,

I am seeking responses (actual or hypothetical) in relation the possibility
of needing to MRI scan a patient on Airborne Precautions

. What processes are in place within your MRI departments for
patients on Airborne Precautions that require scanning?

. Do you know of any manufacturers that have P2/N95 mask that MRI
compatible

Looking forward to your responses

Sharyn

Sharyn Hughes

Acting Clinical Nurse Consultant |Infection Prevention & Control

Royal North Shore Hospital

Reserve Rd St Leonards 2065

Tel 02 99264490

Sharyn.Hughes@health.nsw.gov.au

Click here Infection Prevention and Control
to visit the IPAC webpage

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