Airborne Precautions and Personal Protective Equipment: The Powered Air-Purifying Respirator-Only Approach

Airborne isolation of patients and use of respirators are a foundational strategy to prevent transmission of pathogens like tuberculosis and novel respiratory viruses via airborne route in healthcare settings. Healthcare personnel respiratory protection programs utilize respirators, which may or may not require fit testing for each individual. This chapter reviews the different types of respirators, which include the more common N95 respirator masks and the somewhat less commonly used powered air-purifying respirators, and the levels of protection offered by each type. The chapter also reviews considerations and controversies regarding use of N95 respirators and PAPRs and situations when a PAPR-only approach might work. In each healthcare facility, the epidemiology and risk assessment of the facility, available evidence in published literature, and certain regulatory standards must inform the clinical policies, protocols, and procedures. Key unanswered questions and further areas for research are outlined.