工作场所储备呼吸器和口罩应对大流行性流感的建议指南

Proposed Guidance on Workplace Stockpiling of Respirators and Facemasks for Pandemic Influenza

关于工作场所储备呼吸器和口罩应对大流行性流感的建议指南

Introduction:

导言：

In the event of an influenza pandemic, employers will play a key role in protecting employees' health and safety as well as in limiting the impact on the economy and society. Employers will likely experience employee absences, changes in patterns of commerce and interrupted supply and delivery schedules. To further preparedness efforts, the Department of Labor (DOL) proposes to publish this information on stockpiling respirators and facemasks in occupational settings as an appendix to the DOL and the Department of Health and Human Services (HHS) jointly issued Guidance on Preparing Workplaces for an Influenza Pandemic (February 2007). This proposed guidance is designed to encourage employers in the private and public sectors to purchase and stockpile facemasks and respirators in advance of an influenza pandemic, because manufacturing capacity at the time of an outbreak would not meet the expected demand for respiratory protection devices during the pandemic. Through advanced planning and stockpiling, employers will be able to better protect their employees as well as lessen the impact of a pandemic on their business, society, and the economy.

在大流行性流感暴发的事件中，雇主在保护雇员健康和安全方面发挥着关键性的作用，同时，他们也会帮助抑制流感对经济和社会的影响。雇主很可能会遇到的问题包括，雇员无法上班，商业模式改变，和供给与交货计划受阻等问题。为进一步加强应对和准备，美国劳工部(DOL)建议发布本信息，建议在职业性设施中开展对呼吸器和口罩的储备工作，并以此作为劳工部与健康和人力服务部（HHS）共同发布的《关于工作场所准备应对大流行性流感的指南》（2007年2月）的一个附件。本指南旨在鼓励公共部门和私营机构的雇主，在大规模流感爆发之前，提前购买并储备呼吸器和口罩，原因是，大流行性流感爆发之初的呼吸防护用品的产能，将无法满足大流行流感爆发期间的产品需求。通过提前计划和储备，雇主将可以更好地保护其雇员，也可以减少流感对其商业、社会和经济的影响。

As is explained in more detail in this guidance, employers should consider stockpiling facemasks and respirators. More specifically, it is recommended that employees at very-high risk and high risk of exposure to pandemic influenza use respirators, while employees at medium risk of exposure use facemasks. Neither facemasks nor respirators are recommended for employees at lower risk of exposure to pandemic influenza.

按照指南中的详细说明，雇主应该考虑储备呼吸器和口罩。更加明确地讲，就是建议在大流行性流感爆发期间，面临极高风险和高风险暴露的雇员应使用呼吸器，面临中等风险的雇员应使用口罩，而建议低风险暴露的雇员则不需要使用呼吸器或口罩。

This guidance is advisory in nature and informational in content. It is not a standard or a regulation, and it neither creates new legal obligations nor alters existing obligations created by OSHA standards or the Occupational Safety and Health Act (OSH Act). Pursuant to the OSH Act, employers must comply with safety and health standards as issued and enforced either by OSHA or by an OSHA-approvedState Plan. In addition, Section 5(a)(1) of the OSH Act, the General Duty Clause, requires employers to provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. Employers can be cited for violating the General Duty Clause if there is a recognized hazard and they do not take reasonable steps to prevent or abate the hazard. However, failure to implement any specific recommendations in this guidance is not, in itself, a violation of the General Duty Clause. Citations can only be based on standards, regulations, or the General Duty Clause.

指南的内容是建议性的和提供信息性质的，不是标准或法规，既不会因此产生也不会改变雇主对OSHA标准或《职业安全健康法》（OSH Act）所负的指责义务。依据《职业安全健康法》，雇主必须遵循那些由OSHA，或由OSHA批准的国家计划中，所发出的并强制执行的安全健康标准，此外，《职业安全健康法》第5(a)(1)节，在“通用性责任条款”中规定，雇主必须向雇员提供安全的工作场所，工作场所应没有公认的，可危及生命的和导致重大人身伤害的危险。如果雇主未采取适当措施，防止和降低这些危险，“通用性责任条款”可以被引用，作为雇主违法的法律依据。然而，没有执行本指南所建议的任何具体措施，就其本身而言，并没有违反该“通用性责任条款”。法律条款的引用只适用于标准、法规和“通用性责任条款”。

 

Pandemic Influenza and the Workplace:

大流行性流感和工作场所：

For most employers, protecting their employees during an influenza pandemic will depend on emphasizing proper hygiene (cleaning hands and decontaminating surfaces) and practicing social distancing. Social distancing means reducing the frequency, proximity, and duration of contact between people (both employees and customers) to reduce the chances of spreading pandemic influenza virus from person-to-person. There are additional protective measures, including engineering changes, procedure changes, and the use of personal protective equipment, which employers and employees can implement based upon the occupational exposure risk profile of their job tasks in the work place. Use of respiratory protection (respirators) and barrier protection (facemasks) are components of a comprehensive plan to prepare workplaces for an influenza pandemic.

对绝大多数雇主而言，在大流行性流感期间，对雇员的保护将通过强调彻底的卫生（洗手和表面清洁）和实施人员隔离来完成。人员隔离意味着减少人与人之间（包括雇员间和与顾客间的）接触频率、接近程度和接触时间，降低人和人之间传播流感病毒的机会。此外，雇主和雇员还可以根据工作场所职业暴露风险的特点，采取其他保护措施，包括工程改进、流程改善和使用个人防护用品。使用呼吸防护（呼吸器）和阻隔保护（口罩），是在工作场所中应对大流行性流感的综合性计划的组成部分。

To assist employers in preparing for a pandemic, DOL and HHS have issued Guidance on Preparing Workplaces for an Influenza Pandemic. That document, referred to here as “Preparing Workplaces” provides information that employers and employees can use to evaluate their workplace and reduce the risk of being exposed to the pandemic influenza virus. DOL has also developed a guidance document to help healthcare employers protect their employees during an influenza pandemic: Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers can be found at http://www.osha.gov/Publications/3328-05-2007-English.html. It is important to note that in addition to occupational exposure risks, employees will also have non-occupational exposure risks. Such non-occupational exposure risks could include commuting to and from work on public transportation (e.g., bus or train) or other community exposures (e.g. shopping). By addressing non-occupational exposure risks, employers and employees can minimize the chances of an employee bringing illness into the workplace. Additional information on strategies to reduce community exposures to pandemic influenza can be found on www.pandemicflu.gov

为帮助雇主准备应对流感疫情，DOL和HHS制订了《关于工作场所准备应对大流行性流感的指南》。该文件，本文中简称为“工作场所准备”，向雇主和雇员提供了如何进行工作场所评价，降低大流行性流感病毒暴露的相关信息。DOL还为此专门制订了指导性文件，帮助医疗机构的雇主，在大流行性流感期间保护其雇员，即《关于医疗卫生雇员应对大流行性流感的准备和应急指南》，医疗机构的雇主可以在http://www.osha.gov/Publications/3328-05-2007-English.html网站获得此文件。需要提请注意的是，除了职业性暴露风险之外，雇员还会承受非职业性暴露风险。这种非职业性暴露风险包括，使用公共交通工具上下班（如公交车或火车），或其它社会性暴露（如购物）。通过关注这些非职业性暴露风险，雇主和雇员也能降低雇员将病毒带入工作场所的机会。更多有关降低大流行性流感的社会性暴露的策略性信息，可以通过www.pandemicflu.gov网站获得。

Employee risks of occupational exposure to influenza during a pandemic may vary from very high to high, medium, or lower (caution) risk. The level of risk depends in part on whether or not jobs require close proximity to people potentially infected with the pandemic influenza virus, or whether they are required to have either repeated or extended contact with individuals or groups.

在流感疫情暴发过程中，雇员的职业性流感暴露风险各不相同，从非常高到高，从中等到低等风险都有。风险水平的高低部分取决于雇员的工作是否需要紧密接触可能的感染人员，或是否需要他们反复地或长时间地和个体或人群进行接触。

Very high exposure risk occupations are those with high potential exposure to high concentrations of known or suspected sources of pandemic influenza during specific medical or laboratory procedures.

极高暴露风险的职业，是那些在特定的治疗和实验室操作过程中，极有可能和高浓度的确诊或疑似大流行流感传染源发生接触的人员。

High exposure risk occupations are those with high potential for exposure to known or suspected sources of pandemic influenza virus.

高暴露风险的职业，是那些极有可能和确诊的或疑似的大流行性流感传染源发生接触的人员。

Medium exposure risk occupations include jobs that require frequent, close contact (within 6 feet) exposures to known or suspected sources of pandemic influenza virus such as coworkers, the general public, outpatients, school children or other such individuals or groups.

中等暴露风险的职业，包括那些需要频繁地、近距离地（约2米距离以内）和确诊的或疑似的大流行性流感传染源发生接触的人员，如一起工作的人员、普通公众、门诊病人、学生或其他类似的个体或人群。

Lower exposure risk (caution) occupations are those that do not require contact with people known to be infected with the pandemic virus, nor frequent close contact (within 6 feet) with the public. Even at lower risk levels, however, employers should be cautious and develop preparedness plans to minimize employee infections.

低暴露风险（警戒性）的职业，是那些既不需要和大流行性流感患者直接接触，也不会与普通公众发生近距离（大约2米以内）接触的人员。即使是属于低暴露风险水平，雇主也应当时刻保持警戒，制订好相应的应对计划，尽最大努力减少雇员受到传染。

Employers of critical infrastructure and key resource employees (such as law enforcement, emergency response, or public utility employees) may consider upgrading protective measures for these employees beyond what would be suggested by their exposure risk due to the necessity of such services for the functioning of society as well as the potential difficulties in replacing them during a pandemic (for example, due to extensive training or licensing requirements).

重要基础设施的雇员和关键性劳动力资源（如执法、突发事件应急或公共设施的工作人员）的雇主，应考虑这类人员对社会功能运转的重要性，和在大流行性流感期间的难以替代性（如需要广泛的培训和对执业许可的要求），把对他们防护措施提高到常规风险暴露所需的水平以上。

To help employers determine appropriate work practices and precautions, OSHA has divided workplaces and work operations into four risk zones, according to the likelihood of employees' occupational exposure to pandemic influenza. We show these zones in the shape of a pyramid to represent how the risk will likely be distributed. The vast majority of American workplaces are likely to be in the medium exposure risk or lower exposure risk (caution) groups.

为帮助雇主判断如何正确执行和进行适当防范，OSHA按照雇员在大流行性流感期间所面临的职业风险，把工作场所和作业内容分作4个风险区域，用金字塔的形状来代表风险分布的可能性。在美国，绝大多数的工作场所都可能属于中级暴露风险和低级暴露风险（警戒）区域。

Occupational Risk Pyramid for Pandemic Influenza

表示大流行性流感期间的职业风险水平的金字塔

Very High Exposure Risk:

极高暴露风险：

Healthcare employees (for example, doctors, nurses, paramedics, or dentists) performing aerosol-generating procedures on known or suspected pandemic patients (for example, cough induction procedures, tracheal intubations, bronchoscopies, some dental procedures, or invasive specimen collection).

对确诊或疑似流感病人进行可产生气溶胶的治疗过程（如吸痰、气管插管、支气管镜检、某些牙科治疗，或采集咽拭子）的医护人员（如医生、护士、护理人员，或牙医）。

Healthcare or laboratory personnel collecting respiratory tract specimens from known or suspected pandemic patients.

采集确诊或疑似流感病人的呼吸道样本的医护人员或实验室工作人员。

High Exposure Risk:

高级暴露风险：

Healthcare delivery and support staff exposed to known or suspected pandemic patients (for example, doctors, nurses, and other hospital staff that must enter patients' rooms).

直接接触确诊或疑似流感患者的护理人员和辅助人员（如医生、护士和必须进入病房的医院的其它人员）。

Staff transporting known or suspected pandemic patients (for example, emergency medical technicians).

转运确诊或疑似流感病人的人员（如应急医疗专职人员）。

Staff performing autopsies on known or suspected pandemic patients.

从事确诊或疑似流感病人尸体解剖的人员。

Medium Exposure Risk:

中级暴露风险：

Employees with high-frequency contact with the general population (such as schools, high population density work environments, and some high volume retail).

直接与公众（如学校、人员密集的工作环境和某些客流量很大的零售网点）频繁接触的雇员。

Lower Exposure Risk (Caution):

低级暴露风险（警戒）：

Employees who have minimal occupational contact with the general public and other employees (for example, office employees).

与公众和其他雇员（如办公室雇员）有最低限度的工作性直接接触的雇员。

After discussing the relative advantages and disadvantages of respiratory protection options, we will propose guidance for estimating facemask and respirator usage during a pandemic for workplaces in each of these exposure risk zones.

经过讨论，在权衡各种呼吸防护措施的利弊之后，我们就流感疫病暴发期间，关于如何预测在不同暴露风险区域的工作场所使用口罩和呼吸器的问题，提出如下指导性建议。

 

Facemasks and Respirators:

关于口罩和呼吸器：

As employers evaluate their workplace, facemasks and respirators are the two types of protection that should be considered for use in occupational settings during an influenza pandemic. While the degree of protection offered by these devices in a pandemic environment is uncertain at this time, use of these devices during an influenza pandemic is a recommended part of a comprehensive strategy of personal protection.

雇主在评价工作场所的时候，应考虑在大流行性流感爆发期间，在工作环境中采用口罩和呼吸器这两类保护性措施。尽管我们对这类措施在大流行性流感期间所能提供的保护水平还不能非常确定，但我们仍然建议，在有关人员防护的综合性策略中，应把使用这些防护用品作为其中的一个组成部分。

Facemasks:

口罩：

Facemasks are used as a physical barrier to protect employees from hazards such as splashes of large droplets of blood or body fluids. Facemasks also prevent contamination by trapping large particles of body fluids that may contain bacteria or viruses when they are expelled by the wearer (for example, through coughing or sneezing). Facemasks are cleared by the FDA and are legally marketed in the United States for use in disease prevention. FDA-cleared masks have been tested for their ability to resist blood and body fluids. Facemasks are not designed or certified to prevent the inhalation of small airborne contaminants. The term “facemask” is used in this guidance to refer to Food and Drug Administration (FDA) - cleared surgical, medical, procedure, dental, laser and isolation masks.

口罩可作为一种物理性的屏障，可对雇员提供血液或体液飞沫的防护，口罩也能拦截使用者所排出的含有细菌或病毒的体液飞沫对环境的污染（如通过咳嗽或打喷嚏）。口罩是指经过FDA(美国食品药品管理局)的认证和批准，用于疾病预防的，在美国作为法定上市产品中的一类产品。FDA认证批准的口罩经过了测试，证明其具有阻隔血液和体液的能力。口罩的设计和认证不作为呼吸防护措施，不能提供针对微小的空气污染物的呼吸防护。本指南中所使用的口罩一词，专指经过FDA认证批准的一类医疗器械，即外科手术用的、医用的、治疗用的、牙医用的、激光治疗用的和隔离用的口罩。

Respirators:

呼吸器：

Respirators are used to reduce an employee's exposure to airborne contaminants. Most respirators are designed to fit the face and to provide a tight seal between the respirator's edge and the face. A proper seal between the user's face and the respirator forces inhaled air to be pulled through the respirator's filter material and not through gaps in the seal between the face and respirator. A “fit test” is necessary for most models of respirators because it is the only way to know for certain whether a proper seal can be established between the respirator and the user's face. The advantages and disadvantages of respirators as compared to facemasks are described in Table 1. In some workplaces, respirators will be an important component of protecting employees and allowing them to perform essential work, particularly work that may put them at greater risk for exposure to pandemic influenza. When the use of a respirator is necessary to protect employees from an occupational hazard, the respirator must be used in the context of a comprehensive respiratory protection program established by the employer (see OSHA standard 29 CFR 1910.134, or www.osha.gov/SLTC/respiratoryprotection/index.html).

呼吸器可用于降低雇员对空气污染物的暴露。绝大多数呼吸器的设计都具有和面部的适合性，保证呼吸器的边缘和脸部的紧密贴合。呼吸器和使用者脸部的密合能确保吸入气体都能经过呼吸器的过滤，不会通过呼吸器和脸部之间的缝隙泄漏进入呼吸道。绝大多数的呼吸器都必须依靠“适合性检验”，确认呼吸器和使用者面部能够密合，因为这是唯一的方法。表1 对使用呼吸器的利弊和口罩进行了对比。在某些工作场所，呼吸器将成为在大流行性流感期间，可以向面对极高风险的雇员提供保护，并保证他们从事重要工作的重要措施。当必须使用呼吸器保护雇员预防职业危害时，雇主必须建立全面的呼吸保护计划，对呼吸器的使用加以规范（参见OSHA标准29 CFR 1910.134, 或访问www.osha.gov/SLTC/respiratoryprotection/index.html网站)。

Air purifying respirators are the type of respiratory protection recommended to reduce exposure risk to pandemic influenza in certain occupational settings. Air purifying respirators can be divided into several types. Each of these is described below; Table 1 provides a comparison of these respirator types.

过滤式呼吸器是呼吸防护用品的一种类型。在某些职业性作业环境中，这类呼吸器被推荐作为降低流感暴露的呼吸防护措施。过滤式呼吸器分几个类别，下面分别作介绍。表1对这几类呼吸器也作了比较。

Disposable or filtering facepiece respirators are a type of respiratory protection in which the entire respirator facepiece is comprised of filter material. The most commonly used filtering facepiece respirator is made with material certified to meet the N95 filtration requirements. It is important to note that other National Institute for Occupational Safety and Health (NIOSH)-certified N-, R-, or P- filtering facepiece respirators (e.g., N99, R95, and P100) provide an equivalent or greater level of exposure reduction to airborne particulates as an N95 and can be used if N95s are not available. Some filtering facepiece respirators have an exhalation valve which can reduce breathing resistance, reduce moisture buildup inside the respirator and increase work tolerance and comfort for respirator users. However, respirators with exhalation valves should not be used when there is a need to protect others from possible contamination by the respirator wearer (e.g., a healthcare provider performing surgical or other sterile medical procedures or a person with known or suspected pandemic influenza who could transmit infection to others).

随弃式呼吸防护口罩是呼吸器的一种，呼吸防护口罩的面罩整体都是由过滤材料构成的。最常用的随弃式呼吸防护口罩，使用的是符合N95性能级别要求的过滤材料。有一点需要注意的是，如果无法获得N95级别的产品，美国国家职业安全健康研究所(NIOSH)认证的N-、R-或P-类随弃式呼吸防护口罩（如N99、R95和P100级别）都对空气中悬浮颗粒物具有与N95等效的甚至更高的防护水平。有些随弃式呼吸防护口罩还带有呼气阀，呼气时可以降低阻力，减少面罩内湿热空气的积聚，提高工作中呼吸器使用人员的耐受性和舒适性。然而，当需要保护其他人员免受呼吸器使用者可能产生的污染时（如进行外科手术的医护人员，或其他进行需要灭菌操作的人员，以及可能传染他人的确诊的或疑似的流感患者），则不应使用带呼气阀的呼吸器。

Surgical respirators are a type of respiratory protection designed for certain healthcare work environments that offers the combined protective properties of both a filtering facepiece respirator and a facemask. Surgical N95 respirators are certified by NIOSH as respirators and are also facemasks cleared by FDA as medical devices.

外科手术用呼吸防护口罩是呼吸器的一种，专门为某些医疗环境下的使用而设计，综合了随弃式呼吸防护口罩和外科口罩的防护功能，医用N95级呼吸器由NIOSH认证批准，可作为呼吸器使用，同时由FDA认证批准，作为医疗器械使用。

Reusable elastomeric respirators are a type of respiratory protection that has a flexible, rubber-like facepiece with either permanent or removable filter cartridges. The facepiece can often be cleaned, repaired and reused, and the filter cartridges can be discarded and replaced when they become unsuitable for further use. Other elastomeric respirators with permanent filter cartridges are designed to be disposed of when the cartridges need to be replaced.

可重复使用式呼吸器面罩是一种有弹性的，通常为橡胶材质的面罩，可以使用固定的或可更换的过滤元件。面罩可以经常清洗、维护和重复使用，过滤元件在不适合使用时可以更换。而有些设计成与过滤元件固定式组合的橡胶面罩，会在过滤元件需要更换时一起废弃。

Powered air purifying respirators (PAPRs) are a type of respiratory protection in which a battery-powered blower pulls air through filters that trap particles (including those containing viruses and bacteria) that may be present, and then moves the filtered air to the wearer's facepiece or hood. PAPRs are significantly more expensive than other air purifying respirators but they provide higher levels of protection against airborne particulates. It should also be noted that there are hooded PAPRs that do not require employees to be fit tested in order to use them. Additionally, a PAPR blower unit and battery can be shared by employees (who need protection at different times) who can each have their own reusable hood. A PAPR could be assigned to an individual person, to a staff position (e.g. a floor nurse position staffed by several employees over the course of a week), or to a location such as a treatment room or mobile treatment cart used for aerosol-generating medical procedures. Consequently, several approaches can be used to limit the number of PAPRs that an employer would purchase for pandemic preparedness, as long as proper decontamination procedures are followed between uses or users.

电动送风过滤式呼吸器（PAPR）是过滤式呼吸器的一种，利用电池驱动风机迫使空气通过过滤元件过滤，空气中存在的颗粒物（包括那些含有病毒、细菌的颗粒物）被过滤元件捕获，过滤后的空气被送入面罩或头罩内供使用者呼吸。一套PAPR的价格会比其他呼吸器要高，但PAPR对空气中的颗粒物可提供更高等级的防护。需要注意的， PAPR呼吸器使用的软头罩不需要使用者在使用前进行适合性检验，此外，PAPR系统中的风机和电池部件可与其他使用者共享（在不同时间内使用），每个人各自使用自己的可重复使用的软头罩。一套PAPR可分给个人使用，或给某个岗位使用（例如：一个负责某楼层服务的护士岗位，一周内由数人轮岗），或给某个工作地点使用，如一个治疗室，或流动治疗车，用于会产生气溶胶的治疗过程。由此可见，在应对流感疫情时，可以采取不同方法降低雇员需要PAPR的数量，只要有正确的消毒措施保障交接产品的卫生即可。

 

Replacing Disposable Respirators:

随弃式呼吸防护口罩的更换：

Disposable respirators are designed to be disposed after use. Once worn in the presence of an infectious individual, the respirator should be considered potentially contaminated with infectious material. Touching the outside of the device should be avoided to prevent self-inoculation (touching the contaminated respirator and then touching one's eyes, nose, or mouth). It should be noted that a once-worn respirator will also be contaminated on its inner surface by the microorganisms present in the exhaled air and oral secretions of the wearer.

随弃式呼吸防护口罩设计为使用后即可废弃。一旦用于存在传染源的情况下，使用后的口罩应被视为已被潜在的传染源污染，应避免接触面罩的外表面，防止自我传染（先接触受污染的呼吸器，然后再接触眼睛、鼻子或嘴）。需要注意的是，佩戴过一次的呼吸器的内表面也会被佩戴者呼出的空气及唾液中的微生物所污染。

In the above scenario, users should discard respirators when they become unsuitable for further use due to excessive breathing resistance (e.g., particulate clogging the filter), unacceptable contamination/soiling, or physical damage. In the context of pandemic influenza, some have proposed reusing disposable respirators for prolonged periods of time (e.g., weeks or months) in the event supplies are limited. However, data on decontamination and/or safe reuse of respirators for infectious diseases are currently not available. Although filtering facepiece respirators have been reused during public health crises in resource-limited settings, the safety and efficacy of this approach has yet to be confirmed. It is not possible to give definitive guidance on the safety or efficacy of reuse or decontamination of disposable respirators. In the interim, plans should be based on single use of equipment according to manufacturers' instructions, FDA label claims, and NIOSH user instructions. Respirator users should not attempt to decontaminate filtering facepiece respirators as it may create a health hazard for the user and it may render the respirator ineffective in providing respiratory protection. Reuse may increase the potential for contamination through contact transmission. The risk of contaminating the inside of the respirator through improper handling must be weighed against the need to provide respiratory protection.

按照上述假设，使用者应该在呼吸器不适合继续使用时把它废弃掉，这可能是由于呼吸阻力明显增大（如因为滤料被颗粒物堵塞），或因为呼吸器受到了不可接受水平的污染/玷污，或出现破损。对于流感疫情的防护，有人曾建议重复使用随其式呼吸防护口罩，延长使用时间（例如延长至几周或几个月），以应付货源紧张的问题。然而，目前并没有关于在预防传染病情况下对呼吸防护口罩进行消毒，和/或可安全地重复使用呼吸防护口罩的有关资料，尽管随弃式呼吸防护口罩曾经因货源紧张，在公共卫生突发事件中被重复使用过，但是这种做法的安全性和有效性仍未被证实，对重复使用随弃式呼吸防护口罩，或对其消毒的安全性和有效性，是不可能给出确定的指引意见的。在这个期间，制订应急计划时，雇主仍然需要依据制造商的使用说明、FDA标签的声明和NIOSH的使用指引，一次性使用随弃式呼吸防护口罩。使用者不应试图对随弃式呼吸防护口罩进行消毒，这样不仅会对使用者构成健康危害，也会使呼吸器的防护失效，重复使用还会带来接触传染的潜在风险，因此要在不当操作造成的呼吸器内部污染，与提供呼吸防护之间加以权衡。

Thus, in preparing for an influenza pandemic, employers who anticipate providing respiratory protection to employees for the duration of the pandemic could instead consider using reusable respirators that are designed to be cleaned, repaired and reused. Information on proper cleaning and maintenance of respirators (both elastomeric respirators and PAPRs) is model specific and provided by the manufacturer as part of the NIOSH-certified user instructions. Purchasing reusable respirators also may reduce or eliminate the impact of potential shortages of filtering facepiece respirators and may be more cost effective over the duration of the pandemic. If an employer chooses to use reusable elastomeric respirators, the employer should take into account the initial training needed to teach employees how to properly clean such respirators as well as the time needed for employees to clean the respirators after use.

因此，在应对流感疫情的计划准备中，那些计划向雇员提供呼吸防护的雇主，可以选择考虑使用可更换式呼吸器来代替使用随弃式呼吸防护口罩。可更换式呼吸防护面罩设计可被清洗、维护和重复使用。清洗和保养这类呼吸器（包括呼吸器橡胶面罩和PAPR）的方法因产品型号不同而不同，制造商在NIOSH认证的使用说明中都提供了具体的方法。购买可更换式呼吸器不仅可以降低或消除随弃式呼吸防护口罩因货源不足造成的潜在影响，而且在流感爆发期间使用时还会更经济。如果雇主选择使用可更换式橡胶呼吸器面罩，雇主应考虑前期培训的需要，要培训雇员如何正确清洗呼吸器，以及应在使用多长时间后清洗。

 

Replacing Elastomeric Respirator and PAPR Filters:

关于可更换式呼吸器和PAPR过滤元件的更换：

In the case of elastomeric respirators and PAPRs, the respirator body and PAPR case is designed to be decontaminated and reused in accordance with the manufacturer's use instructions. If the filters are used in an environment where pandemic influenza is the sole air contaminant of concern, then the filters should last a long time if they are not physically damaged or soiled and are handled appropriately to control risk of contamination. In most workplaces, two to three filter sets should last for the duration of the pandemic. However, in certain work environments where there is a significant potential for physical damage or soiling of the filters (e.g., with blood or body fluids), employers may want to stockpile additional filter sets to ensure adequate protection of their employees for the duration of a pandemic.

在使用可更换式呼吸器橡胶面罩和PAPR的情况下，呼吸器本体和PAPR本体的设计允许根据制造商的使用说明消毒，并可重复使用。在过滤元件只被用于流感病毒为唯一污染物的情况下，在没有损坏或玷污，并采取了正确的操作方法控制污染风险的前提下，过滤元件可以使用很长时间。在大多数的工作场所，两到三套过滤元件就应该能满足整个流感流行期间的防护需要。然而，在某些工作环境中，过滤元件则很容易被损坏或玷污（例如受到血液或体液的污染），雇主应为这类雇员储备更多的过滤元件，确保在整个流感流行期间雇员有足够的防护。

The following table summarizes the forgoing information about the advantages and disadvantages of facemasks and of the specific types of respirators previously described, as well as providing rough cost estimates. Employers may find this summary helpful in considering purchasing options for fulfilling the specific recommendations addressed in the remainder of this guidance.

在下面这个表中，对前面描述的不同类型的呼吸器的优缺点进行了简要汇总，并作了粗略的使用费用估算。雇主会发现，这个表对选择储备产品类别，并满足本指南文件后面提出的具体建议要求是非常有帮助的。

Table 1: Advantages and Disadvantages of Respirators and Facemasks

表1：呼吸防护口罩和口罩优缺点对比

防护装置	单价*	优点	缺点
口罩	0.12~0.20美元	降低大的飞溅液滴的暴露风险； 经过防体液喷溅测试； 比佩戴呼吸器呼吸阻力低。	不能降低可吸入性微小颗粒物的暴露； 不能清洗，流感爆发期间可能供应不足； 设计不与面部紧密密合。
N95级呼吸防护口罩（随弃式呼吸防护口罩）	0.50~1.20美元	降低可吸入性微小颗粒物和大的飞溅液滴的暴露风险； 设计能与使用者面部紧密密合； 过滤效率经过认证。	不能清洗，在流感爆发期间可能供应不足； 必须进行适合性检验以确保正确防护； 在有面部毛发，破坏面部与面罩之间的密合时，不能使用； 呼吸阻力比口罩大； 设计并非用于外科手术。
N95级呼吸防护口罩，带呼气阀（随弃式呼吸防护口罩）	1.30~3.00美元	降低可吸入微小颗粒物和大的飞溅液滴的暴露风险； 设计能与使用者面部紧密密合； 过滤效率经过认证； 对于没有呼气阀的呼吸防护口罩而言，呼气阀使呼气阻力降低，并减少面罩内湿气的积聚。	不能清洗，在流感爆发期间可能供应不足； 必须进行适合性检验以确保正确防护； 在有面部毛发，破坏面部与面罩之间的密合时，不能使用； 呼吸阻力比口罩大； 当需要保护其他人不被佩戴者传染时不能使用。 设计并非用于外科手术
医用呼吸防护口罩（随弃式呼吸防护面罩	1.00~1.10美金	降低可吸入微小颗粒物和大的飞溅液滴的暴露风险； 设计能与使用者面部紧密密合 过滤效率经过认证； 经过防体液喷溅、生物适应性和阻燃测试。	不能清洗，在流感爆发期间可能供应不足 必须进行适合性检验以确保正确防护 在有面部毛发，破坏面部与面罩之间的密合时，不能使用； 呼吸阻力比口罩大 相对于其他随弃式呼吸防护口罩，货源非常有限。
可更换式呼吸器橡胶面罩	面罩：10~40美元 过滤元件 2~10美元	降低对可吸入微小颗粒物和大的飞溅液滴的暴露； 设计能与使用者面部紧密密合； 过滤效率经过认证； 可以清洁和重复使用，可降低/消除N95呼吸防护口罩短缺的潜在性影响； 较高的初始投入成本，但长期使用会比随弃式呼吸防护口罩经济； 经过清洁之后，呼吸器可以提供其他人使用； 全面罩呼吸器同时提供眼睛防护； 全面罩呼吸器提供的防护水平高于半面型呼吸器。	必须经过适合性检验确保正确防护； 在有面部毛发，破坏面部与面罩之间的密合时，不能使用； 呼吸阻力比口罩大； 可能影响语言沟通效果； 每次使用后需要清洗和消毒； 当需要保护其他人不被佩戴者传染时不能使用。
电动送风过滤式呼吸器	PAPR： 400~1200 美元 备用充电电池：120~200美元 额外的头罩：75~100美元 过滤元件 20~35美元	降低可吸入性微小颗粒物的暴露； 比随弃式呼吸防护口罩和可更换式呼吸器橡胶面罩提供的防护水平更高； 过滤效率得到认证检测； 可以清洁和重复使用，可降低/消除N95呼吸防护口罩短缺的潜在性影响； 使用软头罩的PAPR呼吸器不需要适合性检验，允许使用者在面部有毛发的情况下使用； 过滤元件可更换； 使用全面罩的设计还同时提供眼睛的防护。	比其他呼吸器价格明显偏高； 电机和电池通常佩戴在腰上（0.7~1.4公斤重）； 某些设备的风扇噪声有可能较高，影响医护人员的沟通和护理； 每次使用后要清洁和消毒； 当需要保护其他人不被佩戴者传染时不能使用。
Device	Unit Cost*	Advantages	Disadvantages
Facemasks	$0.12-0.20	• Reduces exposure to splashes of large droplets. • Tested for fluid resistance. • Easier to breathe through than a respirator.	• Does not reduce exposure to small inhalable particles. • Cannot be decontaminated, may be shortages during a pandemic. • Not designed to form a seal to the face.
N95 respirator (filtering facepiece)	$0.50-1.20	• Reduces exposure to small inhalable particles and large droplets. • Designed to form a tight seal to the face. • Filtration efficiency certified.	• Cannot be decontaminated, may be shortages during a pandemic. • Must be fit-tested to assure full protection. • Cannot be worn with facial hair that interferes with the seal between the face and respirator. • Harder to breathe through than a facemask. • Not designed to be used in surgery.
N95 respirator w/ exhalation valve (filtering facepiece)	$1.30-3.00	• Reduces exposure to small inhalable particles and large droplets. • Designed to form a tight seal to the face. • Filtration efficiency certified. • Exhalation valve makes it easier to exhale and reduces moisture buildup inside the facepiece compared to other filtering facepiece respirators.	• Cannot be decontaminated, may be shortages during a pandemic. • Must be fit-tested to assure full protection. • Cannot be worn with facial hair that interferes with the seal between the face and respirator. • Harder to breathe through than a facemask. • Should not be used when others must be protected from contamination by the wearer. • Not designed to be used in surgery.
Surgical respirator (filtering facepiece)	$1.00-1.10	• Reduces exposure to small inhalable particles and splashes of large droplets that would require a facemask. • Designed to form a tight seal to the face. • Filtration efficiency certified. • Tested for fluid resistance, biocompatibility, and flammability rated.	• Cannot be decontaminated, may be shortages during a pandemic. • Must be fit-tested to assure full protection. • Cannot be worn with facial hair that interferes with the seal between the face and respirator. • Harder to breathe through than a facemask. • Limited availability compared to other filtering facepiece respirators.
Elastomeric respirator (flexible, rubber-like facepiece)	Facepiece $10-40   Filters $2-10	• Reduces exposure to small inhalable particles and large droplets. • Designed to form a tight seal to the face. • Filtration efficiency certified. • Can be decontaminated & reused, can reduce/eliminate the impact of potential N95 shortages. • Higher initial cost, but may be more cost effective than filtering facepieces for longer term use. • Filters are replaceable. • After decontamination, respirators can be used by different individuals. • Full facepiece type provides eye protection. • Full facepiece type provides a higher level of protection than a half facepiece type.	• Must be fit-tested to assure full protection. • Cannot be worn with facial hair that interferes with the seal between the face and respirator. • Harder to breathe through than a facemask. • May interfere with voice communication. • Requires cleaning and disinfection between uses. • Should not be used when others must be protected from contamination by the wearer.
Powered Air-Purifying Respirator (PAPR) (head/face covering with battery powered blower unit)	PAPR $400-1,200   Spare battery $120-200   Extra hood $75-100   Filters $20-35	• Reduces exposure to small inhalable particles. • Provides greater level of protection than filtering facepiece or elastomeric respirators. • Filtration efficiency certified. • Can be decontaminated & reused, can reduce/eliminate the impact of potential N95 shortages. • Hooded PAPRs do not need to be fit tested and can be worn with facial hair. • Reduces/eliminates breathing resistance and moisture buildup inside the facepiece/hood. • Filters are replaceable. • After decontamination, PAPRs can be used by different individuals. • Full facepiece type provides eye protection	• Significantly more expensive than other respirators. • Blower unit/battery typically worn on belt (weighs 1.5-3 lbs.). • On some units, fan noise can make communication and medical care delivery more difficult. • Requires cleaning and disinfection between uses. • Should not be used when others must be protected from contamination by the wearer.

* Cost estimates are current as of publication and intended only for planning purposes. Actual pricing will vary depending on the make, model and quantity of respiratory protection devices selected.

对产品费用的估计以当前公开的资料为依据，仅供计划编制使用。产品实际价格会随呼吸器的品牌、型号和购买数量的不同而有所不同。

Estimating Employee's Occupational Exposure Status:

对雇员职业暴露状况的评估：

The best method for assessing the number of employees at risk of occupational exposure and their particular level(s) of risk is for the employer to evaluate the workplace and develop a site-specific pandemic influenza plan. Then, the employer should assess the occupational exposure risk for each job classification and specific work tasks (for example, aerosol-generating medical procedures). Once an employer has classified jobs and tasks into very high, high, medium, and lower exposure risk categories, she/he should then estimate the number or percentage of employees who fall into each category.

预测存在职业暴露危险的员工人数及其具体的暴露水平的最佳方法，是由雇主对工作场所进行评估，并制订出针对具体场所的流感爆发应对计划。然后，雇主应该评价每个工种和具体工作任务的职业暴露危险（如，产生气溶胶的治疗过程）。一旦雇主将某项工作和任务划分为极高、高、中和低等暴露风险区，然后去估计属于每个风险等级下雇员的人数或百分比。

For example, not all hospital-based healthcare workers provide direct patient care. In addition changes in work practices during a pandemic (such as the cohorting or grouping of patients with pandemic influenza to reduce the number of healthcare workers and non-pandemic patients who may be exposed to pandemic patients) may further affect the number of persons with high risk exposures. In addition, a single employee may at times be at low risk whereas at other times they may have medium or high risk exposures. For example, a law enforcement officer's risk would be different when patrolling in a car (low risk), interacting with persons in the community (medium risk) or transporting someone who may be ill with pandemic influenza (high risk).

举例来说，并不需要所有院内的医护人员都去直接护理病人，而在流感爆发期间，调整工作模式，开可进一步影响属于高暴露风险的人数（比如，将流感病人适当安排在同一病房内，可降低医护人员和非流感病人接触流感病毒的潜在风险）。另外，还应该注意到，一个雇员可能有时处于低风险区域，有时又处于中等或高风险区域，如执法人员在开车巡逻期间（低风险），在接触社区人员期间（中等风险），或在，运送流感疑似病人（高风险）期间，其面临的暴露风险是不同的。

 

Respirator and Facemask Planning Assumptions:

编制呼吸器和口罩使用计划的假设条件：

We recognize that the number of employees with occupational exposure is difficult to predict because of uncertainty of the size or scale of an influenza pandemic. However, using the assumptions listed below, Table 2 provides rough estimates of the percentage of employees potentially exposed to pandemic influenza and their potential respiratory protection needs for some specific occupational sectors.

我们意识到，由于大流行性流感爆发的范围和等级存在一些不确定性，对存在职业暴露风险的雇员人数进行评估是件困难的工作。然而，通过使用下述假设，对某些存在流感暴露可能性，需要呼吸防护的特定职业人群，表2中提供了一个雇员的百分比的粗略估计。

Employers and employees should plan for a pandemic assuming community mitigation interventions (e.g., isolation of cases, voluntary quarantine of case household members, potentially closing schools and canceling other public gatherings, and social distancing) are effective at reducing the pandemic illness rate in communities to about 15%. A mitigated pandemic is currently expected to occur in two waves; community outbreaks in each wave would each last up to 12 weeks in duration (24 weeks total). There are assumed to be five work days per week and thus 120 work days per employee over the two pandemic waves.

雇主和雇员应准备在流感爆发期间，采取减少人群接触的干预性措施（例如：对发病人员的隔离，发病人员的家属的主动隔离，停课，取消其它公众集会和采取社会隔离措施等），这样做可以将发病的可能性降低大约15％。在目前的情况下，我们预期，得到减缓的流感爆发会有两个发病期，每次在当地爆发时，发病期最多会持续12周(共计24周)。假定每周5个工作日，则在这两个发病期间，每名雇员会有120个工作日。

If pandemic vaccine is available and used, an employee's vaccination status will not modify recommendations for the use of respirators and facemasks because vaccines may not be completely effective and will not be available in large supply at the start of a pandemic.

即使有流感疫苗，并接种了疫苗，对雇员使用呼吸器和口罩的建议也不会改变，因为疫苗可能并不完全有效，此外，在流感爆发初期，疫苗可能因短缺而无法获得。

Respirators and facemasks will only be used by employees during pandemic waves in their local community/state and not between pandemic waves, and only during work tasks where they might be exposed to people who are or might be ill with pandemic influenza.

雇员将只需要在当地发生流感爆发的期间使用呼吸器和口罩，在爆发的间歇期不需要使用，并且只有当雇员工作中有可能接触携带或可能携带流感病毒的人群时才需要使用。

These same planning assumptions underlie the estimates of respirator and facemask usage for planning and stockpiling purposes provided in the subsequent sections of this proposed guidance.

所有上述计划性假设，都在下面介绍的制订防护用品储备计划中，作为估算呼吸器和口罩使用量的基础。

表2：对呼吸器和口罩储备量的评估

职业性工作场所	属于中级暴露风险以上雇员的比例	每名雇员每个工作班所需呼吸器或口罩的数量		每名雇员在流感爆发期需要呼吸器和口罩的数量 （按120个工作日计算）
		N95呼吸器（极高和高等风险人群）	口罩（中等风险人群）	N95呼吸器（极高和高等风险人群）	口罩（中等风险人群）
医疗卫生机构： 医院注1 门诊/诊所 长期护理 家庭护理 应急医疗服务	33% 67% 25% 90% 100%	4注2 4 1 2 8	0 0 3 4 0	480 480 120 240 960	0 0 360 480 0
应急反应： 执法 处罚 消防局（非应急服务服务、事业人员和志愿者）	90% 90% 90%	2 1 2	2 3 2	240 120 240	240 360 240
中等风险雇员	参见注释注3	0	2	0	240

Table 2: Stockpiling Estimates for Respirators and Facemasks

Occupational setting	Proportion of medium or higher risk employees	Number of respirators or facemasks per employee per work shift		Number of respirators or facemasks per employee for a pandemic (120 work days)
		N95 Respirators (high or very high risk)	Facemasks (medium risk)	N95 Respirators (high or very high risk)	Facemasks (medium risk)
Healthcare Hospital1 Outpatient office/clinic Long term care Home healthcare Emergency medical services	33% 67% 25% 90% 100%	42 4 1 2 8	0 0 3 4 0	480 480 120 240 960	0 0 360 480 0
First responders Law enforcement Corrections Fire department (non-EMS, career and volunteer)	90% 90% 90%	2 1 2	2 3 2	240 120 240	240 360 240
Medium risk employees	See Note3	0	2	0	240

Note 1. In hospital settings, it is expected that known or suspected pandemic influenza patients will be cohorted (i.e., pandemic patients share rooms only with others pandemic patients in order to reduce the exposure risk to non-pandemic patients; cohorting patients may also include designating specific areas such as a hospital floor or wing for pandemic patient care). Through the cohorting of patients, hospitals are also expected to reduce the number of healthcare providers and support staff who might be exposed to pandemic influenza and thus reduce the number of employees who will need respirators.

注1：在医疗卫生设施内部，预期会将确诊的或疑似流感病人进行分别隔离（也就是说，流感病人只与其他的流感病人同住一个房间，以减少非流感病人的暴露；还可将隔离病区设定在指定的区域，如划出单独的一个楼层，或大楼一侧的区域，专门作为流感病人的护理场所）。通过病区隔离，医院也可减少暴露于流感病毒环境的护理人员和后勤人员的数量，因而减少需要使用呼吸器的人员数量。

Note2. Four respiratory protection devices per shift is the estimate used for most healthcare and emergency response settings where employees are in contact throughout the shift with pandemic influenza patients. For example, employees might use one respirator from the start of the shift until a mid-morning break, a second respirator from the break until lunch, a third respirator from lunch to a mid-afternoon break, and the fourth respirator from the mid-afternoon break until the end of the work shift. If the work flow is not conducive to regular breaks, it may be necessary to modify the estimates used to determine stockpiling recommendation. In the following sections, formulas are provided to calculate respirator stockpiling needs for very high and high exposure risk employees. These formulas can adapted to a specific workplace by substituting estimates of daily respirator needs that are tailored to the work flow and schedule in your place of employment.

注2: 对大多数医疗服务和应急反应机构的雇员而言，他们在整个工作班期间都会与流感病人接触，因此在使用量估计中按照每个工作班使用4个呼吸器计算。例如，雇员可能从上班开始使用第一个呼吸器，一直到上午的午间休息为止，从上午午间休息后到午饭前的时间内使用第二个呼吸器，从午饭后到下午的午间休息之前使用第三个呼吸器，再从下午午间休息到下班的期间使用第四个呼吸器。如果工作的流程不允许定时休息，那么在储备量估算时就有必要修改估算方法。在下面，我们提供了一些计算公式，可用来计算极高风险区域和高级风险区域的雇员对呼吸器储备量的需要。大家也可以用这些公式对其他特定的工作场所进行估算，只需要按照雇员的实际的工作流程调整呼吸器的日常需要量即可。

Note 3. Includes employees in various retail and other settings where frequent and close contact with other people, whose pandemic infection status is unknown, is unavoidable. The purpose of this estimate is for purchasing and stockpiling of respirators and facemasks. During an actual pandemic the distribution of employees exposed at each risk level, and the distribution of respirators and facemasks necessary to protect employees will likely be less at the beginning and end of a pandemic wave and greater during the middle of a wave. These estimates are intended to provide an average over the duration of the pandemic in the absence of a work site-specific pandemic influenza plan.

注3：由于普通人群感染状况未知，有些雇员在工作中又不可避免地需要和他们接触，因此，这里包括了各种零售业或其他需要频繁近距离接触普通人群的雇员。进行估算的目的是为采购/储备呼吸器和口罩进行准备。当流感实际爆发时，在爆发初期和末期阶段，分属不同风险级别的雇员分布的数量，以及用于保护雇员健康的呼吸器和口罩的分发量通常会比较低，而在爆发高峰期，这两个数子则会比较高。而这里的估算，只对整个流感爆发期间采用了一个平均的消耗量，还缺少针对每个具体作业点的流感应对计划。

 

Estimating Respirator Usage in Workplaces Classified at Very High Exposure Risk for Pandemic Influenza:

对属于大流行性流感极高暴露风险的工作场所呼吸器使用量的估算：

Employees Covered:

适用的雇员范围：

Healthcare employees performing aerosol-generating procedures on known or suspected pandemic influenza patients; and Healthcare or laboratory personnel collecting respiratory tract specimens from known or suspected pandemic influenza patients.

那些需要对确诊或疑似流感病人实施可产生气溶胶的医疗救治过程的医护人员;和采集确诊或疑似流感病人呼吸道标本的医护人员或实验室人员。

Respirators are recommended to protect healthcare workers performing aerosol-generating medical procedures on patients known or suspected to be infected with pandemic influenza as well as certain laboratory personnel. Although a reduction in the level of exposure can be provided by a filtering facepiece respirator (e.g., N95, N95 surgical respirator), a reusable elastomeric respirator or a powered air purifying respirator (PAPR) will provide a further reduction in the level of exposure.

对那些需要对确诊或疑似感染患者实施产生气溶胶的治疗的医护人员，以及一些实验室人员，建议采用呼吸器进行呼吸防护。尽管使用随弃式呼吸防护口罩（如N95，医用N95口罩）可以降低暴露水平，但使用可更换式呼吸器橡胶面罩或PAPR却能更进一步地降低暴露水平。

If using disposable N95 or surgical respirators for aerosol-generating medical procedures, healthcare institutions should estimate the total number of such procedures that the facility might reasonably expect to perform during in a severe pandemic and the average number of employees involved in each procedure. Employers should plan on stockpiling:

若在产生气溶胶的治疗过程中使用随弃式N95呼吸防护口罩或医用呼吸防护口罩，各医疗机构应事先做一个合理的预估，看在一个严重的流感爆发期内，本单位可能会有多少数量的这类治疗会发生，以及每次治疗现场会需要多少人员，然后制订储备计划：

1 N95 respirator per employee per aerosol-generating procedure.

每个雇员在每次产生气溶胶的治疗过程中需要1个N95呼吸防护口罩。

If using elastomeric respirators for aerosol-generating medical procedures, healthcare institutions should estimate:

若使用可更换式呼吸器橡胶面罩用于产生气溶胶的治疗过程，医疗机构应按下述方法对使用量进行估算：

1 elastomeric respirator with 3 or more sets of filters per employee, depending on frequency of use.

根据使用频率的不同，1个可更换式呼吸器橡胶面罩需配至少3套过滤元件。

If using PAPRs for aerosol generating medical procedures, healthcare institutions should estimate:

若使用PAPR用于产生气溶胶的治疗过程，医疗机构应按下述方法对使用量进行估算：

The number of patients on which aerosol-generating medical procedures might reasonably be expected to be performed at a given time (e.g., number of treatment rooms or mobile treatment carts).

对于产生气溶胶的治疗过程，合理估计在给定的时间段内，预期可以处置的病人数目（如，治疗室数量或流动治疗车数量）。

The maximum number of healthcare workers (HCWs) expected to be involved in the aerosol-generating medical procedure (for example, four healthcare workers might be involved in the procedure – a treating physician, a nurse, an anesthesiologist, and a respiratory therapist).

对每个会产生气溶胶的治疗过程，预估所需的医务人员（ HCWs ）的最大数量（如共需4个医务人员共同参与——一名外科医生、一名护士、一名麻醉师和一名呼吸科医师）。

For example:

举例：

1 patient/treatment room X 4 HCWs/patient = 4 PAPRs per treatment room + 4-8 sets of filters per PAPR (changing filters every 15-30 pandemic work days, depending on frequency of use).

1名病人/治疗室× 4 HCWs /病人= 4 PAPRs/治疗室+ 4~8套过滤元件/PAPR（一般每15~30个流感爆发期工作日需要更换一次过滤元件，但使用频率会有不同。）。
When PAPRs are used in the workplace, it is possible for several employees to share a single PAPR blower unit and battery. For example, if a hospital employs 5 healthcare workers to provide continuous coverage of a single staff position (e.g., a nurse) over the course of a week, they might purchase 1 blower unit, 2 batteries (one is a spare for recharging while other is in use), and 5 reusable hoods in order to protect the 5 employees.

如果使用PAPRs，几个雇员是有可能共享一套PAPR电机和电池的。例如，如果一个医院聘请5名医护人员，由他们在一周的时间内轮班做一个职位（如护士），那么他们可以只购买1个电动风机， 2个电池（一个作为备用，在另一个电池使用期间进行充电），及5个可重复使用的头罩，供5名雇员进行呼吸保护。

Note: PAPRs and elastomeric respirators may also be used for other patient care activities normally covered under the high risk section of this document.

注：PAPRs和可更换式呼吸器橡胶面罩也可以用于其他的，被本指南划分为高风险暴露的护理活动中

 

Estimating Respirator Usage in Workplaces Classified at High Exposure Risk for Pandemic Influenza:

对属于大流行性流感高暴露风险工作场所呼吸器使用量的估算：

Employees Covered:

涉及的雇员范围：

Healthcare delivery and support staff working closely with (either in direct contact or within 6 feet of) people known or suspected to be infected with pandemic influenza virus.

直接接触，或近距离接触（距离大约2米以内）确诊或疑似流感患者的护理人员和辅助人员。

Staff transporting patients who are known or suspected to be infected with pandemic influenza virus (for example, emergency medical technicians).

转运确诊或疑似流感病人的人员（如应急医疗专职人员）。

Staff performing autopsies on known or suspected pandemic patients.

从事确诊或疑似流感病人尸体解剖的人员。

Respirators are recommended to protect employees working closely with people/patients known or suspected to be infected with pandemic influenza. Such protection can be accomplished by a disposable filtering facepiece (e.g., N95, surgical respirator), a reusable elastomeric respirator or a powered air purifying respirator (PAPR).

建议使用呼吸器来保护需密切接触确诊或疑似流感病毒感染者的雇员。防护措施可以是随弃式呼吸防护口罩（比如N95呼吸防护口罩，医用呼吸防护口罩），可更换式呼吸器橡胶面罩，或电动送风过滤式呼吸器（PAPR）。

If using disposable N95 or surgical respirators to protect healthcare delivery and support staff, employers should plan for:

如果使用随弃式N95呼吸防护口罩，或使用医用呼吸防护口罩保护病人护理和辅助性人员，雇主应该计划如下：
4 N95s/HCW/shift X 120 pandemic workdays = 480 N95s per exposed HCW.

4 个N95/人/班次 × 120流感爆发期工作日= 480 个N95/ 人。
If using disposable N95 or surgical respirators to protect emergency medical service providers who treat/transport patients that are known or suspected to be infected with pandemic influenza, employers should plan for:

如果使用随弃式N95呼吸防护口罩或医用呼吸防护口罩，保护应急医疗服务人员，供治疗/转运确诊或疑似流感患者，雇主应计划如下：

8 N95s/EMT/shift X 120 pandemic workdays = 960 N95s.

8 个N95/人/班次 × 120流感爆发期工作日= 960 个N95 。

The stockpiling recommendation for emergency medical service providers is noticeably higher than for other work environments and is based upon their dynamic and uncontrolled work environment. Employers may consider revising this estimate based upon work volume (e.g., municipalities with high patient volume may need more N95s while those with lower patient volume may need fewer respirators).

可以注意到，对应急医疗服务人员的储备建议数量要明显高于对其他工作环境中工作者的建议，其根据是在于，他们的工作环境具有动态变化和不可控性。雇主可以根据实际工作量，考虑对这个估算数目加以修改（例如，发病人数高的地区需要更多的N95，而发病人数相对较少的地区可能需要较少的呼吸器）。

Option 1 - Using disposable N95 respirators:

选项1：使用随弃式N95呼吸防护口罩：

     480 N95:s @ $0.50/respirator = $240 per employee protected

480个N95@0.5美元/个= 240 美元防护费用/人

 

Option 2 - Using reusable elastomeric respirators:

选项2：使用可更换式呼吸器橡胶面罩：

     1 respirator @ $25 + 3 sets of filters @ $5 set = $40 per employee protected

1个呼吸器@25美元/个 + 3套过滤元件@5美元/套= 40美元防护费用/人

 

Option 3 - Using 1 PAPRs shared by 4 employees on shift work:

选项3：使用1套电动送风过滤式防护器（PAPR），由4个人轮班共享：

      1 PAPR @ $800 + 1 spare battery @$160 + 3 extra hoods @ $90 each + 3 sets of filters @ $30 set = $1,320 / 4 employees = $330 per employee protected

1套PAPR@800美元/个 + 1个备用电池@160美元/个+ 3个额外的头罩@90元/个 + 3套过滤元件@30元/套= 1,320美元/4人 = 330美元防护费用/人

(Note: hooded PAPRs do not need to be fit tested which can result in other programmatic cost savings)

(备注: PAPR的头罩不需要进行密合性检测，可节省相关费用)

 

Estimating Facemask Usage for Patients in Workplaces Classified at High Exposure Risk for Pandemic Influenza:

估算属于大流行性流感高等级暴露风险的工作场中患者使用口罩的数量:

Healthcare providers should consider distributing facemasks to patients with influenza-like illness as a component of an overall pandemic influenza containment strategy. The number of facemasks stockpiled for such purposes are in addition to the numbers presented above for employees' health and safety.

提供医疗卫生服务的机构应考虑，将口罩分发给那些流感样病例患者，作为大流行性流感全面围堵战略的组成部分之一，而为此而储备的口具数量，应是在上述为雇员健康和安全储备的口罩数量之外。

During periods of pandemic influenza activity in the community, facemasks should be offered as part of a respiratory hygiene/cough etiquette strategy to patients who are coughing and/or sneezing, have a fever or have other symptoms of influenza-like illness when they present for health-care services (for more information see Interim Guidance for the Use of Masks to Control Influenza Transmission).

在大流行流感非常活跃的这段期间，对有咳嗽、打喷嚏症状的，有发烧或其它流感样症状的的患者，当他们需要医疗服务时，作为呼吸卫生/咳嗽礼仪策略的组成部分，应向他们提供口罩 (更多信息请参考《控制流感传播口罩使用指南（试行）》)

If tolerated, facemasks should be worn by these patients until:

若条件允许，应佩戴口罩直至：

1. It is determined that the patient does not have either pandemic influenza or another respiratory infection that requires isolation precautions to prevent respiratory droplet transmission; or

1.确定该患者既未患流感，也未患其它呼吸道传染病，不需要采取隔离预防止呼吸性飞沫的传播。

2. The patient has been appropriately isolated, either by placement in a private room or by placement in a room with other patients with the same infection (i.e., cohorting). Once isolated, the patient does not need to wear a facemask unless transport outside the room is necessary.

2.患者已经被适当隔离，通过被安置在一个单独的房间，或是被安置在一个房间，与其他有同样感染的患者同住(即同类人群)。一旦被隔离，这些患者都不需要继续佩戴口罩，除非需要转运要离开这个房间时才需要配戴。

Table 3: Stockpiling Estimates for Facemasks for Use by Ill Patients

表3: 患者使用口罩的储备量估算

Occupational setting 职业设施	Facemasks needed 口罩的需要量
Healthcare 医疗卫生
Hospital (inpatient)4 医院(住院病人) 4	2 per patient per day 每位患者每天2个
Essential visitors5 必要的访客5	3 per visitor per day 每位访客每天3个
Emergency Rooms6 急诊室6	1 per ill person 每位病人1个
Outpatient office/clinic 门诊病人/诊所	2 per patient visit 每个患者访问人员2个
Long term care 长期护理	1 per patient per day 每位患者每天1个
Home healthcare 家庭护理	1 per patient visit 每次患者访问1个
Emergency medical services 紧急医疗救护	1 per ill person 每位病人1个
First responders 应急响应
Law enforcement 执法	1 per ill person 每个病人1个
Corrections 处罚	2 per ill inmate per day 每个同室者每天2个
Fire department (non-EMS, career and volunteer) 消防局(非应急服务人员、事业性人员和志愿者)	1 per ill person 每个病人1个

 

Note 4. Primary use will be when transporting patients to/from and outside of their room.

注4. 主要用途是转运病人，送达/和离开他们的房间。

Note 5. “Essential” visitors may include parents of pediatric patients who need to stay with the patient in their room but will not apply to visitors of all patients. Hospitals will likely encourage social distancing during an influenza pandemic and may restrict visitors to only those deemed "essential.”

注5．“必要的”访客可以包括那些需要和病人一起呆在病房中的父母，但不包括所有访客。在大流行性流感期间，医院将可能鼓励对社会人员实施隔离，限制访客，只允许那些认定为“必要的”访客拜访病人。

Note 6. Projections for stockpiling respiratory protective devices for emergency room or urgent care setting patients should be based on the need to provide a facemask for every patient who is coughing, sneezing or has a fever or other symptoms of influenza-like illness (ILI) when they present for health-care services. Based upon experience with seasonal influenza, only approximately 1/3 of patients presenting with ILI are confirmed to have influenza.

注6．为急诊或者需要紧急护理的病人设计呼吸防护用品的储备数量的计划，应以那些前往医疗服务机构寻求治疗，并有咳嗽、打喷嚏、发烧或其他流感样症状（ILI）的每位病人的需求为基础。根据从季节性流感得来的经验，在有ILI症状的人群中，只有大概三分之一最终会被确诊为患有流感。

When estimating the number of facemasks to stockpile for use by ill persons in a pandemic, consider estimating facemasks per ill patient per day for patients in hospitals (including possible essential visitors), long term care facilities and correctional facilities. When estimating the number of facemasks per patients encountered in other settings (e.g. in emergency rooms, outpatient offices or clinics, home healthcare, emergency services settings and by law enforcement and fire personnel), the stockpile should be sufficient to provide facemasks for each ill individual encountered.

在为大流行性流感期间，对为病人使用的口罩数量进行储备评估时，要考虑到医院、长期护理部门和康复部门中，每个病人每天的口罩需要量（包括“可能的必要的访客数量）。当为在其他部门（例如，急救室、门诊或诊所，家庭护理、急救部门，和执法人员及消防人员等）遇到的每个病人需要的口罩数量进行评估时，储备数量应能够保障为遇到的每个病人提供口罩。

 

Estimating Facemask or Respirator Usage in Workplaces Classified at Medium Exposure Risk for Pandemic Influenza:

估算属于大流行性流感中等级暴露风险的工作场中患者使用口罩的数量:

Employees Covered:

所涉及的雇员包括：

Employees with high-frequency close contact (within 6 feet) with the general population.

直接与公众频繁近距离（约2米距离范围内）接触的雇员。

Facemasks are recommended to protect employees with high-frequency close contact with the general public from sprays of potentially infectious liquid droplets (from talking, coughing, or sneezing). Employers should plan for:

口罩被推荐来保护和公众人群高频率密切接触的员工，预防可能的传染性飞沫的传染（来自于交谈、咳嗽或者打喷嚏）。雇主应按照以下方法作计划：

2 facemasks/employee/shift X 120 pandemic workdays = 240 facemasks per exposed employee.

2个口罩/员工/工作班X 120流感爆发期工作日= 240个口罩/暴露环境工作的员工

Alternatively, employers may choose to provide respirators if there is an expectation of close contact with people who have symptomatic influenza infection or if the employer chooses to provide protection against the risk of airborne influenza transmission. For example, employers in critical infrastructure or key resource industry sectors (e.g., utilities or banking) may consider providing a higher level of protection based upon the essential nature of their services or the difficulty of replacing employees whose job requires extensive training or licensing. In such cases, employers should plan for:

作为选择，当雇主预期雇员会与流感症状患者有直接接触时，或雇主选择预防流感具有空气传播的风险时，向雇员提供呼吸器，例如，重要基础设施的雇员，或提供关键资源的工业部门（如市政或银行）的雇主，基于这类服务的性质，和雇员需要广范培训和执业许可，难以替代，雇主可以考虑提供更高水平的防护措施。在这种情况下，雇主应按照以下方法作计划：

2 N95s/employee/shift X 120 pandemic workdays = 240 N95s per exposed employee;

2个N95呼吸防护口罩/雇员/工作班 X 120个流感爆发期工作日 = 240个N95呼吸防护口罩/暴露环境工作的雇员

or 或者

1 reusable elastomeric respirator + 3 sets of filters per employee.

一个可更换式呼吸器橡胶面罩+ 每个雇员3套过滤元件

While PAPRs would certainly be acceptable to use instead of an N95 or elastomeric respirator, they may be considered costly in the medium exposure risk work environment.

尽管PAPR应该可以代替N95呼吸防护口罩或可更换过滤元件的呼吸器，但在中等暴露风险的工作环境中使用，可能会认为成本太高。

 

Estimating Facemask or Respirator Usage in Workplaces Classified at Lower Exposure Risk (Caution):

估算属于大流行性流感低等级暴露风险（预警）的工作场中使用口罩或呼吸器的数量:

Facemasks and respirators are not recommended in lower exposure risk work environments.

在低暴露风险工作环境不推荐使用口罩和呼吸器。

 

Stockpile Management:

对储备的管理：

When stockpiling items, be aware of each product's shelf life and storage conditions. Stockpiles of supplies should be placed in clean, secure, temperature-controlled environments to prevent damage or contamination of the supplies (e.g., avoid storage areas that are damp or have temperature extremes). Where possible, incorporate product rotation (e.g., consume the oldest supplies first) into your stockpile management system. Surgical masks may or may not have expiration dates listed; however, product shelf-life should be taken into consideration to assure adequate inventory of supplies.

在对每类用品进行储备时，应了解每个产品的保存期和储存条件。物资储备应储存在清洁、安全和有温度控制的环境中，避免物资毁坏或受污染（例如，储存区域应避免潮湿，或温度过高或过低）。如果可能，在管理系统中应采用库存循环的方法（如优先使用旧库存）。外科口罩可能没有标注产品失效期；但仍然要考虑产品的保存期限，确保库存物资满足使用要求。

Source: OSHA and US Department of Labor

资料来源：美国劳工部和职业安全健康管理局。

翻译：3M中国有限公司技术部

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