Scrambling for a respiratory protection plan

By: April 30th, 2009 Email This Post Print This Post

This week’s focus on swine flu has jolted a number of healthcare facilities to reconsider whether they need a respiratory protection plan for their employees. I know, because I’m receiving the phone calls to prove it.

As one caller put it: “If I can get enough N95 respirators to protect my employees, what do I need to do to have my employees wear them?

A little bit of time and planning, for one thing, but that seems to be in short supply right now.

pages-from-osha_pandemic_health-cover-borderWho knows what regulators will overlook in the throes of struggling to cope with a pandemic, but here is what OSHA said in its 2007 Pandemic Influenza Guidance for Healthcare Workers and Healthcare Employers, about what employers must have as elements of a compliant respiratory protection plan.

The OSHA respiratory protection standard (29 CFR 1910.134) requires employers to establish and maintain a written respiratory protection program to protect their respirator-wearing employees. Elements of the program must include the following:

1. Program administrator. Experience is appropriate if it enables the program administrator to recognize, evaluate, and control the hazards in the workplace.

2. Respirator selection. Selection of appropriate respirators requires an understanding of the airborne infectious agents, the operating characteristics of the respirator, and the behaviors of the healthcare workers using it. Respirators for protection from pandemic influenza must provide, at the minimum, an N95 protection value and be certified by NIOSH.

3. Medical evaluations. Employers must evaluate whether employees are able to wear respirators. Evaluation can be performed by questionnaire or medical examination.

4. Fit testing. The standard requires employers to conduct fit testing initially and annually on all employees required to wear respirators with tight-fitting facepieces. Testing takes approximately 30 minutes per employee.

5. User seal checks. Tight-fitting respirators with leaks in the seals or valves cannot reduce the wearer’s exposures to respiratory hazards. Conditions that can interfere with seals or valves include facial hair, facial scars, jewelry or headgear, missing dentures, corrective glasses or goggles, or other personal protective equipment. Every time an employee puts on a respirator, he or she must conduct a user seal check.

6. Maintenance and care of respirators. Employers must provide respirators that are clean, sanitary, and in good working order to ensure that equipment protects as designed.

7. Cleaning and disinfection. Reusable equipment must be regularly cleaned and disinfected according to specified procedures of the standard or manufacturer specifications that are of equivalent effectiveness.

8. Storage of respirators. Employers must store respirators in a manner that protects them from contamination and prevents facepiece or valve deformation.

9. Training and information. Before requiring respirator use during work, employers must provide training on:

  • Respirator necessity and how improper fit, usage, and maintenance can make it ineffective
  • The limitations and capabilities of the selected respirator
  • How to inspect, put on and remove, and check the seals of the respirator
  • The proper respirator maintenance and storage procedures
  • The general requirements of the respiratory protection standard

Employers must retrain employees annually and whenever there are changes in workplace conditions or respirator selection, or whenever there is evidence of improper respirator use.

Are you hustling to get a respiratory protection plan up and running now, or did you heed the advice of OSHA and the CDC years ago and plan ahead?

Comments

By Adam Underwood on June 10th, 2009 at 10:13 am

We are currently seeing a number of our clients evaluating whether or not they need to have medical clearance provided for their EE’s to wear N95’s. We are in agreement with this article that they should have employees cleared and fit tested in advance…even to wear an N95. I get the impression that many organizations are waiting for some “trigger” (a confirmed H1N1 case in their employee population, elevation of the Pandemic threat level to 6, etc.) before they move forward. That could prove to be unfortunate. Now is the time to prepare.

Adam H. Underwood
Director of Business Development
The EI Group, Inc.
http://www.ei1.com

Direct: 919 . 459 . 5264
Mobile: 919 . 621 . 0945

By Sukie Connolly on August 18th, 2009 at 8:02 am

We have been very active at our facility doing fit testing along with training staff to assist with this process. The program administer and occupational health staff are still responsible for medical clearance. This is our issue…when we received the strategic national stockpile (SNS)there were 3 different N-95 particulate respirators in the stock. None of these respirators are the type we currently fit for. Under OSHA guidelines we would need to fit staff for each type of these respirators if we choose to use them due to supply issues. Are there other facilites dealing with this? How are they dealing with this issue? Thank you

We are dealing with the same supply issue. Small 3M respirators are running low. The respirators are on a back order, and have been since May. We have around 7,000 employees. Now we will have to refit each employee in a different brand. What will happen in the fall when all respirators will be on back order?

By Terry Donovan on August 19th, 2009 at 8:46 am

I work in long term care and we have a supply of the 3M respirators on hand and want to start the fit testing process-are you aware or can you provide samples of a medical clearance documentation tool. We want to be sure we screen for all the known potential risk factors in our employees. Thank you

By David LaHoda on August 19th, 2009 at 9:03 am

Click here for the OSHA Respirator Medical Evaluation Questionnaire. It is Appendix C to the respiratory protection standard, 1910.134.

By Diane Hoyt on April 6th, 2011 at 2:05 pm

My Respiratory Therapy tells me that they no longer want to fit test N95 masks as we have not identified a case of TB in our facility for over 10 years. The rationale is they would “just in time” fit test if we identified a need. They also are basing it on the standards for H1N1 where a surgical mask will do.

By L,Heiderman on May 12th, 2011 at 10:51 am

With all the OSHA requirements for fit testing for N95 masks for a TB airborne exposure. Has any studies been done on the amount of time it takes for a person to convert to a positive PPD after a exposure to TB? I know our county Health Dept uses the Concentric Circle approach for testing close contacts to TB patients. In an acute Hospital setting,when patients typically have less then a week stay, does any HCW actually have that amount of accumlative exposure time to be a concern?

 

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