Establishing a Respiratory Protection &
Fit-Testing Program for FQHCs
Amelia Muccio, Director of Disaster Planning, NJPCA
Objectives for FQHCs
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Respiratory Protection Program
Demonstration of Fit Testing
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“Give someone a fish (fit test) and you feed
him for a day (year); Teach someone to fish (fit
test) and you feed him for a lifetime.”
Proper Protection: OSHA’s Part
1910.134
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Program Administration
Worksite Procedures
Respirator Selection
Employee Training
Fit-Testing
Medical Evaluation
Respirator Use, Cleaning, Maintenance
and Repair
Healthcare Industrial Hygiene
“Hierarchy of Controls”
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2.
3.
4.
Engineering
Administrative
Elimination of infection sources
PPE
Components of a Respiratory
Protection Program
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Develop a written plan
Medically evaluate your employees
Complete fit testing and training
Provide the appropriate PPE including a
NIOSH approved N95.
Plan Components
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Procedures for selecting respirators for use in the workplace
Medical evaluation of employees required to use respirators
Fit testing procedures
Procedures for proper use in routine and emergency
situations
Procedures and schedules for cleaning, disinfecting, and
maintenance.
Procedures to ensure adequate air quality, quantity and flow
(atmosphere-supplying respirators)
Training of employees in the respiratory hazards to which they
may be potentially exposed to during routine and emergency
situations.
Training of employees in the proper use of respirators
(donning, doffing, limitations on their use and maintenance)
Procedures for regular evaluation of the effectiveness of the
program.
Respiratory Program
• Written program with work-site
procedures.
• Must include updates and stay current with
new guidance/recommendations.
• Should have program administrator
• Program should have no cost
Develop a Written Plan Including:
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Procedures for respirator selection
Medical evaluation for employees
Fit-Testing for tight-fitting respirators
Procedures for routine and emergency use
Procedures for cleaning, disinfecting, storing,
inspecting, repairing, discarding, and
maintaining respirators.
• Training employees on hazards and proper use
of respirators (donning, doffing, limitations, and
maintenance).
• Routine evaluation of program effectiveness
Training and Information
• Training must be comprehensive, understandable, prior
to use of respirator, updated at least annually including:
• Why the respirator is necessary and the need for proper
fit, usage, and maintenance
• Limitations and capabilities
• Use in emergency situations
• How to inspect, put on and remove, check seals
• Procedures for maintenance and storage
• How to recognize medical signs and symptoms that limit
or prevent effective use
• General requirements of the OSHA regs
Recordingkeeping
• Records and medical evaluations must be
retained and made available per 29 CFR
1910.
• A record of fit tests must be established
and retained until the next fit test is
administered.
• Written copy of current program must be
maintained and available at OSHA’s
request.
Medical Evaluation
• N-95s must be fit tested.
• Medical evaluation before fit testing and use.
• PLHCP performs medical evaluation using a medical
questionnaire or initial medical exam that obtains same
information.
• Follow-Up required for employee who gives positive
responses to any question among 1-8 in Section 2, Part
A of App. C or whose initial medical exam demonstrates
the need for a follow-up medical exam.
• Must include medical tests, consultations, procedures if
deemed necessary to make final determination.
• Confidentiality must be maintained.
Program Evaluation
• Must conduct evaluations of the workplace
as necessary to ensure effective
implementation of the program.
• Factors to be assessed include: respirator
fit, appropriate selection, proper use, and
proper maintenance.
What is a Respirator?
• A respirator is a protective device that covers the
nose and mouth or the entire face or head to
guard the wearer against hazardous
atmospheres.
• Respirators may be:
– Tight-Fitting: that is, half masks, which cover the
mouth and nose and fall face pieces that cover the
face from the hairline to below the chin.
– Loose-Fitting: such as hoods or helmets that cover
the head completely.
Respirators
• WHY: Protection against harmful
elements that can infiltrate respiratory
tract.
• WHEN: Employees need to wear
respirators whenever engineering and
work practice control measures are not
adequate to prevent contamination.
Respirators are not a substitute for
effective engineering and work practice
controls.
Two Major Classes of Respirators
• Air Purifying: remove contaminants from
air
• Atmosphere Supplying: provide clean,
breathable air from an uncontaminated
source
Quantitative vs. Qualitative Fit Testing
•Three accepted OSHA
protocols computerized
means of quantitative fit
•Generated aerosol
•PortacountTM
•Controlled negative
pressure
•Four OSHA accepted
protocols for qualitative fit
•Isoamyl Acetate
(cartridge respirator to
remove organic vapors
•Saccharin (particulate
filter of any class)
Britrex TM (particulate
filter of any class)
Irritant smoke (level 100
particulate filter)
Qualitative (QLFT) Fit Test
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Pass/Fail based on user’s responses
Relies on human senses (can lead to error)
Sensitivity check first
No chewing gum, smoking or eating for 30
minutes before test
Up to 10 squeezes in hood
1-10: 10 initial then in 30 seconds squeeze 5
times
11-20: 20 initial then 10 squeezes
21-30: 30 initial then 15 squeezes
No sensitivity=No test
Qualitative (QLFT) Fit Test
• Procedure: hood over head, chemical in hole in hood
(turned to side) and ask the question, do you taste/smell
it? “sensitivity check”
• Now don respirator and begin fit test
• With respirator on, begin test with 7 tests with full fit test
kit solution
• Need to keep time for exercise and squeezing
• Spray and do exercises
• Pass/Fail—form needed to capture information
• Doff mask properly
• Qualitative Fit-Testing involves the introduction of a
harmless odoriferous into breathing zone. If no odor is
smelt, then the mask fits properly.
Fit Testing
• Fit Testing on tight fitting respirators only.
• Make sure that each employee knows their size
and type of their mask.
• Show worker how to don mask using mirror.
• Determine fit.
• User checks the seal and makes sure mask is
fitting properly.
• If employee has difficulty breathing then they
must be referred to a physician.
• Choose another mask if fit is unacceptable.
• Brief worker on test exercises before fit test.
Test Exercises (1 minute each)
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Normal breathing
Deep breathing
Head side to side
Head up and down
Talk out loud
Bend over or jogging in place
Normal breathing
No adjustments/ask about comfort