VAN BUREN/CASS COUNTY HEALTH DEPARTMENT
RESPIRATORY PROTECTION PROGRAM
POLICY/PROCEDURES
PURPOSE:
A written respiratory protection program with required worksite-specific
procedures and elements for required respirator use. In some settings,
Health Care Workers may be at risk for two types of exposure: a) inhalation of
M. tuberculosis and b) mucous membrane exposure to fluids that may contain
bloodborne pathogens. In these settings, protection against both types of
exposure should be used.
EQUIPMENT:
N-95s disposable mask, State American Lung Personnel for Fit testing.
POLICY:
The employer is responsible for providing a safe and healthful workplace
where respirators are necessary to protect the health of the employee or
whenever respirators are required by the employer, the employer shall
establish and implement a written respiratory protection program with
worksite specific procedures under OSHA 29 CFR 1910.139. The workers
are responsible for following all procedures and written policies developed
by the employer; workers violating these policies may need to be retrained
and provided with positive feedback to improve adherence to the policies.
PROCEDURE:
TB risk assessment:
Very-low and low risk: YEARLY
Intermediate-risk:
EVERY 6-12 MONTHS
High-risk:
EVERY 3 MONTHS
Selecting respirators:
A NIOSH-certified N-95 respirator will be selected on the basis of CDC
guidelines. Respiratory protection for M Tuberculosis (1910.139) and according
to the guidance of American National Standard Practices for Respiratory
Protection (Z88.2-1969). This will be used in compliance with the conditions of
its certifications. There will be a sufficient number of respirator models and sizes
so that it is acceptable and correctly fits the user.
Administrative procedures for the purchase of approved respirators,
inventory control. Types and brands
Medical evaluations: Because most healthcare workers wear the very light,
disposable half-mask respirator, CDC Guidelines (94) recommend that a health
questionnaire be the initial step in the evaluation. If results from this evaluation
are essentially normal, the employee can be cleared for respirator wear. Further
evaluation, should be considered in cases in which potential problems are
suggested on the basis of the questionnaire results. TB skin tests shall be offered
to all current potentially exposed employees and to all new employees prior to
exposure. A two-step baseline shall be used for new employees who have an
initially negative PPD tests result and who have not had a documented negative
TB skin test result during the preceding 12 months. The reading and
interpretation of the TB skin tests shall be performed by a qualified individual as
described in the CDC Guidelines. Periodic evaluations. TB skin testing shall be
conducted every three months for workers in high risk categories, every six
months for workers in intermediate risk categories and annually for low risk
personnel. Workers with a documented positive TB skin test who have received
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treatment for disease or preventive therapy for infection are exempt from the TB
skin test but must be informed periodically about the symptoms of TB and the
need for immediate evaluation of any pulmonary symptoms suggestive of TB by
a physician or trained healthcare provider to determine if symptoms of TB
disease have developed.
Fit testing: All respirators must be fit-tested and user seal checked. A user seal check is
a method for determining whether a respirator has been put on and adjusted to fit
properly and is performed every time a respirator is worn. A fit test is a method used to
select the respirator that provides an adequate and comfortable fit. Fit testing should be
completed at regular periodic intervals (annually) to ensure continued adequate fit. After
fit testing, a wallet sized card should be provided to the respirator user showing the
worker’s name, date, type, brand, model and size of respirator.
Proper use of respirators: Inspection of disposable half-mask respirator:
a) Examine the face piece of the disposable respirator to determine whether it is
functional and has structural integrity. If the filler material is physically
damaged or soiled, discard the respirator. Also discard the respirator if there
are nicks, abrasions, cuts or creases in the face piece-to-face sealing
materials.
b) Check the respirator straps to be sure they are not cut or otherwise damaged.
The straps should be attached at all connection points.
c) Make sure that the metal nose clip is in place and functions correctly.
d) Make sure that the respirator is NIOSH approved. (NIOSH approval will be
marked on the filter, filter package, or respirator box).
Training of employees in respiratory hazards and proper use: The user will be
instructed and trained in the proper use of respirators and their limitations. Both
supervisors and workers will be trained by the State American Lung personnel. The
training should provide the employee an opportunity to handle the respirator, have it
fitted properly, test its face piece-to-face seal, wear it in normal air for a long familiarity
period, and finally wear it in a test atmosphere. Every respirator wearer will receive
fittings instructions, including demonstrations and practice in how the respirator should
be worn, how to adjust it, and how to determine if it fits properly. The user will be taught
the importance of and how to properly store disposable respirators. The users will be
instructed to refer all respirator problems immediately to the Emergency Management
Coordinator. Training may need to be repeated yearly to maintain the respirator skills of
the users.
Respirators should not be worn when conditions prevent a good seal. Such conditions
may be a growth of beard, sideburns, a skull cap that projects under the face piece, or
temple pieces on glasses. Also the absence of one or both dentures can seriously affect
the fit of a face piece. The worker’s diligence in observing these factors will be
evaluated by periodic checks. To assure proper protection, the user seal check will be
done by the wearer each time she/he puts on the respirator. The manufacturer’s
instructions will be followed.
Disposable respirators will be discarded if they are soiled or are no longer functional.
See the manufacturer’s instructions.
Persons will not be assigned to tasks requiring use of respirators unless it has been
determined that they are physically able to perform the work and use the equipment. The
Van Buren/Cass District Health Department’s Medical Director will determine what
health and physical conditions are pertinent. The respirator user’s medical status will be
reviewed annually.
a) The employer shall ensure that each employee can demonstrate knowledge of
at least the following:
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1/ Why the respirator is necessary and how improper fit, usage, or
maintenance can compromise the protective effect of the respirator.
2/ What the limitations and capabilities of the respirator are.
3/ How to inspect, put on and remove, use, and check the seals of the
respirators.
4/ What the procedures are for maintenance and storage of the respirator.
5/ How to recognize medical signs and symptoms that may limit or prevent
the effective use of respirators.
6/ The employer shall provide the training prior to requiring the employee
to use a respirator in the workplace.
7/ Retraining shall be administered annually and when the following
situations occur; changes in the workplace or the type of respirator render
previous training obsolete; inadequacies in the employees’ knowledge or use
of the respirator indicate the employee has not retained the required
understanding or skill.
Evaluation effectiveness: Employer to conduct evaluations of the workplace to ensure
that the written respirator protection program is being properly implemented and to
consult employees to ensure that they are using the respirators properly.
What records are kept, where to keep them and how long to keep them
a) Employee medical records; the medical record for each employee shall be
preserved and maintained for at least the duration of employment plus thirty
(30) years.
b) The employer to establish and retain written information regarding medical
evaluation, fit testing the respirator.
c) Records for the fit testing including name or ID of the employee tested, type
of fit test performed, specific make, model, style and size of respirator tested,
date of test, the pass/fail results or QLFT’s or the fit factor, (fit test records
shall be retained for respirator users until the next fit test is administered
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