VAN BUREN/CASS COUNTY HEALTH DEPARTMENT
RESPIRATORY PROTECTION PROGRAM
POLICY / PROCEDURE
DATE:
February 7, 2006
PURPOSE:
A written respiratory protection program with required worksitespecific procedures and elements for required respirator use. In some
settings, HCW's 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:
PROCEDURE:
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 polices developed by the employer; workers
violating these policies may need to be retrained and provided with
positive feedback to improve adherence to the policies.
TB risk assessment :
Very-low and low risk: YEARLY
Intermediate-risk: EVERY 6-12 MONTS
High-risk: EVERY 3 MONTHS
#of TB patients who were treated in each area and drug susceptibility
patterns (see page 10-of-116)
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
respirators, inventory control. Types and brands
Medical evaluations:
of
approved
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.
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A two step baseline shall be used for new employees who have an initially
negative PPD test 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 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 health care 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 test should be completed at regular,
periodic intervals (annually) to ensure continued adequate fit. After fittesting, a wallet sized card should be provided to the respirator user
showing 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 filer 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
material.
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
fitting 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
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store disposable respirators. The users will be instructed to refer all
respirator problems immediately to the respirator program manager.
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 workers 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
manufactures instructions will be followed.
Disposable respirators will be discarded if they are soiled or are no longer
functional. See the manufactures 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 County District Health
Department physician will determine what health and physical conditions
are pertinent. The respirator users’ medical status will be reviewed
annually.
a.)
The employer shall ensure that each employee can
demonstrate knowledge of at least the following.
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 respirator
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.
Evaluating effectiveness:
Employer to conduct evaluations of
the workplace to ensure that the written respiratory 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 and the respirator.
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c.) Records of 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 of
QLFTs or the fit factor, ( fit test records shall be retained for
respirator users until the next fit test is administered
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