Establishing a Respiratory Protection & Fit-Testing Program for FQHCs

1. Establishing a Respiratory Protection & Fit-Testing Program for FQHCs Amelia Muccio, Director of Disaster Planning, NJPCA

2. Objectives for FQHCs • Respiratory Protection Program • Demonstration of Fit Testing • “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.”

3. Proper Protection: OSHA’s Part 1910.134 • Program Administration • Worksite Procedures • Respirator Selection • Employee Training • Fit-Testing • Medical Evaluation • Respirator Use, Cleaning, Maintenance and Repair

4. Healthcare Industrial Hygiene “Hierarchy of Controls” • Engineering • Administrative • Elimination of infection sources • PPE

5. Components of a Respiratory Protection Program • Develop a written plan • Medically evaluate your employees • Complete fit testing and training • Provide the appropriate PPE including a NIOSH approved N95.

6. Plan Components • 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.

7. 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

8. Develop a Written Plan Including: • 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

9. 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

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. Two Major Classes of Respirators • Air Purifying: remove contaminants from air  • Atmosphere Supplying: provide clean, breathable air from an uncontaminated source

16. 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)

17. Qualitative (QLFT) Fit Test • 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

18. 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.

19. 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.

20. Test Exercises (1 minute each) • 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