Respiratory Protection for Healthcare Workers Training VideoOn November 7, 2019 by Raul Dinwiddie
This is a presentation about the use of respirators in healthcare settings. In certain situations, healthcare workers may need to be protected from airborne hazards, such as infectious agents or hazardous chemicals in their workplace. Respirators are a type of personal protective equipment, or PPE, that can protect you from breathing in such hazards. After viewing this video, you should have a basic understanding of why respirators are used in the healthcare industry, and how to properly use them. You should also understand that a standard issued by OSHA – the Occupational Safety and Health Administration – or by an OSHA-approved State plan, requires your employer to have a comprehensive respiratory protection program whenever respirators must be used. In addition, this video will discuss some common myths about respirators that you may hear in your workplace. It is required that you understand how to use a respirator, and understand the major components of a respiratory protection program. This video may be a part of your respiratory protection training, but it’s not a substitute for the more in-depth, worksite-specific training that your employer is required to provide. While this video discusses your employer’s responsibilities under OSHA’s respiratory protection standard, remember that the purpose of a respirator is to protect your health and safety. So let’s begin: Airborne hazards may be solid particles – like dusts – droplets – like mists – or gases. When such hazards are present in your workplace, your employer must control them in several ways, including engineering controls, work practice controls, and administrative controls. When workers cannot be adequately protected from respiratory hazards through engineering, work practice, and administrative controls, employers must provide, and workers must use, personal protective equipment, also known as PPE. Respirators are a type of PPE used to protect workers against breathing airborne hazards and they are often used with other types of PPE such as gloves, goggles, and procedure gowns. In this presentation, one of our goals is to set the record straight about the proper use of respirators in healthcare settings. So during this video we will take a look at some of the misconceptions, or myths that you may encounter in your workplace. Myth: Respirators are only necessary for tuberculosis – or TB – exposures. Actually there are a number of situations in healthcare settings where workers may need to wear a respirator to protect against airborne hazards – TB is only one of them. There are two primary types of respiratory hazards in healthcare settings – airborne infectious agents and gaseous chemical exposures. Let’s take a look at these two types of hazards, the ways workers might be exposed to them and how they can be protected from them. First let’s look at airborne infectious agents. Probably the most common use of respirators in healthcare settings is to protect workers against airborne infectious agents that cause diseases such as tuberculosis, SARS, pandemic influenza, chicken pox, and measles. Healthcare workers are exposed to these hazards during the care of patients suspected or confirmed to have airborne transmissible diseases. Workers might also be exposed when they enter a negative pressure airborne infection isolation room – or AIIR; when they are present during aerosol-generating medical or laboratory procedures or during autopsies on suspected or confirmed infectious individuals; when they transport infectious patients in an enclosed vehicle; and when they function as first receivers of victims from a biological agent attack. Patient care isn’t the only situation where respiratory protection may be needed to protect workers against airborne transmission. For example, laboratory personnel working with highly infectious agents may need respiratory protection. Also, engineering and maintenance staff may be exposed during tasks such as replacing filters in an isolation room or a laboratory hood ventilation system. Now let’s talk about gaseous chemical exposures. Workers in healthcare settings may also need to use respirators to protect against airborne chemical exposures from substances such as pharmaceuticals during dose preparation, sterilants, like glutaraldehyde, and fixatives like formaldehyde. It’s very important to understand that the respirators used to protect against infectious agents may be inappropriate to protect against chemical hazards. We will discuss respirator selection in more detail later in the program. When a respirator is required by your employer, your employer must develop and implement a comprehensive respiratory protection program. This program must meet the requirements of either Federal or State OSHA’s Respiratory Protection Standard. Employers must comply with the standard, and you need to have a basic understanding of their responsibilities. Your employer must: identify and evaluate hazards; develop a written program; properly select respirators; evaluate respirator use; correct any problems with respirator use; conduct medical evaluations and fit testing; provide for the maintenance, storage and cleaning of respirators; provide training; and provide you with access to specific records and documents, such as a written copy of your employer’s respiratory protection program. Because each workplace is different, your employer’s respiratory protection program must be tailored to your specific workplace. For example, workplaces will differ in types of respiratory hazards, designated personnel, policies, procedures, and methods of compliance. These differences must be reflected in the employer’s program. Your employer’s respiratory protection program must be managed by a properly trained program administrator. Their job is to monitor the implementation of the program and to make sure that workers are properly protected. Myth: Surgical masks provide the same protection as respirators. Respirators and surgical masks are two types of personal protective equipment – or PPE – that are used to protect workers in healthcare settings. A surgical mask is not a respirator, and that’s an important distinction for you and your employer to understand, so let’s review the significant differences between a respirator and a surgical mask. What is a respirator? A respirator is a type of personal protective equipment designed to reduce your exposure to airborne contaminants. Respirators are available in different types and sizes, and the respirator you use must be individually selected to fit your face and to provide a tight seal. A proper seal between your face and the respirator forces inhaled air to be pulled through the respirator’s filter material, and not through gaps between your face and the respirator. If your supervisor requires you to use a respirator, it must be NIOSH-certified and must be used in the context of a comprehensive respiratory protection program, according to OSHA’s Respiratory Protection standard, twenty nine CFR nineteen ten point one thirty four, which includes but is not limited to medical evaluation, fit testing, and training elements. Respirators are used routinely to protect healthcare workers against airborne infectious diseases, such as tuberculosis, anthrax, SARs, and Hantavirus because they protect against both large and small particles. What is a Facemask? A facemask is a loose-fitting, disposable mask that covers your nose and mouth. Surgical masks, dental masks, medical procedure masks, isolation masks and laser masks are all types of facemasks. Facemasks help stop large droplets from being spread by the person wearing them, whether that person is a patient or a healthcare worker. Facemasks also keep splashes or sprays from reaching the mouth and nose of the person wearing them. However, facemasks are not designed or certified to seal tightly against your face or to prevent the inhalation of small airborne contaminants. During inhalation, small airborne contaminants pass through gaps between the face and the facemask and the material of the mask. Remember, facemasks are not considered respirators and they do not provide respiratory protection. Only facemasks that are cleared by the U.S. Food and Drug Administration, the FDA for short, may be legally marketed in the United States. The FDA approval signifies that they have been tested for their ability to resist splashes of blood and other body fluids. To offer protection, both facemasks and respirators need to be worn correctly and consistently throughout the time that they are being used. When used properly, facemasks and respirators both play an important role in preventing exposures to different types of hazards. If you need the protection of both a facemask and a respirator, you can use a surgical N95 respirator. Surgical N95 respirators offer protection from both airborne and body fluid contaminants and are approved by both NIOSH and the FDA. Your employer is responsible for selecting appropriate respirators when they are needed to protect you from airborne hazards. That selection is based in part on the level of protection a given type of respirator can provide. And this brings us to another myth: All respirators offer the same level of protection. The truth is that different types of respirators protect against different hazards and offer different levels of protection. So when your employer selects respirators they must first identify the hazard and then consider these two factors: the respirator’s level of protection and the expected workplace exposure level. Your employer must also consider whether the hazard has any additional characteristics that may affect the type of respirator selected. For example, does the hazard irritate the eyes? Do you need splash and spray protection, as well as eye protection? If so, a full facepiece respirator or some type of eye protection will be needed. There are advantages and disadvantages to each type of respirator, so it’s important that your employer select the type that’s best suited for your work setting and the hazards you face. These are filtering facepiece respirators, sometimes referred to as N95s or TB respirators. They come in a variety of configurations, such as cup shaped, flat fold, and duckbill. Because this is a tight-fitting respirator, it needs to be fit tested to assure a good face seal. This type is commonly used by healthcare providers during patient care. Filtering facepiece respirators do not protect against gaseous chemical hazards, such as formaldehyde and glutaraldehyde, and must not be used for such purposes. Filtering facepiece respirators are available with or without exhalation valves. Respirators with exhalation valves should not be used where a sterile field must be maintained, such as in an operating room. The Surgical N95 respirator, shown here, is used in situations that require the protection of both a surgical mask and a respirator. This is an elastomeric half-facepiece respirator. This type needs to be fit tested and can be used instead of a filtering facepiece respirator. Some healthcare providers are beginning to use this type of respirator for protection against infectious agents. An elastomeric half-facepiece respirator can be cleaned, decontaminated, and reused. Remember, this is not the case for a filtering facepiece respirator, which is normally discarded after use. This is an elastomeric full-facepiece respirator. This type of respirator provides a higher level of protection than filtering facepiece and elastomeric half-facepiece respirators. Why? Because it provides a better seal to the wearer’s face. Another advantage of this respirator is that it covers the wearer’s eyes, protecting them from liquid splashes and chemical vapors. It might be used by workers exposed to formaldehyde or by laboratory, pharmacy, or maintenance personnel. In addition, it could be used by healthcare workers who are first receivers of victims of hazardous substance releases, or by a healthcare facility’s internal hazmat team. This is a loose-fitting facepiece hooded powered air- purifying respirator, also known as a PAPR. A PAPR has a blower that pulls air through attached filters. The blower then pushes the filtered air into the facepiece, which covers all of the wearer’s face. Since it is loose-fitting, it does not need to be fit tested and can be used by workers with facial hair. A PAPR might be used by healthcare providers during direct patient care, and for high exposure risk, aerosol- generating medical and laboratory procedures. These would include bronchoscopy and sputum induction, and during autopsies. In addition, a PAPR might be used by laboratory, pharmacy, or maintenance personnel. There are also full-facepiece PAPRs, as well as PAPRs that have a helmet. When respiratory protection is needed, OSHA requires employers to provide NIOSH-certified respirators to their workers. To see if your respirator is NIOSH-certified, look for the NIOSH logo, as well as the test and certification approval number, or TC number. These can be found on the respirator’s package or user instruction insert, and sometimes they appear directly on respirator components, such as the respirator filter or cartridge. If your respirator is not NIOSH-certified, do not use it in a hazardous area. Myth: It is ok to decorate, write on, or otherwise alter your respirator to make it look more appealing. You must never alter your respirator. Doing so can reduce its protective quality and expose you to the airborne hazard. Never glue or staple things to your respirator; don’t write on your respirator’s filter material; and you must never puncture holes in your respirator. In fact, OSHA requires that respirators be used only in ways that comply with the conditions of their NIOSH certification. Only practices that do not affect the respirator’s ability to protect you are allowed, such as writing your name on your respirator’s straps. Here’s another myth: Anyone can wear a respirator. Not everyone is able to wear a respirator. Before you use a respirator, your employer must evaluate whether you are medically able to wear it. Some conditions that could prevent you from using a respirator include heart conditions, lung disease, and psychological conditions like claustrophobia. A physician or other licensed healthcare professional, such as a registered nurse or physician’s assistant, must perform a medical evaluation that considers your health and your specific job description. The evaluation can be as simple as using the medical questionnaire contained in Appendix C of OSHA’s Respiratory Protection Standard. This questionnaire is designed to identify general medical conditions that could place a worker at risk of serious medical consequences, if a respirator is used. It’s important to answer the questions truthfully. Based on your answers to the questionnaire, the doctor or licensed healthcare professional may decide that a medical examination or tests are necessary to determine if you can safely wear a respirator. If you need these additional tests, your employer is responsible for paying for them, and for ensuring that they are provided during your normal working hours, or at a time and place that’s convenient for you. Your responses to the medical questionnaire are confidential and should not be shared with your employer. After the medical evaluation, the physician or licensed healthcare professional will provide you and your employer with a written recommendation. This recommendation must not include confidential medical information. It must state three things: First, your ability to wear a respirator and any functional limitations on your use of certain types of respirators. Second, the need, if any, for follow-up medical evaluations. And, third, a statement that the doctor or licensed health care professional has provided you with a copy of their written recommendation. Your completed questionnaire is typically maintained by the physician or licensed healthcare professional, along with the rest of your medical records. If your employer maintains these records, then your employer must keep this information confidential and filed separately from your Human Resources – or HR – files. And now, it’s time for another myth: There is no benefit to fit-testing and the only reason to do it is to comply with OSHA standards. If your respirator doesn’t fit properly, contaminated air can leak into the facepiece, and you will not be protected. It’s that simple. Remember, a tight fitting respirator must form and maintain a tight seal with the face or neck in order to protect the wearer from airborne hazards. So before you wear a tight-fitting respirator in the workplace, you must be fit tested with the specific make, model, style, and size of that respirator. The purpose of fit testing is to be sure that the facepiece of the selected respirator fits adequately to your unique facial characteristics. Some people cannot be fitted with a particular respirator. They may require a different make, model, or size of respirator. Or they may require another type or class of respirator. So what is a fit test? A fit test is designed to test the facepiece-to-face seal of the respirator. It can be either qualitative or quantitative, and uses a test agent or instrument to verify the respirator’s fit. This process typically requires fifteen to twenty minutes to complete. Your respirator must be fit tested before you use it in the workplace, and must be retested at least annually to ensure a continued good fit. The fit of your respirator must also be retested whenever you have a significant change in weight, significant dental work – such as new dentures – significant facial surgery, or significant scarring of the face in the area of the seal. When you’ve completed the fit testing process, it’s very important that you know which make, model, and size respirator fits your face properly, and when and where you’ll need to wear it for protection. Since no single respirator can be expected to fit all the many types of faces found in the workplace, your employer needs to provide you with a reasonable selection of sizes and models to choose from. If you find that your respirator becomes uncomfortable or significantly limits your vision or ability to communicate, or is otherwise unacceptable, you must be given an opportunity to select a different type of respirator and be retested. The selection may include a new make, model, or size of respirator. Many workers need to wear prescription glasses or personal protective equipment such as safety glasses or goggles, or earmuffs while performing a job. If you wear prescription glasses, or your job requires you to wear PPE like safety glasses, goggles, or hearing protection, you must wear these items during the fit test to be sure they don’t interfere with the respirator’s fit. If you wear a tight-fitting respirator, remember: facial hair can not come between the sealing surface of the respirator and your face, or interfere with your respirator’s valve function. Also, people with long hair must make sure it doesn’t interfere with the respirator’s ability to seal tightly to the face. Myth: Putting on and taking off a respirator does not require special procedures. The truth is that putting on and taking off your respirator requires step-by-step procedures. Consequently, the training provided to you by your employer must include how to properly put on and take off your respirator, and how to conduct a user seal check when you put it on. A user seal check is a way to verify that the respirator has been properly positioned on your face to assure a proper seal. It must be performed each time you put on a respirator to check that it has been donned correctly. A user seal check is not the same as a fit test, and is not a substitute for a fit test. To see a short video containing general instructions on how to properly put on and take off a respirator, and how to conduct a user seal check, refer to this OSHA website. Myth: Respirators are maintenance-free. Your employer’s respiratory protection program must provide for the cleaning, disinfecting, storage, inspection, and repair of each type of respirator used in your workplace. Remember, all respirators must be inspected for basic function prior to each use. Reusable respirators must be cleaned as often as necessary to prevent them from becoming unsanitary, while filtering facepiece respirators must be disposed of when they become soiled or no longer provide protection. A respirator inspection must include a check of the respirator function, tightness of any connections, and the condition of the various parts, such as the facepiece, head straps, valves, tubes, hoses, and any cartridges, canisters, or filters. In addition, elastomeric parts must be checked for pliability or signs of deterioration. Regular care and maintenance of the respirator is important to ensure that it functions as designed. It is also important for respirators to be stored properly, to protect them from damage, contamination, dust, sunlight, extreme temperatures, excessive moisture, and damaging chemicals. In addition, they must be stored to prevent the facepiece and exhalation valve from being damaged. Avoid carrying a cup-shaped filtering facepiece respirator in your pocket or in a bag. This could crush or distort its shape and prevent the respirator from sealing tightly to your face, thus compromising your protection. Myth: A respirator is only effective for a short period of time and cannot be reused. A properly functioning respirator can provide effective protection for as long as the filters or cartridges work correctly. All filters must be replaced whenever they are damaged, soiled, or cause noticeably increased breathing resistance. Before you use your respirator, you must inspect the outside of the filter material. If your respirator has replaceable filters and those filters appear to be damaged or soiled, they must be changed. If your respirator is a filtering facepiece and the filter material appears to be damaged or soiled, the respirator must be discarded. Remember your employer must develop standard operating procedures for storing, reusing, and disposing of respirators that have been designated as disposable. The same is true for respirators with replaceable filter elements. Of course, there may be other reasons for disposing of a filtering facepiece respirator that still appears to be functional. For example, sometimes infection control procedures may require that a respirator be used only once. Your employer must identify the circumstances in which a filtering facepiece respirator will be considered to be contaminated and not available for reuse. Some gas and vapor hazards require the use of respirator cartridges or canisters that contain materials to absorb or remove the hazards from the air. These cartridges or canisters have a limited service life because they can absorb only a limited amount of hazardous gas or vapor. To assure your protection they must be replaced before they reach this limit. This schedule for replacing worn out cartridges or canisters is known as a change out schedule. Your employer is responsible for providing this information to you. Remember, you must never rely on your ability to smell a contaminant to warn you of cartridge or canister failure. A respirator can’t protect you if you don’t know how to use it properly. So before you use a respirator, your employer must train you about its use. This training must be provided in a way that you can understand and must include at least the following information: Why the respirator is necessary; what the limitations and capabilities of the respirator are; how to inspect, put on and take off, use, and conduct a user seal check of the respirator; how to use the respirator effectively in emergency situations, including situations in which the respirator malfunctions; how to recognize medical signs and symptoms that may limit or prevent you from using a respirator; how improper fit, usage, or maintenance can reduce a respirator’s protection; what the procedures are for maintenance and storage of the respirator; and the requirements of OSHA’s Respiratory Protection Standard. You must be trained before you use a respirator, but this is not the only time that your employer must provide training. If you use a respirator at work, your employer must provide respirator training to you at least every year. This annual retraining will refresh your memory on the information and skills you need to properly use your respirator, and will help ensure your protection. It also gives you the opportunity to ask questions and discuss worksite-specific respirator use with your instructor. In addition, you must be retrained when: Changes in your workplace or the type of respirator you use make your previous training out-of-date. For example, a process change results in you being exposed to a new hazardous substance in your workplace. You can’t remember the information and skills you need to properly use your respirator. This could occur when your supervisor sees that you’re not using your respirator properly or when it’s apparent that you don’t fully understand, or have forgotten, important information. Or when a situation comes up in which re-training is necessary to ensure safe respirator use. Most workers who wear respirators use them because they are required to do so by their employer in order to protect them from airborne hazards. There are some situations where workers may request to wear a respirator even though respirator use is not required under an OSHA standard or by your employer. If your employer permits this, it is considered voluntary respirator use. If you are voluntarily using only filtering facepiece respirators, your employer is required to provide you with a copy of Appendix D of OSHA’s Respiratory Protection Standard, or the equivalent State plan document, which contains certain precautions to be taken. Your employer is also required to ensure that the use of the respirator itself is not creating a health hazard to you, such as dermatitis. If other types of respirators are used voluntarily, your employer must establish and implement those elements of a written program necessary to ensure that you are medically able to use the respirator, and that the respirator is cleaned, stored and maintained so that its use does not present a health hazard to you. Remember, voluntary use is only permitted when your employer has determined that there is no airborne hazard that would require the use of a respirator. If you have additional questions about either the airborne hazards found in your workplace or respirator use in your workplace, ask your supervisor or respiratory protection program administrator. For additional information on respiratory protection in the workplace, consult these OSHA and NIOSH websites.