Millions of American employees, including healthcare workers, rely on respirators to safeguard themselves against occupational diseases transmitted through contaminated air. Ensuring adherence to regulatory protocols for personal protective equipment (PPE), such as respirators, is essential. One pivotal aspect for healthcare facilities to achieve this is having a comprehensive written respiratory protection program when workers are required to wear respirators.
What is a respiratory protection program, and why is it essential for hospitals and healthcare facilities?
Hospitals and healthcare facilities are unique work environments with many challenging occupational health and safety concerns. These organizations sometimes require the use of respirators to keep employees safe from airborne hazards such as aerosol transmissible diseases (ATDs). To ensure maximum protection and effectiveness from respirators, OSHA has requirements in place for employers such as creating and following a written respiratory protection program. A respiratory protection program is designed to protect employees by establishing procedures for selection, use, and care of respirators.
Healthcare personnel who care for patients with ATDs must often work near the source of the hazard, exposing them to a higher risk of inhaling infectious aerosols than the general public. Even with hazard controls in place, such as engineering, administrative, and work practice controls, additional protection from respiratory hazards is sometimes necessary by wearing PPE such as a respirator.
The purpose of a respirator worn by healthcare personnel is primarily to protect the wearer by reducing the concentration of infectious particles in the air they inhale. These particles can originate from infectious patients exhaling, talking, sneezing, or coughing in healthcare settings, as well as from medical procedures and laboratory activities that may aerosolize pathogens.
Respirators, when used within the context of a comprehensive respiratory protection program, are designed and regulated to provide a known level of protection. This program ensures that all employees who are required to wear respirators receive proper training, fit testing, and guidance on maintenance and use. By implementing a comprehensive respiratory protection program, healthcare facilities can effectively safeguard their employees against airborne hazards and ensure a safe working environment.
What are the different types of respirators commonly used in healthcare settings?
A respirator is worn over the mouth and nose or the entire face and prevents users from inhaling harmful airborne substances.
Two key types of respirators, each designed to provide different levels of protection and safeguard against different hazards, are:
- Air-purifying respirators: This type of respirator includes a filter, cartridge, or canister that effectively removes contaminants as air moves through them. The most common types of air-purifying respirators in healthcare are filtering facepiece respirators, such as N95s, and powered air-purifying respirators (PAPRs).
- Atmosphere-supplying respirators: This type of respirator provides clean breathing air from another source, such as a compressor. Supplied air respirators (SAR) and self-contained breathing apparatus (SCBA) are two common types of atmosphere-supplying respirators.
Understanding OSHA's Respiratory Protection Standard and Employer Responsibilities
If employees must wear respirators at work, the Occupational Safety and Health Administration (OSHA) requires employers to have a written respiratory protection program, as outlined in OSHA's respiratory protection standard 1910.134 under the PPE Subpart. The standard aims to safeguard employees from occupational diseases caused by inhaling contaminated air, including harmful dust.
Respirators must be used when engineering control systems are not feasible or insufficient to eliminate the respiratory hazard. They may also be needed while engineering controls are being installed.
Between October 2022 and September 2023, respiratory protection was one of the top-cited OSHA standards in healthcare. Complying with OSHA standards not only helps to keep employees safe but also aids in avoiding citations and monetary penalties.
Employers must provide applicable and suitable respirators to each employee when necessary to protect their health. Moreover, the employer is responsible for establishing and maintaining a respiratory protection program that covers each employee required to use a respirator. This program must include worksite-specific procedures and elements. In addition, the program must be updated as necessary to reflect changes in workplace conditions affecting respirator use.
The program must be run by a designated program administrator who has appropriate training or experience, which is aligned with the program’s level of complexity. Employers should understand OSHA’s respiratory protection standard requirements, be familiar with the respirators used by the staff, and be able to recognize, evaluate, and control hazards in the workplace. OSHA provides a Small Entity Compliance Guide outlining all of the elements a respiratory protection program must meet, including components for voluntary respirator use.
Adhering to these guidelines ensures the effective implementation and maintenance of a comprehensive respiratory protection program, ultimately promoting a safe and healthy work environment for affected employees.
What are the requirements for establishing a respiratory protection program?
According to the requirements of OSHA’s respiratory protection standard, each organization requiring respirator use must incorporate the following elements into their written respiratory protection programs:
- Procedures for respirator selection: Employers must identify and evaluate the respiratory hazards in the workplace before providing an appropriate respirator. OSHA requires that employers select a respirator that is certified by the National Institute of Occupational Safety in Health (NIOSH).
- Procedures for medical evaluations: All employees must undergo medical evaluations by a physician or other licensed healthcare professional (PLHCP) who can provide a written recommendation regarding the employee’s ability to use a respirator. PLHCP evaluations can be conducted through a confidential questionnaire or an in-person exam.
- Procedures for fit testing of tight fitting respirators: Fit testing of a respirator must be done with the same make, model, style, and size of the respirator that the employee is going to use. All tight-fitting respirators must pass a series of tests before initial use, on an annual basis, and whenever the size, style, make, or model of the respirator is changed.
- Procedures for proper use: Employers must establish and implement procedures that prevent facepiece seal leakage and ensure respirators are not removed in hazardous environments during both routine and reasonably foreseeable emergencies.
- Procedures and scheduled maintenance and storage: Respirators must be regularly cleaned and disinfected to maintain sanitary conditions. When used by multiple employees, respirators must undergo cleaning and disinfection before being worn by different individuals. Proper storage procedures are essential to protect respirators from damage, contamination, and exposure to harmful chemicals.
- Procedures for breathing air quality: Employers must ensure the source of air for air-supplying respirators is of high purity, meets quality levels for content, follows moisture requirements, and doesn’t exceed set contaminant levels.
- Procedures for employee training on respiratory hazards: Employers must provide comprehensive training to employees regarding potential respiratory hazards encountered during both routine use and emergencies. This includes instruction on effective respirator usage during emergencies, awareness of how improper fit, usage, or maintenance can compromise protection, and protocols for dealing with malfunctions.
- Procedures for employee training on the proper use of respirators: Employers are required to train employees initially and annually. Each employee will learn how to properly fit and maintain respirators; how to use the respirator effectively in emergencies; how to inspect, put on, remove, and use respirators; and the general requirements of the respiratory protection standard.
- Procedures for regular program evaluation: Regular evaluations must be conducted by employers to ensure program effectiveness, leveraging input from employees to assess proper respirator use and program satisfaction.
- Procedures for cost coverage: Employers are responsible for providing respirators, training, and medical evaluations at no cost to employees.
Learn more about how Stericycle can help your organization navigate OSHA standards such as the Respiratory Protection Standard.
