Respiratory Protection

1. Respiratory Protection Presented by: Elizabeth Gregory, Staff Officer Orange County Respiratory Protection Program Administrator

2. Purpose of Respiratory Protection To provide against both the acute and chronic adverse health effects which may result from worker exposure to atmospheres, which are oxygen deficient and/or contain toxic air contaminants.

3. Philosophy of Respirator Use Respiratory protection is not considered a primary means of controlling worker exposure to air contaminants. The primary means of reducing and eliminating worker exposure to air contaminants is through engineering and administrative controls. Respirators should be used only when effective engineering or administrative controls are not feasible while controls are being implemented, or during emergencies.

4. Respirator Program Management Where respirators are in use in the workplace, a formal respiratory protection program must be established covering the basic requirements outlined in the OSHA Respiratory Protection Standard (29 CFR 1910.134). Education and training must be properly emphasized and conducted periodically. Maintenance, cleaning, and storage programs must be established and routinely followed for reusable respirators.

5. Limitations of Respirator Use • Air purifying respirators do not supply oxygen • Air purifying respirators must not be used in atmospheres, which are immediately dangerous to life and health • Beards, or other facial hair may interfere with the airtight seal between the respirator and face. • No one cartridge is good for everything. You must use approved cartridges for the specific chemical in question. • Misuse of a respirator may result in overexposure, sickness, or death.

6. Scope of 1910.134 • General Industry • Shipyards • Marine Terminals • Long Shoring • Construction

7. Scope of 1910.134 for Tuberculosis • Health Care facilities with patients who have confirmed or suspected cases of TB are treated or transported • Hospitals • Doctor’s Offices • Clinics • Dental personnel (hospital or correctional facilities) • For non-hospital health care facilities, includes only personnel present during performance of high hazard procedures

8. High Hazard Procedures Procedures that involve instrumentation of the lower respirator tract or induce coughing can increase the likelihood of droplet nuclei being expelled into the air. These cough-inducing procedures include: ∙Endotracheal intubation and suctioning ∙Diagnostic sputum induction ∙Aerosol treatments (e.g. pentamidine therapy) ∙Bronchoscopy ∙Irrigation of tuberculosis abscesses, homogenizing or lyophilizing tissue ∙Other processing of tissue that may contain tubercle bacilli

9. Scope of 1910.134 for Tuberculosis • Other facilities include: • Correctional Institutions • Long Term Care Facilities for the Elderly • Homeless Shelters • Drug Treatment Facilities

10. Purpose Assure that employees are protected from overexposure to air contaminants that cannot be reduced to a safe level with acceptable engineering control measures such as substitution, ventilation, or confinement.

11. Permissible Practice Employer: • Provides respirators • Provides appropriate respirator • Establishes and maintains an effective respiratory protection program

12. Written Program Required Elements: • Respirator selection procedure • Medical Evaluations • Fit testing procedures for tight-fitting respirators • Training in potential respiratory hazards for routine and emergency situations • Training in proper use, limitations, and maintenance of respirators • Procedures for regularly evaluating program effectiveness

13. Written Program Employer Requirements: • Develop and implement a complete written respiratory protection program when respirators are required • Certain program elements required for voluntary use • Administered by suitable trained program administrator

14. Written Requirement Required Elements • Procedures/schedules for respirator cleaning/maintenance • Procedures for proper use in routine and foreseeable emergency situations • Procedures to ensure adequate air quality, quantity, and flow for atmosphere-supplying respirators

15. When Respirator Use is Not Required… Employer or employee may provide respirator if use does not create health hazard to user. • Program requirements: • Filtering face-piece respirators • Only mandatory Appendix D • Doesn’t create health hazard to user • Other voluntary use respirators • Appendix D • Medical evaluation • Properly cleaned, stored, and maintained respirator

16. Cost to Employee Required respirators provided at no cost to employees • Voluntary use • Employer not required to provide respirator • Filtering –face-piece • Employer need provide only Appendix D • Other respirators • Employer covers cost associated with ensuring no harm, such as Appendix D, medical evaluation, proper care of respirator

17. Respirator Selection Employer: • Identifies and evaluates the respiratory hazard(s) in the workplace including: • Reasonable estimate of exposure • Identification of contaminants • Chemical State • Physical Form

18. Respirators for IDLH Atmospheres • Full face-piece pressure demand SCBA certified by NIOSH for a minimum service life of thirty minutes OR • Combination full face-piece pressure demand supplied-air respirator (SAR) with auxiliary self-contained air supply • Escape only – NIOSH certified

19. Program Administrator • Employer Designated • Administers/oversees the program • Conducts the required evaluation of program effectiveness

20. Respirator Selection Employer: • Selects and provides appropriate respirator (NIOSH-certified) • NIOSH approval not required for voluntary use (OSHA 10/01/99) • Selects respirators from sufficient models and sizes that are acceptable to and fit the user

21. Medical Evaluation Procedures • Physician or PLHCP to perform medical evaluations which include medical questionnaire (Appendix C), or initial medical examination. • Medical evaluation (exam or questionnaire) shall obtain information requested by questionnaire in Sections 1 and 2, Part A of Appendix C

22. Medical Evaluation - General • Determine the employee’s ability to use a respirator by questionnaire review, and/or medical exam, prior to: • Fit testing • Required respirator use • Voluntary use – except not required for filtering face-piece respirator • Not required for use of escape-only respirators • (SCBA not considered escape only – CPL 2.0 – 120)

23. Follow-Up Medical Examination • Required if positive response to any question among Nos. 1-8, Section 2, or initial medical examination demonstrates need • Includes any medical tests, consultations, or diagnostic procedures that the PLHCP deems necessary

24. PLHCP Written Recommendation Contains Only… • Whether employee medically able to use the respirator and any limitations on use • Whether follow-up medical examinations are needed • Statement that employee received copy

25. Administration of Medical Questionnaire and Examinations In manner understood by employee… • Administer confidentially during the employee’s normal working hours, or at a time and place convenient to the employee • Give employee opportunity to discuss the questionnaire and examination results with the PLHCP

26. PAPR and Medical Evaluation • If negative pressure respirator may place employee heath at increased risk • Employer must provide PAPR if medically acceptable • If subsequently able to use negative pressure respirator per medical evaluation, no longer require PAPR

27. Medical Signs and Symptoms • The following are signs or symptoms that may prevent the use of a respirator: • Seizures • Claustrophobia • Asthma • Emphysema • Pneumonia • Collapsed Lung • Lung Cancer • Broken Ribs • Chest Injuries/Surgeries • Any other lung problems • Heart or Circulation problems • Anxiety

28. Fit Testing • Users of tight-fitting face-piece respirators pass an appropriate Qualitative Fit Test or Quantitative Fit Test • Prior to initial use • Whenever a different face-piece size, style, model, or make is used • At least annually (e.g. – June 1 to June 1)

29. Additional Medical Evaluations • At minimum when… • Employee reports medical signs or symptoms related to respirator use • PLHCP, supervisor, or respirator program administrator informs of the need • Information form respiratory protection program (ex., fit test or program evaluation) • Change in workplace conditions resulting in substantial increase in physiological burden

30. Fit Testing • Not required for • Voluntary use • Escape only • Loose fitting respirators

31. Fit Testing • Conduct additional fit test whenever changes occur that could affect fit (scarring, dental changes, cosmetic surgery, obvious change in body weight) • If after passing a fit test, employee notifies that fit is unacceptable, select different respirator face-piece and retest

32. Face-Piece Seal Protection • Do not permit respirators with tight-fitting face-pieces to be worn by employees who have: • Facial hair that comes between sealing surface or interferes with valve function OR • Any condition that interferes with face-to-face-piece seal or valve function

33. Face-Piece Seal Protection • Corrective glasses, goggles, or other PPE-such equipment is worn in a manner that does not interfere with seal • User seal check performed each time user puts on respirator (Appendix B-1).

34. Respirator Storage • Emergency respirators are: • Accessible to work area • In compartments or covers clearly marked as emergency respirator • Stored according to manufacturer instructions

35. Cleaning and Disinfecting Respirators • Each respirator is clean, sanitary, and in good working order (procedures in Appendix B-2): • Exclusive use respirators cleaned and disinfected as often as necessary to be maintained in sanitary condition • Disposable respirators disposed of properly after each use

36. Respirator Storage • Protect from damage, contamination, dust, sunlight, extreme temperature, excessive moisture, damaging chemicals • Prevent deformation of face-piece and exhalation valve

37. Respirator Inspections • Routinely used respirators inspected before each use and during cleaning • Emergency respirators; • At least monthly in accordance with manufacturer’s recommendations • Checked for proper function before and after each use

38. Training and Information • Use in emergency situations, including malfunctions • How to inspect, put on, remove, use and check the seals • Procedures for maintenance and storage

39. Training and Information • Employee must demonstrate knowledge of at least: • Why respirator is necessary • How improper fit, usage or maintenance can compromise protective effect • Limitations and capabilities of respirator

40. Training and Information • How to recognize medical signs and symptoms that may limit/prevent effective use • General requirements of Respiratory Protection Standard

41. Training and Information • Administer retraining whenever: • Changes in workplace or type of respirator render previous training obsolete • Employee knowledge or use indicates required understanding or skill not retained or other indication that training appears necessary

42. Program Evaluation • Conduct to ensure the provisions of current written program are effectively implemented and continue to be effective • Regularly consult employees who are required to use respirators and correct any problems identified

43. Program Evaluation • Factors assessed include, but not limited to: • Respirator fit • Appropriate respirator selection • Proper use for workplace conditions • Proper respirator maintenance

44. Medical Evaluation Records Retain in accordance with 29 CFR 1910.1020

45. Written Program Record Copy of current written program available to affected employee or OSHA

46. Fit Testing Records • Record for QNFT and QLFTs: • Name of employee, type of test • Make, model, style, and size of respirator • Date of test • Pass/fail results for QLFT • Fit factor, strip chart recording, other recording for QNFTs • Retain records until next fit test is administered

47. Appendices • Compliance is mandatory: • Appendix A (fit testing) • Appendix B-1 (user seal check) • Appendix B-2 (respirator cleaning procedures) • Appendix C (medical evaluation questionnaire) • Appendix D (information for non-mandatory respirator use)

48. 42 CFR 84 Filter Use Times • N-Series (as in N-95s - no oil) • Use generally limited only by considerations of hygiene, damage, and breathing resistance • No more than 8 hours in high filter loading (200 mg) areas (continuous or intermittent) unless specific workplace evaluation

49. User Seal Check • An action by the respirator user to determine if the respirator is properly sealed to the face • There are positive pressure seal checks and negative pressure seal checks

50. Location of Standard and Program Information • OSHA Standard for Respiratory Protection, 29CFR 1910.134 can be located at: • www.osha.gov • Orange County Emergency Services Employee Acknowledgement Form for Fit Testing SOG, Respiratory Protection Program, and Grievance Procedures can be located at: • (S:) drive, SHARED, Acknowledgement Form – Fit Testing SOG, Respiratory Protection Program and/or Grievance Procedures for Fit Testing • Respiratory Fit Testing SOG can be located at: • http://www.co.orange.nc.us, Departments, Emergency Services, Departmental Use, Orange County Emergency Services SOGs (Staff Only)