Introduction to Respiratory Protection

1. Introduction to Respiratory Protection 29 CFR 1910.134

2. Respiratory Hazards • Particulates • dusts • fumes • mists • fibers • Gases and Vapors • Oxygen Deficiency • The primary means to control respiratory hazards is through the use of control measures such as ventilation, enclosures, isolation, substitution of less toxic materials, or work practice modifications, and ppe.

3. Respiratory Tract Naso-pharyngeal Region Trachea Bronchi Bronchiole Terminal Bronchiole Respiratory Bronchiole Alveolar Duct Alveolar Sac Tracheal-bronchial Region (conducting region) Pulmonary Compartment (1/2 tennis court) The major divisions of the respiratory tract (adapted from J.B. West, Respiratory Physiology, 4th ed. Baltimore, MD: Williams and Wilkins, 1990).

4. Droplet vs. Airborne Precautions Droplet Precautions — Intended to prevent transmission of infectious agents spread through close respiratory or mucous membrane contact with respiratory secretions. In addition to standard precautions, droplet precautions require: 􀁸 Mask—Don a mask upon entry into the patient room or cubicle. 􀁸 Other areas addressed include patient placement and patient transport. Airborne Precautions — Intended to prevent transmission of infectious agents that remain infectious over long distances when suspended in the air. In addition to standard precautions, airborne precautions require: 􀁸 Respiratory protection — Wear a fit-tested NIOSH-approved N95 or higher level respirator for respiratory protection when entering the room or home of a patient who is suspected or confirmed to have an airborne infectious disease. 􀁸 Other areas addressed include patient placement, patient transport, personnel restrictions, and exposure management SOURCE: Siegel et al., 2007.

5. Medical (surgical) Masks vs. Respirators Medical masks (the term is used in this report to encompass surgical masks and procedure masks) are loose-fitting coverings of the nose and mouth designed to protect the patient from the cough or exhaled secretions of the physician, nurse, or other healthcare worker. Medical masks are not designed or certified to protect the wearer from exposure to airborne hazards. They may offer some limited, as yet largely undefined, protection as a barrier to splashes and large droplets. However, because of the loose-fitting design of medical masks and their lack of protective engineering, medical masks are not considered personal protective equipment.

6. Benefits of a Medical Mask • Medical masks • Readily available • Inexpensive • But does not provide respiratory protection and is not PPE

7. What is a Respirator? The term respirator is used in the healthcare field to refer to two different medical devices: (1) the personal protective equipment discussed in this report that is used to reduce the wearer’s risk of inhaling hazardous substances and (2) the mechanical ventilator device that is used to maintain the patient’s Respiration following endotracheal intubation. This dual (medical and occupational) use of the term respirator has prompted many healthcare workers to refer to PPE respirators as masks, thereby confounding the important distinctions between medical masks and respirators.

8. What is a Respirator? Respirators are devices that protect workers from inhaling harmful airborne substances …. Some respirators also ensure that workers do not breathe air that contains dangerously low levels of oxygen (O2). (OSHA’s Small Entity Compliance Guide, 9/30/98)

9. What is a Respirator? Respirators are personal protective devices that cover the nose and mouth (or in some cases, more of the face and head) and are used to reduce the wearer’s risk of inhaling hazardous airborne particles. Respirators operate either by purifying the air inhaled by the wearer through filtering materials or by independently supplying breathable air to the wearer. The two major issues related to air-purifying respirators are the filter and the fit—the effectiveness of the filter and the extent to which the respirator has a tight seal with the wearer’s face that does not permit inward leakage.

10. Overview of Use Requirements To effectively wear most types of air-purifying respirators, prospective wearers must undergo annual fit testing (using Qualitative and/or quantitative tests), and they are asked to perform a fit check with each use of the device.

11. Benefits of a Respirator Respirators worn by healthcare workers not only will protect them, but also may reduce the spread of disease from one patient to another (via the healthcare worker) or from an infected but asymptomatic healthcare worker.

12. Respirator? • Is a filtering face piece a respirator? • How about a one-strap mask? • How about a two-strap mask? • What about a surgical mask? . • Ever see a bandana used as a respirator - is it?

13. Two Classes of Respirators • 1) Air-purifying respirators - respirators with an air-purifying filter, cartridge, or canister that remove specific air contaminants such as dusts, fumes, mists, vapors, or fibers by passing ambient air through an air-purifying element • 2) Atmosphere-supplying respirators - provide clean breathing air from an uncontaminated source

14. Two Operational Modes • 1) Negative Pressure - A respirator in which the air pressure inside the face piece is negative during inhalation with respect to the ambient air pressure outside the respirator. • 2) Positive Pressure - A respirator in which the pressure inside the respirator exceeds the ambient air pressure outside the respirator.

15. Air Purifying Respirators • Tight-fitting respirator • Negative pressure • Only for use against particles • One of most common types used in industry Dust Mask OSHA APF = 10

16. Air Purifying Respirators • Tight-fitting respirator • Negative pressure • Uses replaceable filters, canisters, or cartridges • 2nd most common type Half Mask OSHA APF = 10

17. Powered Air-Purifying Respirator (PAPR) • An air-purifying respirator that uses a blower to force the ambient air through air-purifying elements to the respirator • Can be loose fitting or tight fitting • Always positive pressure • Continuous flow OSHA APF = 25 (loose fitting) OSHA APF = 25/1000 (tight fitting)

18. Respirator Filter A component used in respirators to remove solid or liquid aerosols from the inspired air. Also called air purifying element.

19. Classes of Filters 42 CFR Part 84 establishes three series of filters and each has three levels of efficiency. Levels of efficiency 95 99 100 N N95 N99 N100 R R95 R99 R100 P P95 P99 P100 Resistance

20. Cartridge Change Schedule A cartridge change schedule must be developed for cartridges that do not have an end of service life indicator

21. Selection of Respirators The employer shall identify and evaluate the respiratory hazard(s) including a reasonable estimate of employee exposures and should consider workplace and user factors that affect respirator performance and reliability.

22. 1910.134(c)(1) Respiratory protection program • Where respirators are required you need: • Written program • Worksite-specific procedures • Required elements: • Training • Fit testing • Medical evaluations • Care and maintenance • Procedures for respirator selection • Procedures for routine & emergency use

24. Factors That Can Influence Respirator Selection • Worker Medical Condition • Wearing respiratory protection poses a physical burden on the wearer. • When a worker's medical condition would prohibit restrictive breathing conditions, negative pressure respirators would not be an appropriate choice. • Worker Comfort • Worker preferences should be a consideration during the respirator selection process. • Worker-Resident Communication and Perception

25. Employer Responsibilities » Employers must designate a respirator program administrator, qualified by training or experience, to oversee the program » Respirators, training, and medical evaluations must be provided at no cost

26. Written Respirator Program REQUIRED: 1) When respirators are necessary due to air contaminant overexposure 2) When respirators are required by the employer

27. Respirator Use Not Required • Employer may provide respirators at request of employees OR • Allow employees to use their own respirator

28. Voluntary Respirator Use Employer must ensure that: 1) Employees are medically able to use respirators 2) The respirator is cleaned, stored, and maintained properly 3) A written program addresses the two elements listed above 4) Employees are provided with information from Appendix D of the standard

29. Voluntary Respirator Use EXCEPTION: Employers are not required to include in a written respirator program those employees whose only use of respirators involves the voluntary use of filtering facepieces (i.e. dust masks)

30. You Must Wear the Respirator Correctly! You will not be protected if you don't wear your respirator correctly. Follow the manufacturer's instructions. For dust masks (also called filtering facepieces or "N95" respirators) and other half-facepiece respirators this means: • The respirator is properly positioned over your nose and mouth at all times; • The top strap or head harness assembly is positioned high on the back of the head; • The lower strap is worn at the back of the neck below the ears; • Nothing (beards, head coverings, etc.) passes between the skin of the face and the respirator's sealing edge. • Do not take the respirator away from you nose or mouth until you reach clean air! Properly worn respirator Improperly worn respirators Both straps must bepositioned correctly. The nose and mouth mustbe covered at all times.

32. Respirator Fitting Applies Only to Respirators with Tight-fitting Facepieces

33. Respirator Fitting • USER SEAL CHECK • Positive • Negative • FIT TEST • Qualitative • Quantitative

34. User Seal Check The purpose of the user seal check is to subjectively assure that the there is an adequate seal of the face piece to the face of the wearer A user seal check must be performed each time the user puts on the respirator

35. Positive Pressure User Seal Check

36. Negative Pressure User Seal Check

37. Fit Test The main purpose of a fit test is to select the best fitting size and make of respirator within a pre-determined class for a specific individual

38. Fit Test Fit Tests must be performed: 1) Prior to initial use 2) Whenever a different face piece is used 3) Annually 4) When changes in an employee’s physical condition occur 5) Employee indicates that fit is poor

39. Qualitative Fit Test • Four Validated Methods • Saccharine Solution Aerosol • Bitrex Solution • Isoamyl Acetate (Banana Oil) • Irritant Smoke (Stannic Chloride)

40. Saccharine Solution Aerosol

41. Quantitative Fit Test • Four Validated Methods • Generated Aerosol System • Ambient Aerosol System • Controlled Negative Pressure System • REDON

42. Ambient Aerosol System

43. Medical Evaluations 1) Must be provided before fit testing and before an employee is required to use a respirator 2) Must be performed by a physician or PLHCP using a medical questionnaire (from Appendix C of standard) or initial medical screening that obtains the same information 3) Follow-up exam provided if necessary, based on employee’s initial evaluation

44. Medical Evaluations Two situations where medical evaluation is not required: • Voluntary use of filtering facepieces (dust masks) • Use of escape-only respirators Note: OSHA’s expanded health standards contain specific medical monitoring requirements.

45. Medical Evaluations Information provided to PLHCP: a) type and weight of respirator b) duration and frequency of use c) expected work effort d) other protective equipment and clothing worn e) temperature and humidity extremes during use f) copy of written respirator program

46. Medical Evaluations Additional evaluations required if: 1) employee reports medical problems related to respirator use 2) a PLHCP, supervisor, or program administrator indicates need for reevaluation 3) observations during fit testing, program evaluation, etc. indicate need 4) change in workplace conditions result in increase in physiologic burden

47. Respirator Maintenance and Care • Maintain in sanitary condition • Store to prevent damage or contamination • Inspect before use and during cleaning • Emergency use respirators inspected monthly • Repairs done by trained person using parts from same manufacturer

48. Respiratory ProtectionResources • http://www.osha.gov • Slide Presentation • Major Requirements for OSHA’s Respiratory Protection Standard (PDF File) • Respiratory Protection Frequently Asked Questions • Respiratory Protection Standard (Correction)

49. Respiratory Protection Resources • http://www.osha.gov • Summary and Explanation of the Standard • Respiratory Protection Final Rule • Respiratory Protection Technical Advisor

50. Respiratory Protection 29 CFR 1910.134 Voluntary Use of Respirators Yes No No Yes No No Yes Yes Yes Yes