Recently I was working on updating our respiratory program, and training that both the employee and supervisor could easily understand and still meet OSHA 1910.134. How fortunate that on February 12, 2011 the DOL came out with a new training video.

The 33-minute video explains the major components of a respiratory protection program including fit-testing, medical evaluations, training, and maintenance. The video also discusses the difference between respirators and surgical masks, and features a segment on common respiratory hazards found in healthcare settings, including airborne infectious agents that cause diseases such as tuberculosis, pandemic influenza, severe acute respiratory syndrome (SARS), chicken pox, and measles.

Demonstrations also show how respirator use helps protect workers from exposure to airborne chemical hazards such as formaldehyde and glutaraldehyde, which are used commonly in hospital laboratories to preserve tissue samples for medical analysis. These toxic substances can cause eye and nasal irritation, headaches, asthma, and other symptoms. Additionally, formaldehyde is a carcinogen and has been linked to nasal and lung cancer, with possible links to brain cancer and leukemia.

“Employers can’t rely on respirators providing the expected protection if they don’t train their workers on how to use them properly,” said Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels. “This video is an important training tool that teaches proper respirator use and discusses employers’ responsibilities under OSHA’s respiratory protection standard.”

Intended for both employers and employees, the 33-minute video covers the main components of a respiratory protection program, the difference between respirators and surgical masks, and common respiratory hazards in health care settings – including airborne infectious agents that cause diseases such as tuberculosis, according to an OSHA press release.

The risk of influenza to healthcare workers is not a new concern, but the ongoing experience with novel influenza A (nH1N1) makes this issue even more urgent. Among the many considerations for the health and well-being of healthcare workers is the question about what types of personal protective equipment (PPE) (respiratory protection, gloves, gowns, eye protection, and other equipment) are needed to protect these frontline workers. PPE needs to be regarded one part of a set of infection control strategies to reduce the potential for infection in healthcare workers. At the request of the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) the Institute of Medicine convened the Committee on Respiratory Protection for Healthcare Workers in the Workplace Against Novel H1N1 Influenza A to provide recommendations regarding the necessary respiratory protection for healthcare workers in their workplace against novel H1N1 influenza A.

RESPIRATORY PROTECTION

The committee focused solely on the scientific and empirical evidence regarding the efficacy of various types of personal respiratory protective equipment (e.g., medical masks and respirators). Studies on influenza transmission show that airborne (inhalation) transmission is one of the potential routes of transmission. N95 respirators are documented to filter out 95 to 99 percent of relevant particles and have maximum effectiveness when properly fitted to the face of users. Research results on the filtration and fit of medical masks show wide variation in penetration of aerosol particles and inadequate fit suggesting that the use of medical masks is unlikely to be effective against airborne transmission.

Recommendationation 1: Use Fit -Teste d N95 Respirators espirators

Healthcare workers (including those in non-hospital settings) who are in close contact with individuals with nH1N1 influenza or influenza-like illnesses should use fit-tested N95 respirators or respirators that are demonstrably more effective as one measure in the continuum of safety and infection control efforts to reduce the risk of infection.

• The committee endorses the current CDC guidelines and recommends that these guidelines should be continued until or unless further evidence can be provided to the effect that other forms of protection or other guidelines are equally or more effective.

• Employers should ensure that the use and fit testing of N95 respirators be conducted in accordance with OSHA regulations, and healthcare workers should use the equipment as required by regulations and employer policies.

It is important to note that controversy exists regarding clinical guideline decision making as many factors besides efficacy may affect policy decisions for PPE guidance including economics, equipment supplies, vaccine availability, immunization status, extent of worker compliance, and logistical considerations in the implementation of such guidance. The committee was not charged to address these other issues.

OSHA is proposing to add two PortaCount® quantitative fit-testing protocols to its Respiratory Protection Standard (29 CFR 1910.134); the proposed protocols would apply to employers in general industry, shipyard employment, and the construction industry. The first of the two proposed protocols consists of the eight fit-testing exercises described in Part I.A.14 of Appendix A of the Respiratory Protection Standard, except each exercise would last 30 seconds instead of the currently required 60 seconds.\1\ The second proposed protocol would eliminate two of the eight fit-testing exercises, and each of the remaining six exercises would last 40 seconds; in addition, this proposed protocol would increase the current minimum pass-fail fit-testing criterion from a fit factor of 100 to 200 for half masks, and from 500 to 1,000 for full facepieces.