1. Establishing a Respiratory Protection & Fit-Testing Program for FQHCs Amelia Muccio, Director of Disaster Planning, NJPCA

2. Objectives for FQHCs Respiratory Protection Program Demonstration of Fit Testing “Give someone a fish (fit test) and you feed him for a day (year); Teach someone to fish (fit test) and you feed him for a lifetime.”

3. Proper Protection: OSHA’s Part 1910.134 Program Administration Worksite Procedures Respirator Selection Employee Training Fit-Testing Medical Evaluation Respirator Use, Cleaning, Maintenance and Repair

4. Healthcare Industrial Hygiene “Hierarchy of Controls” 1.Engineering 2.Administrative 3.Elimination of infection sources 4.PPE

5. Components of a Respiratory Protection Program Develop a written plan Medically evaluate your employees Complete fit testing and training Provide the appropriate PPE including a NIOSH approved N95.

6. Plan Components Procedures for selecting respirators for use in the workplace Medical evaluation of employees required to use respirators Fit testing procedures Procedures for proper use in routine and emergency situations Procedures and schedules for cleaning, disinfecting, and maintenance. Procedures to ensure adequate air quality, quantity and flow (atmosphere-supplying respirators) Training of employees in the respiratory hazards to which they may be potentially exposed to during routine and emergency situations. Training of employees in the proper use of respirators (donning, doffing, limitations on their use and maintenance) Procedures for regular evaluation of the effectiveness of the program.

7. Respiratory Program Written program with work-site procedures. Must include updates and stay current with new guidance/recommendations. Should have program administrator Program should have no cost

8. Develop a Written Plan Including: Procedures for respirator selection Medical evaluation for employees Fit-Testing for tight-fitting respirators Procedures for routine and emergency use Procedures for cleaning, disinfecting, storing, inspecting, repairing, discarding, and maintaining respirators. Training employees on hazards and proper use of respirators (donning, doffing, limitations, and maintenance). Routine evaluation of program effectiveness

9. Training and Information Training must be comprehensive, understandable, prior to use of respirator, updated at least annually including: Why the respirator is necessary and the need for proper fit, usage, and maintenance Limitations and capabilities Use in emergency situations How to inspect, put on and remove, check seals Procedures for maintenance and storage How to recognize medical signs and symptoms that limit or prevent effective use General requirements of the OSHA regs

10. Recordingkeeping Records and medical evaluations must be retained and made available per 29 CFR 1910. A record of fit tests must be established and retained until the next fit test is administered. Written copy of current program must be maintained and available at OSHA’s request.

11. Medical Evaluation N-95s must be fit tested. Medical evaluation before fit testing and use. PLHCP performs medical evaluation using a medical questionnaire or initial medical exam that obtains same information. Follow-Up required for employee who gives positive responses to any question among 1-8 in Section 2, Part A of App. C or whose initial medical exam demonstrates the need for a follow-up medical exam. Must include medical tests, consultations, procedures if deemed necessary to make final determination. Confidentiality must be maintained.

12. Program Evaluation Must conduct evaluations of the workplace as necessary to ensure effective implementation of the program. Factors to be assessed include: respirator fit, appropriate selection, proper use, and proper maintenance.

13. What is a Respirator? A respirator is a protective device that covers the nose and mouth or the entire face or head to guard the wearer against hazardous atmospheres. Respirators may be: –Tight-Fitting: that is, half masks, which cover the mouth and nose and fall face pieces that cover the face from the hairline to below the chin. –Loose-Fitting: such as hoods or helmets that cover the head completely.

14. Respirators WHY: Protection against harmful elements that can infiltrate respiratory tract. WHEN: Employees need to wear respirators whenever engineering and work practice control measures are not adequate to prevent contamination. Respirators are not a substitute for effective engineering and work practice controls.

15. Two Major Classes of Respirators Air Purifying: remove contaminants from air Atmosphere Supplying: provide clean, breathable air from an uncontaminated source

16. Quantitative vs. Qualitative Fit Testing Three accepted OSHA protocols computerized means of quantitative fit Generated aerosol Portacount TM Controlled negative pressure Four OSHA accepted protocols for qualitative fit Isoamyl Acetate (cartridge respirator to remove organic vapors Saccharin (particulate filter of any class) Britrex TM (particulate filter of any class) Irritant smoke (level 100 particulate filter)

17. Qualitative (QLFT) Fit Test Pass/Fail based on user’s responses Relies on human senses (can lead to error) Sensitivity check first No chewing gum, smoking or eating for 30 minutes before test Up to 10 squeezes in hood 1-10: 10 initial then in 30 seconds squeeze 5 times 11-20: 20 initial then 10 squeezes 21-30: 30 initial then 15 squeezes No sensitivity=No test

18. Qualitative (QLFT) Fit Test Procedure: hood over head, chemical in hole in hood (turned to side) and ask the question, do you taste/smell it? “sensitivity check” Now don respirator and begin fit test With respirator on, begin test with 7 tests with full fit test kit solution Need to keep time for exercise and squeezing Spray and do exercises Pass/Fail—form needed to capture information Doff mask properly Qualitative Fit-Testing involves the introduction of a harmless odoriferous into breathing zone. If no odor is smelt, then the mask fits properly.

19. Fit Testing Fit Testing on tight fitting respirators only. Make sure that each employee knows their size and type of their mask. Show worker how to don mask using mirror. Determine fit. User checks the seal and makes sure mask is fitting properly. If employee has difficulty breathing then they must be referred to a physician. Choose another mask if fit is unacceptable. Brief worker on test exercises before fit test.

20. Test Exercises (1 minute each) 1.Normal breathing 2.Deep breathing 3.Head side to side 4.Head up and down 5.Talk out loud 6.Bend over or jogging in place 7.Normal breathing No adjustments/ask about comfort