Minimize the number of staff interacting with students identified to have flu-like symptoms
Although vaccination is an administrative control, it is one of the most effective interventions for preventing transmissions of influenza
Prevents transmission in work, community, and home settings
Personal Protective Equipment (PPE)
Least effective control in the hierarchy
Relies on the individual to use and maintain properly
Implementation of policies for eliminating exposures, engineering controls and administrative controls reduces the need to rely on N95 respirators
End of Module 2 - Hierarchy of Controls
Click here for Module 3
Module 3 - Components Of A Respiratory Protection Program
Components of a Respiratory Protection Program
Written program specific to the workplace
Specify employees from each department/ unit that are included in respiratory protection program
Assign a qualified administrator to implement program
A person is qualified when they have had the appropriate training or experience to administer or oversee the program and conduct the required program evaluation
Selecting a Respirator
Must be NIOSH - Certified Respirator used in compliance with the conditions of its certification
Based on respiratory hazards and activities encountered in the workplace
Provide sufficient number of models and sizes to fit a variety of staff facial morphology (2009 H1N1 demand may limit ability to provide a variety of sizes and models)
Employee Medical Evaluation
The employer must select a Physician or Other Licensed Health Care Professional (PLHCP) to perform medical evaluations
The PLHCP may be a physician, registered nurse, nurse practitioner, physician assistant or other licensed health care professional acting within the scope of their state license, registration, or certification (OSHA Directive CPL 2-0.120)
The PLHCP uses a medical questionnaire from the OSHA Respiratory Standard, Appendix C, that is considered an initial medical examination (NOTE: the ASTM Z88 standard provides some guidance for medical qualifications for respirator use.)
Respirator Fit Testing Procedures
Qualitative fit test method using Saccharin or Bitrex
Utilize same make, model and size employee will use
Fit test will be performed annually
Employee Respirator Training
Provide effective training to employees required to use respirators
Conduct annually: comprehensive and understandable
Include proper use, inspection and reasons for use
Program Evaluation For Proper Implementation
Respirator Fit Testing
End of Module 3 - Components of a Respiratory Protection Program Click here for Module 4
Module 4 - Medical Evaluation
Initial Medical Evaluation (Questionnaire or Medical Exam)
A respirator may place a respiratory burden on employees that varies with the job and workplace conditions, and the medical status of the employee
The employer shall provide a medical evaluation to the employee before the employee is fit tested or required to use the respirator
The employer shall identify a physician or other licensed health care professional (PLHCP) to perform medical evaluations (as defined on the Employee Medical Assessment slide)
The PLHCP shall obtain information specified by the OSHA Respirator Medical Evaluation Questionnaire (see Appendix C of 29CFR1910.134)
Follow-up Medical Examination
The employer shall ensure that an employee receives a follow-up medical examination (physical exam) when the initial medical evaluation warrants one
The follow up medical examination must be performed by a licensed physician, nurse practitioner, or physician’s assistant.
The follow-up medical examination shall include any medical tests, consultations, or diagnostic procedures that the PLHCP deems necessary to make a final determination that the user can safely wear a respirator.
Administration of the Medical Questionnaire and Examinations
Both the questionnaire and the examinations shall be administered confidentially during the employee's normal working hours or at a time and place convenient to the employee
The questionnaire shall be administered in such a manner that is understood by the employee
The employer shall provide the employee with an opportunity to discuss the questionnaire and examination results with the PLHCP
Employer Provides the PLHCP with the Following Information:
Type and weight of the respirator to be used by the employee
Duration and frequency of respiratory use
Expected physical work effort
Additional protective clothing and equipment to be worn
Temperature and humidity extremes
Copy of the company's written respiratory protection program
Copy of the medical evaluation section of the OSHA respiratory protection standard
Employer shall obtain a written recommendation from PLHCP to determine the employees ability to use a respirator.
The written recommendation shall specify:
limitations on respiratory use related to medical condition of the employee
limitations on respirator use related to the workplace conditions
whether or not the employee is medically able to use the respirator
a statement that the PLHCP has provided the employee with a copy of the written recommendation
Sample PLHCP Approval Physician or other Licensed Health Care Professional Medical Evaluation (PLHCP) for N95 Respirator Use Employer Name: _________________________________________________________ Employee Name: ____________________________ Last 4 #’s of SS#: _________ Medical Evaluation: The employee had the following medical evaluation for respirator use: (check all that apply) □ ---Respirator Medical Evaluation Questionnaire (1910.134 Appendix C) □ ---Initial Respirator Medical Exam □ ---Follow-up Respirator Medical Exam Medical Determination: (check all that apply) □ ---Medically cleared for use of a disposable N95 respirator without restrictions. □ --- Not medically cleared for use of a disposable N95 respirator. □ ---Medically cleared for use of a disposable N95 respirator with the following restrictions: □ ---Limitations on respirator use related to medical condition of employee. □ ---Limitations on respirator use related to workplace conditions. □ ---Details of limitations are noted below: (ex.─ limiting duration or frequency of use, discontinuing if symptoms occur, etc.)
Sample PLHCP Approval (cont) □ ---Re-evaluation of medical clearance recommended in ____ years. □ ---The employee and employer were sent a copy of this written recommendation and were apprised of the medical evaluation results. □ ---Additional Comments/Information: _______________________________________ _______________________________________________________________________ ________________________________________________________________________ PLHCP: Printed Name of Physician or LHCP: __________________________________________ Title: (Physician or LHCP) __________________________________________________ Physician or LHCP Signature: ________________________________________________ Date: ____________________________________________________________________
Negative Medical Determination
If the PLHCP finds a medical condition that may place the employee's health at increased risk if a negative pressure respirator such as a N-95 is used, the employer should reevaluate if another person can fill the role with the ILI student.
Alternatives should be considered from the administrative, engineering and workpractice controls.
Additional Medical Evaluations Shall be Provided When:
An employee reports medical signs or symptoms that are related to ability to use a respirator
A PLHCP, supervisor, or the respiratory program administrator determines the need for a re-evaluation
Workplace conditions and employee work activities change
End of Module 4 - Medical Evaluation
Click here for Module 5
Module 5 - Employee Training
Employee Training about Hazards and Proper Use of N-95 Respirators
Employers are required to provide training to employees who are required to wear N-95 respirators
This training program is intended for health care personnel identified in the CDC October 14, 2009 guidance on infection control
When Should the Training be Provided?
Prior to requiring the employee to use a respirator (initial use)
When there are changes in the workplace
When there are changes in the type of respirators selected or used
When there are inadequacies in the employee's knowledge or skill of respirator usage
What Subjects Should Employee Training Cover?
Why the respirator is necessary
When it should be used
What are the limitations and capabilities of the respirator
How improper fit, usage, or maintenance can compromise the protective effect of the respirator
How to inspect, put on and remove, use and check the seals of the respirator
Employee Training Subjects (cont.)
The procedures for maintenance and storage of the respirator
How to recognize medical signs and symptoms that may indicate a respiratory problem
The procedure for reporting a problem associated with the respirator
Storing N-95 particulate respirators
Supplies should be placed in clean, secure, temperature-controlled environments to prevent damage or contamination
Avoid storage areas that are damp or have temperature extremes
Use oldest supplies first
End of Module 5 - Employee Training
Click here for Module 6
Module 6 – Fit-Testing
If a respirator does not form a tight seal around the face, contaminated air may leak around the edges of the face seal.
Respirator effectiveness relies on this face-to-mask seal.
The only way to determine if a respirator fits and is capable of protecting properly is to fit-test the respirator.
You will be fit-tested with a specific make, model, style and size of respirator.
Fit tests should be provided by personnel trained in the OSHA Respirator Standard fit-testing procedures (29CFR 1910.134 and 1910.134 Appendix A)
OSHA requires this fit-testing prior to
initial use and then annually.
Simple “pass” or “fail” test.
Wearer provides subjective response to tasting or smelling the test agent that is released … state if detect taste or odor.
Test agent may be saccharin (sweet) or bitrex (bitter).
If the wearer can taste or smell the substance the fit is inadequate - “fail”.
If the wearer can NOT taste or smell the substance during the test - “pass”.
Components of a fit test kit
Fit test solutions
Sensitivity Test Key Points
Precautions For Fit-Testing
Wearer must put the respirator on without help.
If wearer cannot “pass” the fit-testing after 2 attempts, move on to testing another size or another make, model and style if available.
Tester should never manipulate the respirator to obtain a fit.
Modifications should never be made to the respirator (for example, tying a knot in the straps) to make it fit.
Wearer should not eat, drink (except plain water), smoke or chew gum for 15 minutes before the fit-test.
End of Module 6 – Fit-Testing
Click here for Module 7
Module 7 – Putting On A Respirator, Performing A User Seal Check, and Removing A Respirator
Putting On A Respirator - Preparation
BEFORE handling a respirator, wash hands thoroughly with soap and water.
Select the make, model, style and size of respirator you were tested on and “passed”.
Check that the respirator is clean, undamaged and the straps have elasticity. If your respirator has been damaged - DO NOT USE IT. Get a new one.
Anything that comes between the respirator and your face will make the respirator less effective.
Do NOT allow facial hair, hair, jewelry, glasses or clothing to come between your face and the respirator.
Putting On A Respirator
Position the respirator in your hands with the nosepiece at fingertips.
Cup the respirator in your hand, with nosepiece at your fingertips and headbands hanging freely.
Position the respirator under your chin with the nosepiece up. The bottom strap is positioned around your neck, below the ears. The top strap rests high at the top back of your head. Straps do not cross.
Place the fingertips of both hands at the top of the metal nose clip. Slide your fingertips down to mold the nose area to the shape of your nose.
Putting On A Respirator - Demonstration
Putting On A Respirator (cont) - Demonstration
User Seal Check
Perform a user seal check each time the respirator is used.
1. Place both hands completely over the respirator to block
as much air as possible.
Take a quick breath in to see if the respirator seals tightly to the face. The respirator should collapse.
Be careful not to disturb the position of the respirator.
2. Place both hands over the respirator and exhale.
Check for leakage around the face, such as forehead hair movement or fogging of glasses.
Do NOT attempt to get a better fit by tying the straps into knots.
If air leaks around your nose, readjust the nosepiece.
If air leaks at the mask edges, work the straps back along the sides of your head until a proper seal is achieved.
If you cannot achieve a proper seal, see your respiratory protection program administrator.
User Seal Check - Demonstration
Removing A Respirator
If wearing gloves, first discard gloves
Front of respirator may be contaminated – DO NOT TOUCH!
Lift the bottom elastic strap of the respirator over your head first without touching respirator
Then lift off the top elastic strap and carefully remove
Respirator may be discarded in waste containers
Immediately wash your hands thoroughly
Removing A Respirator - Demonstration
End of Module 7 – Putting On A Respirator, Performing A User Seal Check, and Removing A Respirator