AHCA » Facility Operations » Clinical Practice

Yesterday, the Centers for Disease Control and Prevention reported 10,053 laboratory confirmed and probable novel H1N1 Influenza cases and 17 deaths in all 50 states and the District of Columbia. The largest number of novel H1N1 confirmed and probable cases (more than 60% of cases) continue to be between the ages of 5 years and 24 years old.

Since influenza is unpredictable, we don’t know what the fall influenza season will bring.  Manufacturers have produced vaccine for the seasonal flu and are taking orders for those vaccines. Whether there will be an additional vaccine for H1N1 has not yet been decided though it is being worked on.

N95 Respirators

Though we don’t know what will happen this fall, some long term care facilities may determine that they would like to have N95 respirators on hand. Other facilities may conduct a hazard analysis and determine that N95s are not necessary. Regardless, it is probably wise to have some understanding of the preparation needed for N95s. It can take time to choose an appropriate respirator, arrange for a qualified trainer, and provide training, fit testing, and medical evaluation for workers using the respirators. Here are a few things to think about in advance in case a facility would like on hand at least a few N95s:

• Facilities should purchase only National Institute of Occupational Safety and Health (NIOSH)-certified N95 respirators (see http://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html for listing);
• N95s must be fit-tested so facilities should inquire about, and probably purchase, a fit-testing kit(s) if they purchase respirators.
• Someone on staff may need to be trained to conduct fit testing.
• The Occupational Safety and Health Administration’s (OSHA’s) Respiratory Protection Standard, 29 CFR 1910.134,  takes effect when N95s are used, not when they are purchased. Thus, if facilities purchase respirators and store them away for future use, they do not have to fit test or otherwise comply with the OSHA standard until such time as they use the N95s.
• According to OSHA regulation, workers must be medically evaluated to ensure that they can perform work tasks while wearing a respirator.  This can be accomplished by having a physician or other licensed healthcare provider review a respiratory questionnaire completed by the worker. Appendix C of OSHA’s Respiratory Protection Standard at http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9783 contains the mandatory questionnaire.
•  Information on OSHA’s Respiratory Protection Standard may be accessed from OSHA’s website at http://www.osha.gov/dcsp/ote/trng-materials/respirators/respirators.html. Since the Respiratory Protection Standard has not changed in several years, AHCA’s 2004 memo summarizing the requirements may be useful and is found at http://www.ahcancal.org/facility_operations/fire_life_safety/Pages/OSHARespiritoryProtectionStandard.aspx.